Healthcare Transparency

Focus On Price And Clinical Performance Information

Executive Summary

Price Transparency:

1. The College supports the goal of price transparency for services and products provided by all healthcare stakeholders to patients / consumers.

2. The College recommends that any methodology used to publicly report price is also transparent, and contains adequate protections to ensure the reporting of reliable and valid price information.

3. The College recommends that price information provided to patients/consumers should be readily available, presented in a manner that is easily understood and reflective of its limitations.

4. The College recommends that any formal governmental or private sector requirement for price transparency minimize the administrative burden on the participating physicians or other healthcare professionals.

5. The College recommends that price should never be used as the sole criterion for choosing a physician or any other healthcare professional. Price should only be considered along with the explicit consideration of the quality of services delivered and/or the effectiveness of the intervention.

Performance Transparency:

6. The College supports the goal of performance transparency for services and products provided by all healthcare stakeholders to patients / consumers.

7. The College reaffirms and expands upon the qualities of a good performance measure as reported in the ACP policy paper, Linking Physician Payment to Quality Care.¹ Quality measures used to evaluate physician performance should be:

• reliable, valid and based on sound scientific evidence
• clearly defined based on up-to date, accurate data
• adjusted for variations in case mix, severity and risk
• based on adequate sample size to be representative
• selected based on where there has been strong consensus among stakeholders and predictive of overall quality performance
• reflective of processes of care that physicians and other clinicians can influence or impact
• constructed so as to result in minimal or no unintended harmful consequences (e.g., adversely impact access to care) o as least burdensome as possible
• related to clinical conditions prioritized to have the greatest impact
• should be developed, selected and implemented through a transparent process o easily understood by patients / consumers and other users

8. The College highlights the importance of process transparency in the public reporting of healthcare performance information the explicit delineation of the methodology and evidence base used to develop the measures being reported.

9. The College reaffirms the importance of physicians and other healthcare professionals having timely access to assessed performance information prior to public reporting and the availability of a fair and accurate appeals process to examine potential inaccuracies as reflected in the ACP policy paper Developing a Fair Process through which Physicians Participating in Performance Measurement Programs can Request a Reconsideration of Their Rating.²

10. The College reaffirms the ACP Policy Statement Pertaining to Health Plan Programs to Rate Physicians.³ and recommends that the expansion of public reporting of physician performance differences takes into account the technical capability to report reliable, valid and useful differences.

11. The College supports the use of standardized performance measures and data collection methodology, consensually agreed upon by relevant nationally recognized healthcare stakeholders, in efforts to publicly report the performance of physician and other healthcare professionals. In addition, the College supports the collection of both public and private data by trusted third party entities so that physician and other clinician’s performance can be assessed as comprehensively as possible.

12. The College, while recognizing and supporting the increased patient / consumer interest in obtaining and providing physician performance information, does not support the use of web-based physician rating sites that rely on subjective and invalidated data, and do not meet the College’s standards for physician performance measurement.

13. The College supports increased efforts to determine and employ the most effective means of presenting performance information to patients / consumers, and to educate these information users on the meaning of performance differences among providers and on how to effectively use this information to make informed healthcare choices.

Transparency is defined as characterized by visibility or accessibility of information especially concerning business practices and readily understood.⁴ When applied to the healthcare arena, the concept of transparency typically focuses on the public reporting of information and processes. For example, healthcare transparency has been defined by the Institute of Medicine (IOM) as making available to the public, in a reliable and understandable manner, information on the health care system’s quality, efficiency and consumer experience with care, which includes price and quality data, so as to influence the behavior of patients, providers, payers and others to achieve better outcomes (quality and cost of care).⁵

The issue of transparency has been raised regarding multiple healthcare aspects. An overview of the major domains of healthcare transparency is provided in Table 1.

Audiences for transparent healthcare information range across the entire spectrum of stakeholders including patients / consumers, employers / purchasers, health plans, providers and policy makers.⁶ A recent Commonwealth Fund survey of healthcare opinion leaders concluded that transparency in healthcare is essential for moving towards a higher performing health care system in the United States.⁷

The literature reflects a number of potential benefits from increased healthcare transparency including: ^8,9,10

• Improved availability of information needed by consumers to make informed healthcare choices

• Increased trust in the patient-physician relationship and health care systems

• Improved quality, safety and efficiency throughout the healthcare system due to competition and/or the availability of clinical benchmarks.

This policy paper introduces the general issue of healthcare transparency and proceeds to focus on price and clinical performance transparency with particular emphasis on issues related to physicians and their relationships with healthcare patients/consumers. It offers an overview of significant issues and activities related to this subset of transparency, reviews current ACP policy and provides new policy recommendations where required.

Read this policy paper

Healthcare Transparency

A Policy Paper of the American College of Physicians

This paper, written by Neil Kirschner, PhD, was developed for the Medical Service Policy Committee of the American College of Physicians (ACP); Yul Ejnes, MD, (Chair); Thomas G. Tape, MD (Vice Chair); Anne-Marie Audet, MD; Stephan D. Fihn, MD; Donald Hatton, MD; M. Douglas Leahy, MD; Kesavan Kutty, MD; Keith Michl, MD; Mary M. Newman, MD; Arash Mostaghimi, MD; Mark Richmond, MD; Rama Shankar, MBBS; James M. Walker, MD. Approved by the Board of Regents on August 1, 2010.

How to cite this paper:

American College of Physicians. Healthcare Transparency Focus on Price and Clinical Performance Information. Philadelphia: American College of Physicians; 2010: Policy Paper. (Available from American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.)

Copyright ©2010 American College of Physicians.

references

1. American College of Physicians. Linking Physician Payments to Quality Care. Philadelphia: American College of Physicians; 2005.
2. American College of Physicians. Developing a Fair Process Through Which Physicians Participating in Performance Measurement Programs Can Request a Reconsideration of their Ratings. April 2007.
3. American College of Physicians. ACP Policy Statement Pertaining to Health Plan Programs to Rate Physicians. 2008.
4. Merriam-Webster Dictionary Online.
5. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the Twenty-First Century. National Academies Press. 2001.
6. Colmers, JM. Public Reporting and Transparency. The Commonwealth Fund. January 2007.
7. Shea K Shih A. Davis K. Health Care Opinion Leaders Views on the Transparency of Health Care Quality and Price Information in the United States. The Commonwealth Fund. November 2007.
8. Colmers, JM. Public Reporting and Transparency. The Commonwealth Fund. January 2007.
9. Collins, SR. PhD and Davis K. Ph.D. Transparency in Health Care: The Time Has Come, Invited Testimony to the House of Representatives Energy and Commerce Committee Subcommittee on Health. The Commonwealth Fund. March 15, 2006. 10. American College of Physicians. Ethics Manuel (Fifth Edition.) 2005.