Legislators have done good work enforcing hospital price transparency, but quality comparison tools are still lacking, Alex Friswold, a medical student at Boston-based Harvard Medical School, and David Bernstein, MD, a resident at four Boston hospitals, wrote in an opinion piece published Aug. 14 in the Harvard Business Review.
Recently, the House passed a price transparency bill focused on hospitals and pharmacies, but there are no tools or databases for patients and employers that adequately evaluate the quality of health services by system or specialty, they wrote. Currently, CMS has a tool that allows patients to search for clinicians in their area, but it does not allow patients to search by condition or subspecialty and ratings are based on the hospital the physician works at rather than the individual.
Other rating systems, including third-party physician-review websites, do not provide quality measures based on clinical outcomes but rather subjective questions such as "how likely are you to recommend this physician?" Mr. Friswold and Dr. Bernstein wrote.
"The absence of meaningful quality measurements is a symptom of how the U.S. health system was designed," the authors wrote. "Fee-for-service reimbursement incentivizes volume and margin, not health or the measurement of patient-centered outcomes."
Mr. Friswold and Dr. Bernstein suggest three steps employers and governments can take to address the gap:
1) Incentivize the adoption of patient-centered quality measures at the condition level. This could include adopting quality measures created by the International Consortium for Health Outcomes Measurement and providing incentives to use the measures.
2) Identify clinicians, such as surgeons, who meet a minimum volume threshold for common procedures. This would allow patients to search and compare clinicians based on their condition as well as show which physicians have the most practice with those procedures.
3) Ensure the accuracy of clinician directories. Clinician directories do not specify if physicians are reachable, accepting of their health plan, or accepting new patients. Health plan physician directories should undergo quality checks to verify accuracy and include specialists performing specific procedures based on volume data, the authors wrote.