Are We Finally Entering the Golden Age of Healthcare Transparency?

When will patients start reviewing quality data before choosing their doctors and hospitals? The answer has been “soon” for several years, but “soon” may finally be the right answer. If you doubt it, check out the Commonwealth Fund’s new site, “Why Not The Best?” The central premise of the healthcare transparency movement has been that
putting data on the Web (quality, safety, satisfaction, even cost) will change consumer behavior, the way such data does for autos and restaurants. The movement, which began in earnest with the launch of the HospitalCompare website by Medicare in 2003, lives by the following catechism:

  1. Let’s post some, even rudimentary, quality data on the Web
  2. Patients will look at the data, and demand improvement of their existing providers or choose better ones
  3. This consumerism will create “skin in the game” around performance data
  4. Hospitals and providers, now motivated to improve, will do what it takes to get better.

Shockingly, in the past five years, these mantras have proven to be way off the mark. Instead,

  1. Some rudimentary quality data has been placed on the Web
  2. Few people are looking at these data, and virtually no real patients are making their healthcare purchasing decisions based on them.
  3. And yet… hospitals are doing organizational cartwheels trying to improve their performance on the publicly reported indicators.

Although #2 is surprising, #3 is truly flabbergasting — it demonstrates the power of shame and embarrassment as motivating forces. Remember last year’s NEJM study by Lindenauer, which found that pay-for-performance worked only slightly better than public reporting? I interpreted this as a negative study for P4P, because if transparency worked this well without any evidence of consumer-induced market pressures, just imagine how well it will work when real people are paying attention to the data.

This month, the Center for Studying Health System Change released another survey that showed that virtually nobody’s aunt is looking up quality data on the Web before choosing doctors and hospitals. The survey found that most patients continue to make their choices based on physician referrals or good old word-of-mouth. In the survey, only 11 percent of people said they used the Web when choosing a new PCP, 7 percent when choosing a specialist, and 3 percent when choosing a facility for a procedure. And, as the authors point out, these figures probably overstate the percent who actually look up quality data, since they refer to any use of the Web, including seeing whether the doctor “looks nice” on Google Images.

What will it take to get people to scrutinize healthcare quality data the way they do data on cars and appliances? Time, undoubtedly, as
consumers need to become aware that quality and satisfaction data are out there and familiar with the key concepts. But the presentation of the information will also have to get better. Many of the existing websites, including Medicare’s HospitalCompare, remain aesthetically challenged, mired in the “hey, isn’t AOL cool” era. A population accustomed to watching John King at the CNN Magic Wall wants bells and whistles with its facts and figures.

This month, the Commonwealth Fund, which has become an essential resource in the quality and safety fields, launched a new website, “Why Not the Best?” (www.whynotthebest.org). [Truth in advertising break: I consulted a bit on the site’s development, without compensation.] Do spend a few minutes playing around with the site. Although primarily designed for healthcare professionals and organizations (witness the stories from innovators and the improvement tools), the site is the first I’ve seen that marries healthcare transparency with modern web capabilities. For example, I was able to track my own hospital’s performance over time on a very slick dynamic graph. I quickly located other hospitals in my region by clicking on them on a Google Map, and easily pulled up each one’s quality data. Without breaking a sweat, I was able to compare my hospital’s performance to the best performers in California, or the best in the nation, or the best teaching hospitals, and much more. It is very cool.

The explanation for the failure of healthcare quality websites to catch on clearly isn’t that patients aren’t on the Web, or that they don’t want to use the Web to get information about their health. As described recently in the NY Times, many patients are already using “Dr. Google” to research their diseases and symptoms. And disease-specific social networking sites like patientslikeme are booming. This makes consumers’ apparent lack of interest in quality data all-the-more surprising.

The bottom line is that we will soon learn if consumers’ low uptake of healthcare quality information is due to technical and aesthetic
limitations of the websites or something more fundamental. If it is the former, expect that use will skyrocket as more sites – with data
presented in more pleasing ways using today’s remarkable web capabilities  – roll out. (Oh yeah, having the quality data become more
accurate and meaningful will also be a big help.)

Although the dynamics of healthcare are famously different than those of other industries, once the lion of consumer choice begins to roar, watch out! It could be the game-changer everyone’s been waiting for.

Robert Wachter, MD, is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Lee Goldman, he coined the term “hospitalist” in an influential 1996 essay in The New England Journal of Medicine. His most recent book, Understanding Patient Safety, (McGraw-Hill, 2008) examines the factors that have contributed to what is often described as “an epidemic” facing American hospitals. His posts appear semi-regularly on THCB and on his own blog, Wachter’s World.

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