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Public Reporting of Cost Measures in Health
Technical Briefs, No. 19
Investigators: John FP Bridges, PhD, Zackary Berger, MD, PhD, Matthew Austin, PhD, Najlla Nassery, MD, MPH, Ritu Sharma, BSc, Yohalakshmi Chelladurai, MBBS, MPH, Taruja D Karmarkar, MHS, and Jodi B Segal, MD, MPH.
Author Information and AffiliationsStructured Abstract
Background:
One of the intended goals of publicly reporting the cost and quality of health care providers is to empower consumers to make informed decisions, thus contributing to improved efficiency of the health care system. While public quality reporting is well documented, less is known about public reporting of costs and the impact it has on consumers.
Purpose:
We sought to document current practices for public reporting Web sites that include measures of costs of health care providers, and aimed to assess if these practices are consumer centered.
Methods:
Guided by discussions with Key Informants and a targeted literature review, we collected data from active public reporting Web sites in December 2013. We conducted a systematic scan to identify Web sites that report cost measures, and cataloged these measures. We then assessed the degree to which this cost reporting was consumer centered by applying our novel taxonomy, PRICE, that has five domains: (1) price transparency, (2) real comparisons, (3) information on value, (4) connect to care, and (5) ease of use. We assessed each of these domains across three criteria (for a total score of 15) and summarized the data using averages of the sum of criteria (in total and by domain).
Findings:
We identified 372 Web sites of which 102 were duplicates and 211 were excluded after two stages of review. State departments of health or state hospital associations operated 75 percent of the 59 Web sites that reported costs at the provider or facility level. All the Web sites reported on inpatient care and 71 percent reported average charges. Only 2 percent of these Web sites reported out-of-pocket costs, 7 percent reported costs using symbols or figures, and 14 percent reported current-year data. The PRICE taxonomy produced a median consumer centeredness score (summed across all domains) of 8 of 15, with a range from 4 to 11. For the included Web sites, ease of use was the highest rated domain (mean of 2.6 out of 3) and information on value was the lowest (0.7 out of 3).
Conclusions:
Several factors limit the effectiveness of current public reporting of costs practices. These include a focus on charges (rather than consumers' out-of-pocket expenses), heterogeneity and ambiguity in the cost measures and data sources, and a lack of consumer-centered interfaces that allow the customization of searches that are relevant to consumers. Other limiting factors are the paucity of Web sites that provide cost and quality data, a lack of public awareness, and the need for research demonstrating the impact of publicly reported cost measures.
Contents
- Preface
- Acknowledgments
- Key Informants
- Peer Reviewers
- Background
- Objective
- Guiding Questions
- Methods
- Results
- Summary and Implications
- References
- Appendix A Targeted Literature Review
- Appendix B List of Web Sites Reviewed
- Appendix C Characteristics of Included Web Sites
- Appendix D Characteristics of Semipublic Web Sites
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2012-00007-I, Prepared by: Johns Hopkins University Evidence-based Practice Center, Baltimore, MD
Suggested citation:
Bridges JFP, Berger Z, Austin M, Nassery N, Sharma R, Chelladurai Y, Karmarkar TD, Segal JB. Public Reporting of Cost Measures in Health: An Environmental Scan of Current Practices and Assessment of Consumer Centeredness. Technical Brief No. 19 (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No.290-2012-00007-I). AHRQ Publication No. 15-EHC009-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2015. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00007-I).
The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and providers, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies may not be stated or implied.
None of the investigators have any affiliation or financial involvement that conflicts with the material presented in this report.
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.ahrq.gov
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