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Provider Transparency, Price Transparency, and Medical Outcomes Transparency

October 19, 2020

Important keys to healthcare reform

Over the past few decades, hospitals have become competitive for patients and have spent millions on advertising and marketing. The same goes for healthcare insurance carriers.

Much of the messaging is focused on specialty services such as orthopedics or heart care. More recently, in the past five years, emergency departments began advertising for shortest wait times. For children’s hospitals, the ads feature friendly and kind-looking medical staff.

Cost and quality govern consumer decisions

What hasn’t taken hold yet is advertising featuring price, outcomes statistics, and the actual medical credentials of patient-facing medical staff. As mentioned below, healthcare organizations and some state licensing board websites will include star ratings, license and certification detail, and some personal information about providers.

The core elements of competitive advantage are price and features. With almost everything we purchase; those two considerations lead the decision-making process.

The healthcare industry is slowly transforming to see patients as consumers. On the price transparency front, starting January 1, 2021, according to the Centers for Medicare and Medicaid (CMS) “each hospital operating in the United States will be required to provide clear, accessible pricing information online about the items and services they provide in two ways:

  1. As a comprehensive machine-readable file with all items and services.
  2. In a display of shoppable services in a consumer-friendly format.

This information will make it easier for consumers to shop and compare prices across hospitals and estimate the cost of care before going to the hospital.”

Definitely a step in the right direction. As Hugh Greeley discusses in his Credentialing Digest, even beyond pricing and overall hospital outcome metrics, full transparency regarding each provider’s medical credentials, peer reviews, and outcomes is the information a healthcare consumer really needs to make a fully informed decision about the most important things—health, quality of life, longevity.

The following is produced by Hugh Greeley of Hugh’s Credentialing Digest

There is much discussion about transparency in hospital quality, patient satisfaction rates, pricing of patient care, and even physician-specific Medicare volumes and reimbursement amounts. Why not cry the qualification of medical staff members from the rooftops?

Medical credentialing is required by health systems and payers: Why not share more provider information with healthcare consumers?

While price transparency is frequently discussed, the other levels of transparency should be patient outcomes and provider qualifications. Any American considering a hospital stay should be able to simply go online to compare hospitals relative to infection rates, degrees of surgical success, and many other metrics….our health is our greatest and most important asset. Would we not want to compare performance relative to any health and medical care the way we compare electricians or carpet installers? Inevitably when we are able to do this, hospitals will be driven by quality, service, and cost – all of which will be necessary to compete.

It’s a fact that patients are consumers and should be able to better compare hospitals. Many might not do this because of the immediacy of illness or injury, but an increasing number are already seeking out as much information about their hospital of choice as possible.

Consumer access to a provider’s basic credentials status is the next step

This trend also has credentialing implications. Today consumers are able to view a wealth of information about their physician or a prospective provider. See the Massachusetts State Board of Medicine website for a glimpse of the type of data and information that is increasingly being made available to the public by some state licensure boards.

Those hospitals interested in transparency might strongly consider allowing the public access to as much information about members of the staff as those consumers can gather from other public sources. Why not demonstrate the excellence of doctors or staffs on “doc finder” websites? Load them up with data about physicians’ current and past credentials.

An example of a detailed provider profile:

Dr. Marcus Welby

  • Completed Harvard Medical School in 1991.
  • Successfully completed his residency in internal medicine at Massachusetts General Hospital in 1994.
  • Successfully completed a fellowship training program in infectious diseases at Stanford University in 1996.
  • He is certified in both internal medicine and infectious diseases. He has been in clinical practice without interruption since completing his formal training.
  • He holds special certification in advanced cardiac life support.
  • He is widely published.
  • __ percent of his patients expressed satisfaction with his care, according to the Press Ganey survey organization.
  • He is licensed in four states and has never had a disciplinary action reported.
  • He has been on the medical staffs of three accredited hospitals and is currently on the staff here at Memorial with full privileges in internal medicine and infectious diseases.
  • He has had no malpractice suits filed against him.
  • He has had no disciplinary actions taken by any hospital, governmental agency, or professional board.
  • As a member of our staff, he is very busy and considered by his peers to be an excellent physician.

More and more physicians are able to add a video to their profile in which they discuss their personal medical philosophies directly with potential patients.

You might also allow any concerned physicians to opt-out of this service.

This is transparency at its best.

Technology is the key to patient safety through sound choices of providers

In today’s world of technology, it is possible to access data in real-time in order to stay current with provider directories.

Verisys provides its exclusion, license, and physician monitoring as well as sanction screening to healthcare organization clients with the gold standard of provider data, FACIS®, a database containing millions of historical and current records on provider exclusion, sanctions, debarment, and disciplinary actions among additional data derived from nationwide attorney’s general press releases.

Hugh Greeley Written by Hugh Greeley
Credentialing and Healthcare Industry Expert
HG Healthcare Consultant
Connect with Hugh

 

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