Value for the Dollar
Americans have looked at health care as something for which we'll pay any price-anyone should be able to have the best medical care available to save their lives. Recent moves to publish health care report cards online have come under attack as giving inaccurate pictures of the health care provided by various institutions or for trying to quantify the unquantifiable. Do you think hospitals and other health care providers can be held accountable through means such as online report cards? If not, how else can we be sure that we are getting value for dollar in an era where health care costs are soaring as a percentage of GDP? Conklin: We believe in transparency and so have been publishing our quality and performance information for quite some time and making it available on our Web site (www.christushealth.org). So, yes, we do believe that report cards are important. However, as long as the focus remains solely on physicians and acute care and we do not fix the problems with the underlying health care system, this data will only tell part of the story.Temple: I think the idea that we can enforce accountability for clinical excellence via "hospital report cards" is a terrific idea on the face of it and should be encouraged, but there are some real issues with it. For instance, could an insurer who may be creating a "report card" for its members gauge its providers based on providing what it deems to be the most "cost-effective" care versus what the safest care might be deemed to be? Also, even if you get past the notion of possible bias, how do you craft a report card that is robust enough to be useful but not so complex as to be overwhelming to a consumer? Another thing to consider-if you are grading the level of mortality for a given procedure, how would you factor in certain hospitals that get the highest acuity cases and would almost inevitably have higher mortality rates, but really are providing superior care to a much more challenged population? This may be an opportunity for a credible industry panel to be formed with all relevant constituencies represented to come up with a single report card that would be considered to be the "gold standard," and do it in as unbiased a way as possible. So, yes, let's keep going down this road, but remain mindful of the pitfalls that we will certainly encounter.
We need a more rational health care system focused on health and wellness, rather than sickness. And statistics ought to be focused on finding out who does a better job keeping people healthy, versus morbidity and mortality statistics, patient satisfaction, measures of efficiency, etc. Until we tie all these pieces together and develop report cards focused around health and wellness, we will continue down the present, untenable path.