Center for Studying Health System Changes Releases Report on Physician/Hospital Comparison Information

While health plans are developing tools to help consumers compare price and quality information across hospitals and physicians, the tools' usefulness are limited, according to a study released by the Center for Studying Health System Change (HSC). Responding to large employers' interest in greater health care price and quality transparency, health plans generally provide some price information on inpatient and outpatient procedures and services, according to the study. However, the information often lacks specificity about individual providers, and its availability is often limited to enrollees in specific geographic areas. Likewise, few plans provide price information on services in physicians' offices. The study's findings are detailed in a new HSC Research Brief—A Health Plan Work in Progress: Hospital-Physician Price and Quality Transparency.

Other key study findings include:

• Few plans provide price information that is customized to reflect individual enrollees' benefit design.
• Few health plans reported providing price information for physician services; when they do, they generally provide the average cost of physician office visits in a particular geographic area, sometimes by city or zip code, and these costs are not specific to particular physicians.
• Plans are weighing the advantages of providing price and quality information against potential pitfalls. Plan executives perceive one of the biggest risks to be the misinterpretation of price and quality information by consumers. Health plan respondents were particularly concerned that enrollees may interpret high price as a proxy for high quality and shift to higher-cost providers, thus raising costs, but not necessarily improving quality.

To view the entire study go to:
http://www.hschange.org/CONTENT/1008/

Comment from AMCNO on the HSC study: This study illustrates why there is a need for the AMCNO sponsored legislation currently before the Ohio legislature - SB 355. The purpose of SB 355 is to provide patients with accurate information when selecting a physician. This legislation would prevent health insurance companies from ranking physicians solely based on specific criteria to persuade a consumer to choose one physician over another. The designations would be made based on cost efficiency, quality of care or clinical experience. This legislation will establish standards for the physician designations. It stresses that health plans must use risk-adjusted data, base grades, and ratings at least in part on nationally recognized quality of care measures. The legislation also allows physicians the right to review and appeal their ratings prior to the ratings being released to the public. The AMCNO will continue to monitor the progress of this and other legislation developed to establish criteria for physician ranking programs.