Tampa Bay Adult Congenital Heart Disease Clinic presents

Heart Health through Education

In Search of Affordable, Effective High Quality Care

 Written by

Marie Cheine

Edited by Hector Fontanet, M.D., FACC 

November 2007

 Assessing the quality of healthcare and comparing healthcare costs has recently become easier for the patient who is interesting in researching publicly available information. On August 22, 2006, President Bush signed Executive Order 13410: Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs, which came into effect on January 1, 2007. This order requires federally funded health care programs to:

·        Implement programs that measure quality of services supplied by healthcare providers

·        Participate in the aggregation of claims and other data for purposes of quality measurement

·        Make pricing information made available to enrollees (and the option to share the information with the public)

·        Encourage the provision and receipt of high quality and efficient healthcare. Promote quality and efficiency of care such as encouraging pay-for-performance models

This Executive Order supports a move toward publicly measuring the costs of providing healthcare. Popular opinion is that when patients can obtain information about price and quality, they can make better decisions about their healthcare. We welcome these efforts and encourage consumers to take an active role in healthcare decisions. The availability of cost and quality of care benchmarks to the public should energize conscientious healthcare providers and facilities to guide, educate and aid patients in their decisions and choices for treatment and promotion of health. After all the information consumers obtain from published data may not be representative of all the information that is required to make critical healthcare decisions.

There is no doubt that the public is being inundated with information regarding the cost of healthcare. Indeed, “value-driven” healthcare is the new buzzword. Health and Human Services Secretary Mike Leavitt met with major US employers to discuss “value-driven” healthcare and challenged them to “implement “four cornerstones of value-driven health care. In response, “Value-Driven Healthcare, a Purchaser Guide” was recently published: (http://www.leapfroggroup.org/media/file/Employer_Purchaser_Guide_05_11_07.pdf) The Leapfrog Group states on its website that “now, all major groups of health care purchasers have clear direction on how to jumpstart value-based purchasing and bring health care into the 21st century.”

Continued Move toward Greater Value

There is an increase in the private sector, in cooperation with insurance carriers, the medical profession and employers to pool information and share it publicly. On August 26, 2007, the Tampa Tribune published an article entitled “A Bill of Health that Doesn’t Add Up. It published comparison of clinical outcome and cost of four popular in-patient procedures among regional hospitals. While the costs of the same procedure can vary by large amounts (compare coronary bypass surgery in Brandon Hospital at $93,000.00 to Tampa General at $44,000.00 and University Community at $30,000.00) the outcomes do not necessarily correlate with the cost.

Some of the data obtained for the Tampa Tribune article came from Humana’s claims database. The same article also states that Humana’s profit last year was more than $600 million implying an intrinsic bias in the accuracy and reasons for cost discrepancies.  Health care consumers should rely on multiple sources for information in quality and cost of care that are objective, unbiased and utilize accepted comparison tools for quality and cost of care.

Let the buyer beware

By definition, buyer alone is responsible for assessing the quality of a purchase before buying (www.dictionary.com). But is the healthcare consumer fully qualified to make healthcare decisions based on data compiled by insurance companies and hospitals?

While the information is valuable and useful, measuring the quality of healthcare is not an exact science. When comparing column A to column B, does one have enough information to understand the data provided? If one hospital or one surgeon or doctor has a higher mortality rate for a certain procedure, does that surgeon or doctor also have the most experience and therefore is referred only the most complicated cases, or the most high-risk patients? Does the surgeon, doctor, or hospital that has the lowest mortality for a certain procedure see only healthy, well-insured patients, or only do procedures on patients with the lowest risk? Similarly, does the highest complication rate mean the highest risk patient or simply the highest complication rate?

The rising costs of healthcare need to be addressed. The current trends towards tier cost-sharing and quality assurance are certainly moves in the right direction. But the costs of healthcare are also based on other issues not addressed in the Value Based Healthcare Initiatives or the publication of hospital pricing, such as the unrelenting costs of malpractice insurance for hospitals and physicians and of course the burden of providing healthcare to the indigent and uninsured community.

Gathering reliable and pertinent information is an important and necessary part of making any decision. When making major healthcare decisions, one must remember that the information being made public will not provide all the answers. Ask your healthcare provider pertinent questions. Feel comfortable with the answers you are receiving and if not, it would be in your best interest to seek a second opinion. There are some decisions that cannot be made only based on dollars and cents, or information is simply not available.

Sources

http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/06-7220.pdf

 http://www2.tbo.com/content/2007/aug/26/na-a-bill-of-health-that-doesnt-add-up/?news-money

 http://www.leapfroggroup.org/news/leapfrog_news/Purchaser_Guide