Pennsylvania has been held up as a model for health care reform at the national level with regard to collecting and reporting quality and cost data, with employers in the Keystone State steering care to the best-performing hospitals.
A state agency known as the Pennsylvania Health Care Cost Containment Council in Harrisburg, Pa. (or PHC4, for short) has published medical outcomes involving more than 50 types of treatments and surgery at hospitals for the past two decades.
By making this information public, policymakers sought to
Nearly one-third of all states are seeking to develop a medical claims database from all health plans and private payers, while others are mirroring the Keystone State’s collection of clinical data on various medical conditions, according to Anne Gauthie, a senior fellow at the National Academy for State Health Policy in Washington, D.C.
There’s reason to believe that the patchwork of state initiatives aimed at measuring health care quality and cost can translate on a national level. She notes that “this is probably as good a bipartisan issue as we’ve ever had. There is strong agreement that better information on the quality and cost of care is one of the key components of getting to a higher-value health care system.”
Better care costs less
PHC4 Executive Director Joe Martin notes that the data his agency has gathered and reported indicated “a great deal of preventable error and waste.” One area where there has been significant improvement is in the state’s hospital-acquired infection rate, which fell nearly 8% and saved an estimated $370 million. Another is the mortality rate, once well above the national average in Pennsylvania, whose population is one of the nation’s oldest. That measure has since fallen below the U.S. baseline during the past 14 years.
“We estimate that trend has saved about 47,000 lives and $2 billion in charges that would have occurred if the state’s mortality rate had stayed the same,” he reports.
In addition, the chance of someone dying in a Pennsylvania hospital from a heart attack, congestive heart failure, brain hemorrhage, stroke, pneumonia and septic infection is anywhere from 21% to 41% lower than a facility in other states, according to 2008 study in the American Journal of Medical Quality.
Gauthie describes the PHC4 initiative as “a fabulous example of how when we have good information and it is compared, we have great variation in quality, as well as in costs in this country. There’s inspiration for those who are not performing well to figure out how to measure up to the highest performers.”
Inconsistent data
A key lesson in Pennsylvania, she says, “is that when you measure a specific condition, you really can compare providers on the provision of care, both quality and price for a specific condition. But there is not a general correlation. So a hospital that performs well on cardiac care may not perform well on some other area.”
Gauthie says hospitals across the state have expressed concern that the PCH4 methodology doesn’t take into account whether they’re caring for sicker populations or patients were admitted with multiple conditions, and therefore, measures related to
As for pricing information, she says the data can be skewed for teaching hospitals that are teeming with residents and face higher expenses, as well as facilities that provide a greater level of uncompensated care.
Martin admits that “there’s a certain amount of concern” about the data’s consistency among hospitals, which also have griped about imprecise or unnecessary information being published, as well as insurers, employer groups, and union health and welfare funds. But he hastens to add that “there are so many different payment scenarios across health plans that a fair amount of work has to be done to try and figure out the most credible way and consistent way to collect, analyze and report that information.”
Mark Dever, benefits manager at Duquesne Light in Pittsburgh, Pa., recalls rejecting a health system’s over-priced offer to be the exclusive provider of Duquesne Light’s highly unionized workforce during collective bargaining about six years ago.
He has used PHC4 information for more than 10 years and says it’s an appealing tool that provides objective and credible data on a range of issues, such as the average stay and mortality rate, which hospitals can comment on, which also fits the growing
Dever considers a report issued within the past two years showing the average insurance costs for hospitals particularly telling. “It’s very competitive in the Pittsburgh market,” he says. “There are certain hospitals that cost more than others, but the outcomes aren’t dramatically different. And as more individuals become more responsible for a greater share of payments, I think that information is going to be very critical for people to access and ask, ‘what am I getting for my dollar?’”
But since a high level of sophistication is required to understand PHC4 data, this information may not exactly resonate at the consumer level, cautions Margaret E. “Peggy” O’Kane, president of the National Committee for Quality Assurance in Washington, D.C.
“We need to get off the idea that somehow if we just put it out there consumers are going to vote with their feet,” she explains. “There are a number of ways in which transparency works. One of them is that the organizations being reported on don’t want to look bad.
“The other point,” she continues, “is it’s not like people sit and look for a hospital like they look for a body shop. It will depend on which doctor they’re with, and the doctor will have a relationship with a particular hospital. So there is a stickiness in that whole set of transactions that really doesn’t make the consumer choice model very powerful in that set of circumstances.”
Guest blogger Bruce Shutan is a former managing editor of Employee Benefit News and a freelance writer based in Los Angeles.
