Transparency 2.0

I had the opportunity recently to speak about our practice of posting patient comments and survey scores on our physicians’ web pages. The conference at which I presented was devoted to “transparency and innovation” and it became clear to me that making patient satisfaction scores public, while innovative today, will be universal pretty soon. The same forces that convinced us to go this far – rising consumerism among care-seekers, the ubiquity of ratings and information for other goods and services, and the evolution of payment models away from fee-for-service – will compel us to provide more and more information to patients and potential patients.

What might that look like? Here are a few possibilities.

Operational transparency. We provide information to patients about the care that others have experienced “in the exam room” with their physicians, but not about other things that matter to patients, like how easy it is to get an appointment, or how long the average wait in the office is, or how quickly we provide lab results. It is now not uncommon now to see highway billboards indicating average wait times in local emergency departments. I think we will soon be expected to provide similar information for our physician offices.

Price transparency. As more and more people face higher out of pocket costs because of high-deductible health plans and limited (or no) out of network benefits, consumer price-sensitivity will continue to rise. Obviously, acting on prices requires knowing the prices. Even if patients may be reluctant to “shop by price” I believe they will choose price certainty over price uncertainty, and providers will be pushed to provide more and better information about the actual costs that patients face.

Outcome transparency. There was a big splash recently when CMS and a bunch of private payers announced (another) effort to harmonize their quality measures in order to reduce the burden of collection and reporting on providers. Nearly all of those measures are about processes of care, rather than about how patients actually fare with the care they receive. That seems to me a little like continuing to work on perfecting the horse and buggy instead of acknowledging that patients want to drive a car. I agree with Porter and Lee, who (again) outlined the need to move to measuring outcomes of care, and especially those outcomes that matter most to patients, such as functional recovery or freedom from pain and disability.

I think that organizations that take the lead in providing information like this will win big. What do you think?


2 thoughts on “Transparency 2.0

  1. Hi, these are good steps, but there are still a lot of pot holes in the transparency road, especially in areas that have doctor shortages.
    One problem is that many patients don’t believe that reviews about medical care are accurate, especially with-Clean up and manage your online reviews programs.
    I believe that much of the medical world doesn’t care about transparency, and can always find a justification for wrong info—example-3 weeks ago, I took a friend-an office manager at an atomic laboratory into a day surgery. I asked what her co-pay would be. She said it was just less than $150-she told me the exact price. When she checked in, the co-pay changed to almost $900. Then doctors and staff often are not in charge of final billing. I was told that my co-pay for a day surgery would be either $35 or a $450, and it depended on how the surgery staff wrote it up and how it was read by insurance. I was lucky-it was indeed $35.
    Basically, everyone blames everybody else for descision, procedure problems, etc. which is why patients don’t really believe information released about a health provider or health system. I’ll give you more reasons why I’m doubtful about posted veracity.
    Surveys don’t ask complete questions, so problems can be solved. I am constantly asked if the doctor is polite on a scale. I am asked if the doctor explained his/her position and plan of action. Nowhere has any survey asked me if I agreed with what the doctor said or prescribed. The doctor just politely bulldozes through my objections and dismisses my medical history. So, I’m stuck saying the doctor was polite.
    Next, many patients are scared of reporting bad visits for fear of having future problems somewhere along the line. After all, it’s easier to blame the patient for misunderstanding for a dozen different reasons. .

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