1. Does Public Reporting of Cost or Resource Use Measures for a Consumer Audience Make Sense? Ateev Mehrotra, MD, MPH University of Pittsburgh School of Medicine RAND Health

2. Outline 1. Current landscape of measures 2. Concerns with current model 3. Suggestions for improvement

3. New Jersey Hospital Price Compare

4. Medicare Hospital Compare

5. Florida Agency for Health Care Administration. Nursing Home Guide

6. What is a Cost or Resource Use Measure? Terminology can be confusing Resource use, value, relative costs, efficiency “Efficiency” per IOM is a quality domain Distinction b’ween cost & efficiency/value Costs for a given outcome Health outcomes per dollar Cost & Resource Use Measures PMPM / patient per year Per episode costs Per hospitalization costs Utilization measures – generic prescribing Overuse measures Price transparency – daily price of nursing home

7. Selection Model Berwick et al, 2003, Medical Care Selection of Providers

8. Concerns with Selection Pathway 1. Consumers typically immune to costs 2. Higher costs = higher quality 3. Lack of trust and understanding 4. Not relevant to decisions actually made Our view is that in their current form and absent any financial incentives, publicly reporting of cost measures is unlikely to lead to the hoped for consumer response.

9. Quality of care for deliveries How much you will pay out of your own pocket? HIGH QUALITY HOSPITALS AT A REASONABLE PRICE Hospital A$100 Hospital B $100 Hospital C $100 OTHER HOSPITALS Hospital J$250 Hospital K $250 Hospital L $250 Click here for details on how quality measured Click here for how we decide on out of pocket costs Making Selection Pathway More Viable Improvements - Relevant choices - Less is more - Link to quality - Link out of pocket $$ - More information - Test, test, test

10. Quality of care for deliveries How much you will pay out of your own pocket? HIGH QUALITY HOSPITALS AT A REASONABLE PRICE Hospital A$100 Hospital B $100 Hospital C $100 OTHER HOSPITALS Hospital J$250 Hospital K $250 Hospital L $250 Click here for details on how quality measured Click here for how we decide on out of pocket costs Making Selection Pathway More Viable Improvements - Relevant choices - Less is more - Link quality, not value - Link out of pocket $$ - More information - Test, test, test

11. Quality of care for deliveries How much you will pay out of your own pocket? HIGH QUALITY HOSPITALS AT A REASONABLE PRICE Hospital A$100 Hospital B $100 Hospital C $100 OTHER HOSPITALS Hospital J$250 Hospital K $250 Hospital L $250 Click here for details on how quality measured Click here for how we decide on out of pocket costs Making Selection Pathway More Viable Improvements - Relevant choices - Less is more - Link quality, not value - Link out of pocket $$ - More information - Test, test, test

12. Quality of care for deliveries How much you will pay out of your own pocket? HIGH QUALITY HOSPITALS AT A REASONABLE PRICE Hospital A$100 Hospital B $100 Hospital C $100 OTHER HOSPITALS Hospital J$250 Hospital K $250 Hospital L $250 Click here for details on how quality measured Click here for how we decide on out of pocket costs Making Selection Pathway More Viable Improvements - Relevant choices - Less is more - Link quality, not value - Link out of pocket $$ - More information - Test, test, test

13. Quality of care for deliveries How much you will pay out of your own pocket? HIGH QUALITY HOSPITALS AT A REASONABLE PRICE Hospital A$100 Hospital B $100 Hospital C $100 OTHER HOSPITALS Hospital J$250 Hospital K $250 Hospital L $250 Click here for details on how quality measured Click here for how we decide on out of pocket costs Making Selection Pathway More Viable Improvements - Relevant choices - Less is more - Link quality, not value - Link out of pocket $$ - More information - Test, test, test

14. Quality of care for deliveries How much you will pay out of your own pocket? HIGH QUALITY HOSPITALS AT A REASONABLE PRICE Hospital A$100 Hospital B $100 Hospital C $100 OTHER HOSPITALS Hospital J$250 Hospital K $250 Hospital L $250 Click here for details on how quality measured Click here for how we decide on out of pocket costs Making Selection Pathway More Viable Improvements - Relevant choices - Less is more - Link quality, not value - Link out of pocket $$ - More information - Test, test, test

15. Quality of care for deliveries How much you will pay out of your own pocket? HIGH QUALITY HOSPITALS AT A REASONABLE PRICE Hospital A$100 Hospital B $100 Hospital C $100 OTHER HOSPITALS Hospital J$250 Hospital K $250 Hospital L $250 Click here for details on how quality measured Click here for how we decide on out of pocket costs Improvements - Relevant choices - Less is more - Link quality, not value - Link out of pocket $$ - More information - Test, test, test Making Selection Pathway More Viable

16. Do Consumer Need to Respond? Reputation

17. Higher than Average Rehospitalizations Hospital A 13.1% Hospital B 12.2% Hospital C 12.1% Hospital D 9.2% Hospital E 8.3% Average Hospital 4.1% Care for Myocardial Infarction Key points - Focus on reputation - Choice not patient relevant - More complex data - Focus on high cost providers Making Reputation Pathway More Viable

18. Key points - Focus on reputation - Choice not patient relevant - More complex data - Focus on high cost providers Higher than Average Rehospitalizations Hospital A 13.1% Hospital B 12.2% Hospital C 12.1% Hospital D 9.2% Hospital E 8.3% Average Hospital 4.1% Making Reputation Pathway More Viable Infarction

19. Higher than Average Rehospitalizations Hospital A 13.1% Hospital B 12.2% Hospital C 12.1% Hospital D 9.2% Hospital E 8.3% Average Hospital 4.1% Making Reputation Pathway More Viable Care for Myocardial Infarction Key points - Focus on reputation - Choice not patient relevant - More complex data - Focus on high cost providers

20. Higher than Average Rehospitalizations Hospital A 13.1% Hospital B 12.2% Hospital C 12.1% Hospital D 9.2% Hospital E 8.3% Average Hospital 4.1% Making Reputation Pathway More Viable Care for Myocardial Infarction Key points - Focus on reputation - Choice not patient relevant - More complex data - Focus on high cost providers

21. Higher than Average Rehospitalizations Hospital A 13.1% Hospital B 12.2% Hospital C 12.1% Hospital D 9.2% Hospital E 8.3% Average Hospital 4.1% Making Reputation Pathway More Viable Care for Myocardial Infarction Key points - Focus on reputation - Choice not patient relevant - More complex data - Focus only on high cost providers

22. Key Take Aways In current form cost measures unlikely to have the desired impact Consider which pathway on which to focus –Impacts presentation, choice of measures, link to quality, and financial incentives Limited scientific evidence base on consumer response

23. Acknowledgements Co-authors –Judy Hibbard –Arnie Milstein –Peter Hussey Paper written for AHRQ National Summit on Public Reporting for Consumers Questions –Ateev Mehrotra –mehrotra@rand.orgmehrotra@rand.org