We've discussed price transparency in health care before. And certainly, cost is an important factor in deciding on a provider.
But it is certainly not the only factor, nor is it necessarily the most important one.
HealthGrades, based in Colorado, touts itself as “the
leading healthcare ratings organization, providing ratings and profiles
of hospitals, nursing homes and physicians to consumers, corporations,
health plans and hospitals.” According to their research,
poor-quality care in a hospital deals a blow to employers through
higher medical costs, longer leaves of absence and even the loss of
Quite an indictment of lower performing providers.
HealthGrades analyzed some 39 million hospitalizations in 2003, 2004
and 2005, comparing outcomes at almost 5,000 hospitals. Those that
ranked in the top 5% averaged a 28% lower mortality rate, and a 5%
lower complications rate. This is disturbing, because it highlights a
“preventable gap between high-quality hospitals and the rest of the
field.” In fact, the company posits that over 150,000 lives could have
been saved, and over 12,000 complications avoided, had the other
hospitals been at the same level as that elite 5%.
Their latest study, details of which were released last month, found
that patients treated at those top tier hospitals were a third less
likely to suffer fatal complications than those treated at the other
4,700 hospitals. This is the fifth year that HealthGrades has done such
a survey, so one supposes that they’re on to something.
While this isn’t strictly an insurance issue, it’s certainly relevant
to the underlying precept of Consumercentric Healthcare; one of the
basic tools of consumer empowerment is access to provider information.
While carriers have begun to publish provider cost information,
provider competence is still not as easily ascertained. Some companies,
such as Blue Cross of Minnesota, are beginning to make such information
available, and hopefully, others will follow suit.
And, of course, there’s increasing pressure on provider networks to
make quality of care a more important metric, as opposed to just cost
of care. Yet, there are pitfalls in this effort, as well: Regence Blue
Shield, based in Washington state, tried putting together a kind of
“elite” network of providers. One physician, who had been on the list
and then dropped, has sued them for being excluded.
No good deed…
Henry Stern, LUTCF is an independent insurance agent in Dayton, OH.
A licensed Continuing Education instructor for Ohio and Kentucky, he
has well over 20 years of experience in “the biz.” He blogs every day
(or so it seems) at InsureBlog.