What is Transparency in Healthcare?

magnifying glassThe strategy of transparency is rapidly gaining momentum within the field of insurance, and throughout healthcare. Employers, committed to providing benefits for their employees, are now enlisting the services of transparency providers to cut healthcare cost. But what is transparency?

Transparency, in its simplest form, is the disclosure of the quality and cost of healthcare providers. Traditionally, when someone undergoes a medical procedure they do not have a reasonable idea of the cost of the procedure—whether it be a knee replacement, kidney transplant or MRI. Furthermore, they often lack an adequate understanding of the quality of the medical care they are to receive. Transparency allows the consumer to gain knowledge of the cost and quality of care before choosing where to receive medical care and who will provide the care.

Quality of Care

Doctors do not provide equal care. As one expert in the field asked, “What do you call the guy who graduated last in medical school?” The answer: Doctor.

Measurements of quality abound for consumers. Many would-be car buyers rely on Consumer Reports, just as your neighbor may check out Angie’s List before selecting an electrician. Bidders on eBay will select sellers based on positive feedback and number of transactions. Before purchasing a hotel room we may check online ratings and reviews of previous guests. Yet, selecting a doctor is often very different. Sadly, many of us will spend more time reading reviews of a restaurant than those of a physician to whom we will be entrusting our health.

We often choose a doctor based on who is available to take new patients or who has offices nearby. Or, we simply may take a recommendation of a friend who had a good experience. In many cases, we go with the recommendation from our doctor for a specialist, not knowing what benefits the referring doctor may receive for making the recommendation. We may do the same in selecting a medical facility. We go wherever we are told to go to have the x-ray, MRI or colonoscopy.  It many cases, it’s a blind trust without having verifiable data to justify our decision.

Transparency Provides Measurable Data

Some of us may take the time to look up the resumes and view the photos of doctors before making a selection. Yet, in selecting a physician wouldn’t it be helpful to know more than just what is provided in the biography on the website—a biography that has been carefully crafted by an accomplished PR firm? Of course!

Verifiable data can be known and we would be wiser for taking the opportunity to obtain it. Below are the types of questions that can produce the data needed to make a wise and educated selection of a physician:

  • Where did they get their training?
  • What are their certifications?
  • How long have they been in practice?
  • If having surgery, how many times have they performed this procedure?
  • What is their mortality rate?
  • What is their success rate in treating the condition?
  • How many times have they been sued for malpractice?
  • Has there been disciplinary action taken with them?
  • Do they have privileges in the highest quality medical facilities and hospitals?

It is not just the quality of the physician that matters, but also the medical facility where care will be administered. Think about the death of Joan Rivers; Would she still be with us today if a more thorough evaluation of the outpatient facility where she had her procedure had been conducted?

When considering a clinic, hospital or other medical facility it would be advantageous to know information that doesn’t always make it into the press release. Some of the quality indicators for medical facilities will provide information such as:

  • Rates of serious complications
  • Rates for blood stream infections
  • Blood clot prevention rates
  • Infection prevention rates
  • Mortality rates for specific conditions
  • Cleanliness of rooms
  • Patient satisfaction
  • Proper use of antibiotics
  • Patient safety

Quality of care is a critical piece to transparency. Cost is the other.

Cost of Care

The cost of an MRI can be as a little as a few hundred dollars to as much as thousands of dollars. When transparency tools and services are used, the savings can be huge.

Patient Care found that the price of a mammogram can vary from a low of $300 to a high of $3,000 and an ultrasound can range from $95 to $2,600. The cost variance of major procedures can be much larger. MAP found the cost of a kidney transplant in southern California to range anywhere from $110,000 to $177,000—and the cheaper facility had the highest three-year survival rate at 96.61%

Compass Healthcare Advisers report saving their clients an average of $17,991 on bariatric surgery, over $5,000 on a hysterectomy, over $4,000 on knee surgeries and also on PET scans.

The resources for cost savings in healthcare are available.

What Employers Can Do

Employers have options if they want to assist their employees in receiving quality care while also reducing the cost of medical claims. Below are three transparency providers for employers:

Medical Advocate Program (MAP)

Compass Healthcare Advisers

Patient Care

A Word of Caution

Transparency is not always the right pursuit. If the medical condition is urgent or emergent, it would unwise to delay care. But when there is time to research and evaluate, using transparency in the decision-making process is the best practice.

Advertisements

About Jack W Bruce
Jack W Bruce Jr. is a novice blogger, husband and father of four, living in Atlanta, Georgia. He is a lover of God, a reader and a wanna-be runner. Jack’s blogs include www.jackwbruce.wordpress.com and www.jackintheteambox.com. Jack can also be found on LinkedIn at www.linkedin.com/in/jackwbruce.

One Response to What is Transparency in Healthcare?

  1. Glenn Dunehew says:

    Great article. Ask the right questions.
    Thanks for the Raving.
    Glenn

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: