Who knew "Obamacare" had some sunshine provisions to help people make informed decisions about where and how to spend their health care dollars—x-raying hospitals and other providers to permit comparisons of not only prices but readmissions, infections and doctors' and nurses' performance?
David Whelan, writing in Forbes magazine, reports.
In Iowa the Hospital Licensing Board, which is controlled by former hospital executives, recently voted to block a measure that would force hospitals to disclose “Never Events”–the 28 types of medical errors that should never happen. (Amputating the wrong limb, fertilizing a woman with the wrong sperm, etc.)
Check out this quote from the Des Moines Register, which has been all over the story:
Dr. Tom Evans of the Iowa Healthcare Collaborative said counting “never events” is like “trying to count lightning strikes in order to predict the weather.”
Is that so? As a patient I’d sure like to know if the hospital down the street is the scene of sexual assaults on patients, hands over babies to the wrong parents, or conducts surgeries on the wrong patients. I’d even like to know about more mundane occurrences like drug contaminations. I wouldn’t put that information in the same usefulness category as lighting strikes, comets and moonbeams.
But don’t blame the hospital industry for not seeing the issue that way. Nobody likes change. And the industry has gotten used to operating behind the curtain of accountability. In California an official at the state hospital association once told me that consumers don’t have the ability to understand infection rate reports from hospitals, and therefore hospitals shouldn’t have to release them.
Luckily the the health reform bill cuts through a lot of that bull. Here’s how:
*Beginning next month hospitals will have to report to Medicare their rates of hospital-acquired infections. If they don’t start doing so by 2012 they will lose 2% of their Medicare reimbursement money. Fighting infections has the potential to save $45 billion a year and spare tens of thousands of patients painful extended stays in the ICU. Consumers will be able to access the data on HospitalCompare.HHS.Gov, Medicare’s health shopping portal.
*In 2013 Medicare will begin paying hospitals bonuses for preventing re-admissions of patients with pneumonia, heart failure or heart attacks. Those readmission rates will also be reported on the Hospital Compare Web site. This is an important metric since hospitals that discharge patients too quickly may be churning their beds at the expense of your health.
*The bill also creates a “Physician Compare” Web site as well. According to attorney Beth Christian, the Web site will include data on outcomes, efficiency and care coordination. It will also include data on non-physician caregivers like nurses. This is very edgy stuff. For years the feds have resisted attempts to release physician-specific data to consumers. In so doing they aided the careers of many bad doctors who bounced from hospital to hospital and state to state. Government agencies fought lawsuits that sought access to the National Practitioners Database, which is a resource for hospitals to share disciplinary and lawsuit data on doctors. They’ve also prevented the Consumer’s Checkbook organization from obtaining a copy of the physician-specific Medicare file to use for outcomes-based ratings. It’s not clear to me yet how good the new Physician Compare Web site will be. Hospital Compare started out slow. And certainly you can expect doctors groups to try to water it down during the rule-making process. But it’s definitely an exciting prospect.
*Hospitals will be forced to publish their prices. Right now hospital pricing is opaque. There’s the Chargemaster rate that’s sent to cash-paying foreigners and Americans who are uninsured. Then there’s the Medicare and Medicaid rates. Every health insurance plan has its own rates negotiated somewhere in between. A hospital executive told me once that for a specific operation a facility might have 50 different prices. The negotiated prices will no doubt remain hidden. But the bill forces hospitals to post their “standard charges” which presumably means realistic ones, not the inflated list prices. Check out what Spectrum Health is doing in Grand Rapids, Mich. It’s a nice preview of what’s to come–and part of the transparency makeover that health care providers should embrace.
The one area where the health bill doesn’t insist on transparency is in national reporting of “never events”. Hopefully that will get added at a not too later date. Maybe then even Iowa will be forced to do the right thing.
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