More Health Care Plays

Health care consumers need reliable information about the quality of health care they receive. Government can help by giving them the tools they need to evaluate providers and insurers and choose the right course of action for their future health.

Too often, health care consumers do not receive the recommended basic care, and what they do receive varies widely from standard practices established by national health care experts. But that is just the tip of the iceberg. An Institute of Medicine report has estimated that as many as 98,000 people die each year from medical errors during a hospital stay. Much of this could be avoided if patients had more information about insurer practices and physician and hospital success rates.

Despite its reputation for high quality, the U.S. health care system has no way to systematically assess and reward high quality care. Good providers are seldom rewarded with more patients, money, or higher status. The answer to these quality deficits is to make quality improvement the way of life in health care, replacing today's incessant fighting among insurers and providers with healthy competition based on quality medical delivery and accountability.

"Patient safety is an overriding health care issue. With information, patients can make better, more informed health care decisions. This legislation will help patients do that." -- Former Gov. Mark Warner, Virginia

Information is a powerful tool to improve quality. Usually, health care professionals are so embarrassed about reports of poor performance they will make improvements even before the public generally becomes aware of a problem. States have taken a wide variety of approaches to give consumers the right to know. Here are some of the leading initiatives:

Physician Profiles and Malpractice Information. About one-half of the states publish physicians' malpractice records and other information, such as education and certification on the Internet. As one of the first, Massachusetts' physician profile website is extraordinarily popular. It received over seven million hits in its first four years of operation. In the past, physicians groups have staunchly opposed such measures, but more recently, medical societies have sometimes supported physician profiles. An effort to give consumers broader information about the performance of individual doctors and other providers is underway. A coalition of consumers, labor unions, and employers called the Consumer-Purchaser Disclosure Project has established national guidelines for assessing the costs and quality of individual providers. They will encourage health plans and other purchasers to use and issue more assessments in ways that providers will acknowledge are fair and accurate.

Hospital Performance and Safety Information. Hospital-acquired infections afflict about 2 million patients and kill 100,000 patients each year. According the U.S. Centers for Disease Control, hospital-acquired infections add $16,000 to the cost of each hospital patients care and add $27.5 billion annually to US hospital costs. They add about $5 billion a year to health care costs. Twenty-two states require hospitals to report their infection rates to the public, according to Consumers Union, which has spearheaded the reporting campaign, so that hospitals have an additional incentive to lower their infection rates. Six states have issued reports about their hospitals so far with Pennsylvania providing the most comprehensive information about infections occurring in hospitals. In the 2008 Pennsylvania report on infections occurring in 2006 over 30,000 hospital-acquired infections were reported.

Health Care Outcomes Information. As part of the State Children's Health Insurance Program, many states, including Washington, have required health plans to report their health care performance in three areas: early childhood development, children with chronic conditions, and adolescent preventive care. Reporting this data starts a virtuous cycle in which consumers demand and providers deliver higher quality care.

Consumer Rights Information. Giving people the right to challenge health insurance coverage decisions is only helpful if consumers know their rights. For example, Maryland requires HMOs to tell consumers about their right to appeal a decision when such a denial occurs. This rule makes insurers a bit more circumspect in their decisions, knowing that members and policyholders will have immediate information about the recourses open to them.

The United States needs a national strategy to improve health care quality. This effort would ensure that information on medical costs and quality is disclosed and publicized, that providers and insurers are rewarded for their success, and that consumers know and exercise their rights to manage their health care decisions. States will play a key role in empowering patients, and can take reasonable and intermediate steps to get the ball rolling.

Resources for Action

Performance Measurement and Reporting, Rhode Island Department of Health
http://www.health.ri.gov/chic/performance/index.php

Massachusetts Board of Registration in Medicine: Physician Profiles
http://profiles.massmedboard.org/
MA-Physician-Profile-Find-Doctor.asp

Florida Department of Health Practitioner Profiling
http://www.doh.state.fl.us/MQA/profiling/index.html

Patient Right to Know Act of 2001, Georgia House Bill 156, 2001
www.legis.state.ga.us/legis/2001_02/sum/hb156.htm

Stop Hospital Infection, Consumers Union
www.stophospitalinfections.org

Leapfrog Group
www.leapfroggroup.org/

Maryland House Bill 59, 2000
mlis.state.md.us/2000rs/billfile/hb0059.htm

National Quality Forum
www.qualityforum.org/

"'Patient Charter' for Physician Performance Measurement, Reporting and Tiering Programs," Consumer-Purchaser Disclosure Project, April 1, 2008
http://healthcaredisclosure.org/activities/charter/

Health Care Choices
www.healthcarechoices.org

Additional Reading

"Health Grades Quality Study: Fifth Annual Patient Safety in American Hospitals Study," Health Grades, Inc., April 2008,
http://www.healthgrades.com/media/dms/pdf/
PatientSafetyInAmericanHospitalsStudy2008.pdf

"Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002," By R. Monina Klevens et al., Public Health Reports, MarchApril 2007
http://www.cdc.gov/ncidod/dhqp/pdf/hicpac/infections_deaths.pdf

"Crossing the Quality Chasm: A New Health System for the 21st Century," Institute of Medicine
http://books.nap.edu/catalog/10027.html

Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, Editors, "To Err Is Human: Building a Safer Health System," Institute of Medicine, 2000
www.nap.edu/catalog/9728.html

Contacts

Lisa McGiffert
Consumers Union
1300 Guadalupe St, Suite 100
Austin, TX 78701
(512) 477-4431, ext. 115
(512) 477-8934 (fax) lmcgiffert@consumer.org

David B. Kendall
Senior Fellow for Health Policy
Progressive Policy Institute
4021 Heritage Way
Missoula, MT 59802
(406) 543-2265
dkendall@ppionline.org