Craig Saylor Navigating health-care costs in an era of ‘transparency’

March 17-- Mar. 17--Much attention has been given recently to hospital price transparency.

While at face value this is obviously a very consumer-friendly topic, it is overshadowed by what true transparency should reveal.

Transparency implies openness, communication and accountability. It is operating in such a way that it is easy for others to see what actions are performed.

But is that happening?

What is the true cost of health care as it relates to the total experience? This can be summed up by out-of-pocket expenses, if travel is involved and subsequent care outcomes.

Let's begin with out-of-pocket expense. Does the hospital provide a reasonable explanation of this expense in advance to the consumer? My recent experience related to scheduling a "health-care service" was excellent. My portion of responsibility for payment was clearly explained and I was offered a discount if paid within an established time frame.

Travel is sometimes promoted by insurance companies by offering a discount if you use one of their "owned" facilities.

In western Pennsylvania, traveling over mountains or on congested highways is not typically the stressor we need, particularly when faced with a health-care need or service.

While the automobile has become one of the greatest disruptors in health care, travel should be at the discretion of the consumer and not the insurer.

Outcomes of care really are the end products of the health-care experience. We too often cannot determine our probability of a positive outcome through information from our health-care providers. In other words, will care at facility A be superior to care at facility B, C or D?

Navigating hospital websites and consumer information is difficult and can be as confusing and misleading as a Black Friday sale. Hospitals use terms such as "Quality," "World Class" and "Excellence" without the supporting data behind the terms used.

A review of local and major facility websites did not, in a consumer friendly fashion, provide actual outcomes to care.

Single-source references, with a limited demographic scope, are not a complete picture of the care provided.

Designations such as Centers of Excellence by organizations are indeed credible. Designated centers by medical societies reflect a high standard of care.

Compliments should be given to a Westmoreland County organization that uses the CareChex system of determining patient safety and quality. This data methodology is a superior method of quality and safety determination.

In this writer's opinion, health care could be better served through the transparency of quality data in the fashion displayed on the Cleveland Clinic's website. The Clinic's care outcomes, in real numbers, are displayed and compared to national references.

The health-care system is changing, and the consumer must adapt to this evolving landscape.

Many health-care professionals are employed and thus are encouraged to "keep the care" within the system. Additionally, recommendations given by friends, family, and biased facility advertising, should be validated with facts.

Shouldn't choice be consumer driven? Shouldn't health-care quality become the most transparent information available to the public?

The recently released IBM Watson "Top 100 Hospitals" report, recognizes just one health system, St. Luke's in eastern Pennsylvania, and two hospitals -- St. Clair Hospital and West Penn Hospital, both in the Pittsburgh market -- across Pennsylvania.

The report, which is not a pay-to-play report, indicates that if all Medicare inpatients received the same level of care as delivered at these recognized facilities, the following is achievable:

--More than 103,000 additional lives could be saved;

--More than 38,000 additional patients could be complication-free;

--More than $8.2 billion in inpatient costs could be saved; and

--Approximately 155,000 fewer discharged patients would be readmitted within 30 days.

While these data are limited demographically to the Medicare community, they do use risk and severity adjustments, with adequate volumes to bring validity to the reported numbers.

March is once again a month of "quality" because the Hospital Compare reports were just released to the general public. This requires us to become our own advocates for quality care by carefully reviewing and understanding reports such as Hospital Compare and PHC4.

Become weary of low volume comparisons, so-called star ratings, terms such as number of cases too small, and no different than the national average, unless you are content with average?

While this article is focused on the provider side of health-care quality, equal attention should be spent on quality of care, and expenses related to the insurer we select for coverage. Metrics such as percent of insurer-driven hospital observation admissions, insurer coverage related to long-term acute care, and skilled nursing-care coverage, are critical to the patient experience and quality outcomes. This is a subject for another day.

Until health-care providers begin to display real numbers, easily understood by the average consumer, in a truly open manner, transparency to the average consumer will require individuals to visit multiple websites for an informed choice in care.

Craig Saylor retired from Somerset Hospital as CEO after serving the organization for 35 years in various roles. He holds a fellowship with the American College for Healthcare Executives and is credentialed in Healthcare Quality.

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