Second Opinion: The Right Direction
Column
Written by Michael Sharkey   
Thursday, 01 May 2008
“The great thing in the world is not so much where we stand, as in what direction we are moving.”     —Oliver Wendell Holmes

Second Opinion: The Right Direction - Health Executive - RedCoat PublishingThis quote from the great physician-poet perfectly suits my sentiments regarding CMS’s work in progress, the Hospital Compare consumer Web site.

When I first surfed over to Hospital Compare (www.hospitalcompare.hhs.gov) many moons ago, it was about as inviting as your friendly neighborhood department of motor vehicles. I saw little to nothing an average consumer could pull from the site, and it was nowhere near the ballpark of the “Travelocity of healthcare” HHS Secretary Mike Leavitt describes as his vision.

But HHS’s announcement in late March of an updated and more robust Hospital Compare caught my eye, and I decided to give it another look. I was pleasantly surprised to see how far the site has come, and I can’t help but feel a sense of enthusiasm about the direction it’s moving. However, I’m still frustrated when I consider where the site stands.

When I read information like, “Percent of pneumonia patients whose initial emergency room blood culture was performed prior to the administration of the first hospital dose of antibiotics: 75%,” my shoulders slump. Can anyone at CMS, HHS, AHRQ, or any other acronym please tell me what the hell the average consumer is suppose to make of dozens of statistics like that?

Imagine surfing Travelocity, looking for a nice, reasonably priced hotel in Boston. You click on a potential destination of choice, hoping to learn a bit more about the quality of the establishment, and you’re presented with a dozen nuggets like, “Percent of guests who were handed a fresh pen to complete their initial front desk check-in prior to being directed to their accommodations: 80%.”

The bottom line is the 26 quality measures a consumer can see when comparing hospitals on the CMS site are not for consumers; they’re for healthcare professionals. In this regard, Hospital Compare thrives. As proven by other agencies and states with similar initiatives, like Wisconsin, publicly reporting quality data naturally leads hospitals to benchmark themselves against one another and creates a sense of urgency to drive improvement. But according to HHS, Hospital Compare is supposed to help “patients shop for hospital care based on quality and price.”

Quality we’ve covered. Price is an equally disappointing story. CMS uses “Average Medicare payment to hospital” as its cost barometer. While it’s interesting to see the average payment a hospital receives from CMS for treating a particular diagnosis, what do those figures really tell consumers about the cost of care? What do those numbers mean to people with private insurance? What are the out-of-pocket costs? Why can’t Hospital Compare simply tell me what a hospital charges to treat a particular condition, the same way a travel Web site tells me what a hotel charges for a particular room?

To beat the Travelocity example to death, it would be like seeing the price of a hotel room listed in a new foreign currency with no information given on how this currency relates to your dollar. In a word: frustrating.

This mountain of quality and cost data CMS has gathered is extremely valuable, but it’s only one half of the formula. For Hospital Compare to truly succeed in its mission, the agency bears the responsibility to interpret all of this information for consumers.

Since my first visit to Hospital Compare, there’s no question the site has become kinder, gentler, and more intuitive. And the addition of Consumer Assessment of Healthcare Providers and Systems hospital survey information is invaluable—it’s straightforward data consumers can actually use to help them make their healthcare decisions. It’s also a sure sign the site is on the right path. 

That’s why the great thing is not where Hospital Compare stands, but in the direction it’s moving.
 
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