Quality information on individual physicians is publicly available only in a few states, making it virtually impossible for employees to make health care value purchasing decisions, according to a report by the Health Care Incentives Improvement Institute Inc., a nonprofit group that designs programs to boost health care quality and affordability.
Newtown, Conn.-based HCI3's “State Report Card on Transparency of Physician Quality Information” released Tuesday gave most states a grade of D or F. Only two states — Minnesota and Washington — received an A, and California received a C.
An earlier report co-published by HCI3 and Catalyst for Payment Reform found the vast majority of states also get a failing grade in health care price transparency.
“Consumers are paying more out of pocket for health care, but there are significant variations in the quality of care,” said HCI3 Executive Director Francois de Brantes during a webinar where the report card was unveiled. “If consumers have good information on the cost and quality of care, they are more apt to make value purchasing decisions.”
However, “lack of information … on price and quality puts consumers at a huge disadvantage,” especially when they are enrolled in high-deductible health plans,” Mr. de Brantes said. “Ultimately, the financial health (as well as) the physical health of patients is contingent on their clinicians delivering quality care.”
He cited as an example a patient with coronary artery disease who undergoes stent surgery performed by a specialist recommended by his primary care physician.
“It's an expensive procedure, costing anywhere from $20,000 to $25,000,” Mr. de Brantes said. In an HDHP, “the portion a patient pays is significant. And if there are complications, those are additional costs. How do you manage this expense if there is little actionable information on the quality of care provided by that specialist?”
Moreover, “imputing that your (primary care physician), who has great quality ratings, will only refer patients to doctors who are equally good is a spurious assumption,” Mr. de Brantes said.
For its report card, HCI3 graded states on the percentage of physicians and supporting health care professionals, such as physician assistants and nurse practitioners, that publicly report quality information; the type of measurement provided, such as outcomes, process and/or patient experience; and the accessibility of this information to consumers.
The Robert Wood Johnson Foundation's national directory for comparing health care quality served as the starting point for the review, with researchers examining whether that information was current, free to consumers, produced by independent third parties, and included a range of physicians including specialists and supporting health care professionals. While most states had information about primary care doctors, information on specialists or supporting health care professionals was severely lacking, according to the HCI3 report.
The two states receiving an A have had strong, consistent measuring and reporting programs in place for many years, according to the report.
Minnesota, for example, has had statewide transparency initiatives for more than a decade, resulting in 66% of clinicians reporting quality data. In addition, Minnesota HealthScores, an online resource, provides patient-friendly quality reports on area clinics, medical groups and hospitals as well as average cost comparisons for common procedures.
In Washington, the Puget Sound Alliance compares the performance of doctors in medical groups across several practice areas including treatment of diabetes, heart disease, asthma, chronic obstructive pulmonary disease and assessment of patient experience. Its database includes quality information on 55% of the medical providers in e state.
California, which received a grade of C, has publicly available quality information on 37% of medical providers in the state.
Other states are considering laws or regulations to ensure the availability of quality and cost information on hospitals and physicians, and the Patient Protection and Affordable Care Act obliges health plans participating in health insurance exchanges to offer provider quality and price information to plan members.
The report is available here.