Okay, we all know the theory–give consumers provider quality and price information and we will save lots of money. Necessary for this outcome are two primary circumstances. One is the ability to collect accurate and meaningful information and provide it in a timely and easy to use format. The second is the ability of consumers to understand the information and use it appropriately in their decision-making. As might be imagined, the first likely is easier to accomplish than the latter, particularly among consumers who have the highest health spending. A Government Accounting Office report focuses on the first need, reviewing two private and five government quality and price information websites. (GAO Report) Among other things, GAO called selected providers in two cities to try to independently verify the cost information on the websites, reviewed the literature and interviewed subject matter experts. Based on information from the private websites, GAO confirms that in the same area, two providers may charge vastly different prices for the same service. GAO used the example of hospital maternity care in Boston, which ranged from $6,834 to $21,554. Another example is the cost of an MRI in Indianapolis, which ranged from $277 to $5,184, with the consumer payment ranging from that $277 low to $2,637. Low or high-quality providers could have lower costs; there was no clear relationship. The importance of the websites in creating access to cost and quality data was demonstrated by CMS’ difficulty in obtaining the information by calling providers directly. GAO noted that consumers find much information available on websites not relevant to their specific circumstance. Patients want cost and quality information on the specific service they need and for their specific insurance coverage. And they want to know the source of the data, because they want to be able to judge credibility.
GAO listed eight characteristics of effective transparency tools in regard to data presented, including: cover a broad range of services; cover a broad range of providers; describe key differences in clinical quality, especially patient-reported outcomes; describe differences in patients’ experiences with providers; describe cost differences, especially out-of-pocket amounts; provide timely data and describe strengths and limitations of the data. Equally, if not more important, were seven characteristics related to how the data is presented, including: use plain language and clear graphics; explain the purpose of the quality performance ratings; summarize and organize in a manner that makes patterns easy to see; let consumers customize the data; allow comparison of multiple providers in one screen; put cost and quality data together and ensure easy use and navigation of the tool.
GAO also analyzed five websites maintained by CMS–the Compare sites for physicians, hospitals, nursing homes, dialysis, and home health. Not surprisingly, the report finds these sites to have lower utility than the commercial ones and to perform poorly in regard to the key characteristics GAO listed. In particular, GAO said that they lacked relevant information on cost, especially on out-of-pocket costs, and that the quality information was also not particularly meaningful and was presented in a hard to understand manner, not using clear language or symbols and not allowing consumers to customize the data presentation. Whether it ultimately makes a significant dent in health spending or not, it is an important characteristic of a good health system that timely, accurate information on provider costs and quality are available to patients and that they are given tools and education to help them make decisions that fit their needs and values.