1150 Seventeenth Street, N.W., Washington, D.C. 20036
-
-
Email Event
-
-
Improving the availability of accurate and actionable information about the comparative performance of physicians could assist efforts to upgrade the affordability and quality of U.S. health care. However, getting from theory to practice in achieving those objectives has remained quite challenging. This forum will examine several recent initiatives that hold
Listen to Audio
play
pause
Download Audio as MP3
promise for better performance. Robert Krughoff of Consumers’ Checkbook and the Center for the Study of Services will highlight the results of a three-city pilot project that surveyed consumers on their experience of care with individual physicians. Bruce Steinwald of the Government Accountability Office will describe how Medicare claims data can be used to profile the resource use of physicians and provide them with confidential feedback to improve the efficiency of the care they deliver. Thomas P. Miller of AEI will examine how the latest House and Senate health reform bills attempt to improve the measurement and reporting of physician performance and will suggest how to meet the different information needs of different audiences--patients, physicians, and payers--more effectively.
| 9:00 a.m. | Registration | |
| 9:15 |
Presenters: | Robert Krughoff, Consumers’ Checkbook and Center for the Study of Services |
| Thomas P. Miller, AEI | ||
| A. Bruce Steinwald, Government Accountability Office | ||
| 11:00 | Adjournment |
WASHINGTON, DECEMBER 2, 2009--Improving the affordability and quality of U.S. health care necessarily will involve improving physicians' performance in delivering care to their patients. Several recent studies presented at an AEI event on December 2, 2009, "Can We Tell Physicians Apart without Better Scorecards?" highlighted a number of underemphasized approaches and promising alternatives for evaluating health care value and measuring physicians' performance.
"Satisfaction is not a trivial consideration in a trillion dollar industry," stated longtime consumer advocate Robert Krughoff, founder of the Consumers' Checkbook and the Center for the Study of Services. "There is increasing evidence that what patients can tell you about doctors really relates to clinical outcomes."
Krughoff detailed how patients are the key source of information in major aspects of care, including physician-patient communication, shared decision making, and care coordination. True choice in health care, however, must utilize reliable and easily accessible data to help consumers make informed decisions about choosing a provider.
In a web-based demonstration, Krughoff provided a glimpse of such evolving practices. Checkbook's website featured ratings of individual doctors in the Kansas City, Memphis, and Denver areas. The ratings were the product of an extensive methodology; Checkbook surveyed thousands of patients regarding their experience of care with individual doctors in major health plans, and the sample size (between forty-eight and fifty-eight ratings per doctor in the three cities) was substantially larger than any previous physician rating systems. Krughoff acknowledged that ultimately, performance measures must balance greater information and transparency in health care with real logistical, financial, and administrative barriers in data acquisition.
A. Bruce Steinwald, a former senior executive on the health care team of the Government Accountability Office (GAO), presented the results of a September 2009 report by the GAO which suggested how per capita performance measures, using Medicare data, could provide confidential feedback to providers and improve the efficiency of care. This approach first measures per-patient resource use for a defined population and then attributes that resource use to physicians. Identifying outlier physicians--those whose patients use a much higher amount of health care resources, event after adjustment for their initial health conditions--can help the Centers for Medicare and Medicaid Services (CMS) deliver more targeted feedback reports to providers who see Medicare patients. Steinwald asserted that such measures must be used in conjunction with broader financial incentives for doctors to improve care.
"Feedback looks like it's here to stay, but . . . we concluded that the per capita measures we used are useful for providing feedback, but probably not an end in itself," said Steinwald.
In the final presentation of the morning, AEI Resident Fellow Thomas P. Miller echoed Steinwald's comments by arguing that performance measures must be targeted in scope and presented in ways that satisfy the various needs of patients, providers, and payers. "It's not a matter of just adding to the total pile of information that you can't sort through, but getting better information than what we currently have," said Miller. "We have to set some priorities because we can't do everything."
Miller argued that the health care system must work within its current abilities and not simply hold out for an ideal, seamlessly integrated network of electronic data aggregation. Transparency is important in the system, but it must be achieved within the constraints of a medical community that has been hostile to perceived overbearing and flawed performance measures. Ultimately, Miller noted, performance measurements must identify the relevant decision makers in the delivery system, present data in actionable ways, and seek accountability through incentive systems and feedback.
In the context of current health reform legislation, however, all three panelists were hesitant that greater transparency and consumer-driven care could expand its footing. In a question-and-answer session, Miller expressed concern that various components of the Senate's Patient Protection and Affordable Care Act would insulate individual patients from cost and value considerations and further disincentivize them from seeking better performing physicians.
"This is primarily an effort to hide price tags further rather than to make them more vivid," said Miller. "So we're suppressing on one end what might make a lot of different individuals care more about what is going on in their care."
Speaker biographies
Robert M. Krughoff is founder and president of Consumers' Checkbook and the Center for the Study of Services, an independent, nonprofit consumer organization founded in 1974. The organization publishes local versions of Consumers' Checkbook magazine in seven major metropolitan areas. The magazine evaluates local service firms such as hospitals, auto repair shops, and banks. The center also has developed the Consumers' Guide to Hospitals, Guide to Health Plans for Federal Employees, Guide to Top Doctors, and other materials and services for consumers. It also conducts large-scale surveys for other organizations, including managing all of the surveys of members of Medicare Advantage plans and prescription drug plans for Centers for Medicare and Medicaid Services. Before founding the center, Mr. Krughoff served in the U.S. Department of Health, Education, and Welfare (predecessor to the Department of Health and Human Services) as director of the Office of Research and Evaluation Planning and as special assistant to the assistant secretary for planning and evaluation. He currently serves on the board of directors of the Consumer Federation of America and has served as treasurer on the board of directors of Consumers Union, publisher of Consumer Reports magazine. He chairs the Technology Assessment Advisory Committee for the ECRI Institute.
Thomas P. Miller is a resident fellow at AEI, where he focuses on health policy, with particular emphasis on information transparency, health insurance regulation, and consumer-driven health care. He is a member of the National Advisory Council for the Agency for Healthcare Research and Quality. Before joining AEI, Mr. Miller served for three years as a senior health economist for the Joint Economic Committee, where he organized a series of hearings focusing on promising reforms in private health care markets. He also has been director of health policy studies at the Cato Institute and director of economic policy studies at the Competitive Enterprise Institute. Mr. Miller's writing has appeared in publications such as Health Affairs, the Wall Street Journal, the New York Times, the Washington Post, the Los Angeles Times, Reader's Digest, National Review, the Journal of Law and Contemporary Problems, Regulation, and Cato Journal. Before coming to Washington to work on public policy, he was a trial attorney, a journalist, and a radio broadcaster.
A. Bruce Steinwald is an independent consultant specializing in health policy, health economics and financing, and Medicare payment issues. From 2002 through late 2009, Mr. Steinwald served as a senior executive on the U.S. Government Accountability Office's health care team in Washington, D.C. He testified before Congress on Medicare payment and systemwide health care financing issues and supervised the preparation of reports on these topics. Mr. Steinwald has held positions both in and out of government over the past forty years and has authored and coauthored numerous articles in health economics and health policy.
