When it comes to generating revenue, the U.S. health care system sometimes rewards quantity over quality. Fixing the flawed incentives will require greater transparency about the costs and values of services, experts said Oct. 9-10, 2015, at the sixth annual Workshop on Health IT and Economics, hosted by the Center for Health Information and Decision Systems (CHIDS) at the University of Maryland’s Robert H. Smith School of Business.
“Excessive use of low-value services is one of the weaknesses of the fee-for-service reimbursement system,” said opening keynote speaker Kate Goodrich, director of the Quality Measurement and Health Assessment Group at the Center for Clinical Standards and Quality within the U.S. Centers for Medicare and Medicaid Service.
The centers where she works announced reforms in August, following a pilot study with more than 2,100 healthcare organizations, including hospitals, nursing facilities and physician group practices. Under the Bundled Payments for Care Improvement initiative, payments to providers are based on an episode of care — such as for heart bypass surgery or a hip replacement — rather than separate procedures in care delivery. The initiative is part of the Department of Health and Human Services’ Affordable Care Act-driven move to “incentivize better care, smarter spending, and healthier people.”
However, getting the majority of healthcare consumers to engage in, and subsequently, reinforce this transition presents a significant challenge for industry leaders, experts said at the CHIDS event, which brought together more than 100 researchers and industry decision-makers in Washington, D.C.
Goodrich outlined Medicare and Medicaid “Compare” websites and a corresponding Five-Star Quality Rating System to push quality transparency throughout the healthcare system. The ratings, including for hospitals, are designed to simplify provider quality ratings for consumers.
However, Smith professor and CHIDS co-director Gordon Gao's2015 study, “Website Ratings of Physicians and Their Quality of Care,” found no evidence associating online physician-satisfaction ratings with clinical quality measures. Still, earlier this year, he said consumers should look to the Medicare and Medicaid ratings as complementary to existing, online patient reviews.
Gao, following Goodrich’s presentation, introduced “Quality Transparency” panelists, who said U.S. healthcare consumers are not conditioned to study the marketplace for quality and value, like when shopping for other products.
“Consumers believe healthcare quality in this country is high and uniformly distributed, which is not the case at all,” said Consumers Union Director Lynn Quincy, one of the participants in the opening panel discussion. “Consumers right now get a raw deal in terms of value. We overpay for health care.”
Consumers haven’t engaged themselves in terms of seeking value, said another panelist, Robert Krughoff, president of Consumers CHECKBOOK. “This is true in all of the types of local services we look at,” he said. “Many people don’t think, don’t shop. They just act. … Databases will need to be compatible, uniform and broadly available from state to state.”
Quincy, whose organization operates as a division of Consumer Reports, said marketers of quality-ratings platforms should be mindful that most consumers “don’t want to spend day in and day out thinking about healthcare quality.” Instead of having to search for quality care sources, they want poor quality sources weeded out, “so they can choose from only high-quality providers.”
An additional engagement strategy is to “target demographic groups faring most poorly in receiving quality care,” said another panelist: Inovalon Senior Director of Statistical Research Christie Teigland. One of the worse-off patient groups, she said, are dual-eligible (Medicare and Medicaid) patients.
Other healthcare industry stakeholders are responding to the transition, including to an HHS benchmark of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models by the end of 2016.
“Private payers are invited to share in these goals and seven of the 10 largest payers have bought in,” Goodrich said.
The transparency panelists’ concerns reflected a broader assessment by subsequent keynote speaker Glenn Tobin, CEO of Crimson, an advisory board company. “The past 15 years in healthcare IT, the dominant strategy has (centered on) implementing EHRs,” he said. “We all can point to ways that we’re not quite there yet. But three years ago, we were trying to figure out ‘How do we get the data in?’ Now, we’re struggling with ‘How do we get value out?’ ‘How do we create value from EHRs?’”
Smith School Senior Associate Dean for Faculty and Research Ritu Agarwal, who chaired the workshop as CHIDS founding co-director, said the workshop, collectively, revealed:
- “Health information technology and health analytics continue to be key enablers in achieving the goals of healthcare reform.”
- “Patient engagement with health and healthcare is improving as a result of more empowerment with information and technology, but we still have some distance to go.”
- “The importance of electronic health information exchange cannot be overstated — it is absolutely critical.”
In addition to Tobin and Goodrich, Jonathan Kolstad, assistant professor for the Haas Economic Analysis and Policy Group at the University of California Berkeley and Chief Data Scientist of Picwell, delivered a keynote speech illuminating methods and opportunities for big data and health economics research.
Discussion topics throughout the workshop included Advanced Analytics in Care Delivery, Health IT’s Impact of Care Quality, EMR and Reimbursement, Health IT Adoption, Information and Health Services Efficiency, Technology for Social Good in Healthcare, and Mobile Health.
Additional research sessions involved faculty from UMD Harvard Medical School, Carnegie Mellon, Notre Dame, Johns Hopkins University, University of Arizona, University of Virginia, UTHealth, Northwestern University and several other leading institutions in the United States and from overseas.
Also part of the workshop, CHIDS presented awards for best paper (“Is Technology Eating Nurses? Staffing Decisions in Nursing Home” by Susan F. Lu, Huaxia Rui and Avi Seidmann from the University of Rochester”); best student-authored paper (“Heterogeneous Treatment Effect of Electronic Medical Records on Hospital Efficiency” by Ruirui Sun, City University of New York); and best young researcher (Niam Yaraghi, representing the Brookings Institution, for “An Empirical Analysis of the Financial Benefits of Health Information Exchange in Emergency Departments”).
Sun also was chosen for the workshop’s doctoral consortium. Others selected were Andy Weeger of Neu-Ulm University of Applied Sciences (Germany) and University of Bamberg (Germany), Anton Ivanov of SUNY at Buffalo, Danish Hasnain Saifee of the University of Texas at Dallas, Genna R. Cohen of the University of Michigan School of Public Health, Kartik Ganju of Temple University’s Fox School of Business and Management, Nicolae Done of Johns Hopkins Bloomberg School of Public Health, Tianshu Sun of UMD’s Robert H. Smith School of Business, Xiao Liu of the University of Arizona and Yiye Zhang of Carnegie Mellon University.
The Workshop on Health IT and Economics is partially supported by the United States Agency for Healthcare Research and Quality, the Robert H. Smith School of Business, the Foundation for the Advanced Education of the Sciences and the University of Minnesota School of Public Health. For more information about the workshop and its history, go to http://go.umd.edu/o46.