Consumer-driven health care has been the cause du jour for large employers, consumer groups, and the Bush administration. The idea is that if "consumers" (patients) are given "transparent" information on the quality and cost of care of individual clinicians and health care facilities, they will choose the ones that offer the best value. Physicians and hospitals would then be "incentivized", so the theory goes, to improve their care and lower their prices, leading to overall quality gains and cost savings.
Often, health quality report cards are linked to financial models, such as health savings accounts, designed to encourage patients to set aside money to pay for their own care.
Underpinning consumer-driven care is the belief that patients want to see health quality report cards. And, that they will use quality and cost comparisons to prudently select physicians and hospitals that offer the best value.
But what if patients prefer to make health care decisions on intangible things - like a recommendation from a next door neighbor - that can't be captured on a report card?
Niko Karvounis writes in the Health Beat blog that "patients' health care priorities aren't entirely rational - and so relationships, and not rankings, are important ... Interaction is paramount." He cites an October Kaiser Family Foundation survey, which found that less than half of patients who come across comparative data on health care providers actually use it.
ACP has supported efforts to provide patients with physician-specific information on the quality and cost of care - with safeguards. Earlier this year, we expressed support for the "Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs", which has been endorsed by leading health plans, consumer, business, and physician groups. It includes the following principles:
- Measurement is based on sound national standards and methodology.
- Both consumers and physicians have input into the measurement process and how results are reported.
- Measurement is a transparent process so that both consumers and physicians can understand the basis upon which performance is being measured and reported.
- Physicians have adequate notice and opportunity to correct any errors.
- Physicians will have information that helps them improve the quality of care they provide.
Still, the Kaiser survey suggests that performance measurement and reporting programs may work best - if they work at all - when incorporated into models, such as the Patient Centered Medical Home, which support the relationship between physicians and their patients. The Patient Centered Medical Home encourages patients to have a personal relationship with a physician who is responsible for helping the patient get all the care they need, supported by a better payment system (including payment for services that fall outside of the office visit) and practice-based health information systems.
PCMHs report on the quality and efficiency of care, but it is the physician-patient relationship that is at its heart.
Today's questions: Do you think patients should have information on your health care quality and efficiency grades? Do you think such information will lead patients to make wiser choices in picking doctors or hospitals?