State unveils guide to hospitals


State regulators unveiled yesterday a somewhat expanded version of their consumer guide to hospitals, including price comparisons for the most common procedures.

But what's important, the state officials say, is not where the Web-based guide is now, but where it is headed - more information on hospital quality. The new guide, for example, shows for the first time how often each hospital used antibiotics to prevent infections among hip, knee and colon surgery patients. By next year, however, the guide is expected to include not just whether the hospitals tried to reduce infections, but actual infection rates.

Present and future tweaks in the hospital guide, as well as in-state reports on nursing homes and HMOs, put Maryland squarely in an accelerating trend toward what the health policy people call "transparency" - arming consumers with more and better-quality information and cost data to help them choose their doctors, hospitals and other care providers.

The transparency surge - Medicare, the Blue Cross and Blue Shield Association and insurance giant Aetna all announced initiatives this month - is linked to the growth of so-called consumer-driven health plans. These are high-deductible health insurance policies, usually linked to tax-sheltered savings accounts.

Proponents say the new policies will help control costs because patients are using some of their own money and will watch prices more closely. Critics say it will simply pass more costs from employers and insurers to patients.

"Like it or not, we're on our way to a more retail health system," said Greg Scandlen, president and CEO of Consumers for Health Care Choices, a national advocacy group based in Hagerstown. "It's essential for patients to know what the price is going to be when they open their wallet."

"This is an area that's really kind of exploding," said Kathleen Strukoff, a senior vice president in the Baltimore office of Aon Consulting, which advises employers on benefits programs.

A national survey of employers by Aon, released this week, found that 28 percent are currently offering consumer-directed plans, up from 22 percent last year - and from nearly zero the year before.

Even among more traditional health plans, she said, employers have been increasing the portions paid by the patient, so there's more need for price information.

While lots of price-and-quality reports are being launched, even those doing the launching describe them as early-stage efforts.

"This is a start," said Dr. Richard Fornadel, Aetna's Mid-Atlantic medical director. "It's not the be-all and end-all." Beginning in August, Aetna will give its members information on physician charges, quality and "efficiency" in a number of markets, including Maryland.

Sara Collins, assistant vice president of the Commonwealth Fund, a New York foundation that studies health policy, said a number of issues remain in getting the information in shape to help consumers. For example, doctors and hospitals generally charge by individual services and often can't predict just what services will be needed when they start a course of treatment.

Measuring quality introduces another set of complications. Medical and claims records will show whether a patient survived a surgery, but not necessarily whether his knee feels better.

"Even under the most optimistic scenarios," Collins said, "it will be five to 10 years before systematic and useful information is available."

State officials, too, say they expect the reporting to grow in sophistication.

"Although we are pleased with the progress made to date, we recognize that we remain in Phase 1 of hospital reporting - the reporting of process measures," Stephen J. Salamon, chairman of the Maryland Health Care Commission, said at a news conference yesterday. "We have heard from Marylanders that they want the next generation of reporting to provide information about actual outcomes."

They also expect that quality reporting, not price reporting, will have the greatest impact.

Dr. Rex Cowdry, the commission's executive director, noted that price information in the new guide is for in-patient care, and most hospital admissions will exceed any deductible or out-of-pocket limit. Over time, the guide will add charges for outpatient services as well.

The price information, which compares all of the state's hospitals on the 15 most common treatments, shows considerable variation in some cases. Although state regulators control the rates hospitals charge, they vary from hospital to hospital based on factors including teaching costs, local labor costs and the amount of care given the uninsured.

Even the quality information, Cowdry said, is unlikely to cause a large number of patients to choose one hospital over another. Rather, he said, experience with the state's HMO "report card" over a decade and with quality reporting in other states shows the main impact is to get all the organizations to focus on quality and bring up scores overall.

The guide includes some measures of hospital process, such as whether heart attack patients were given the recommended medication. It also reports, for a number of conditions including pneumonia and chest pain, whether the patients were readmitted to the hospital after they were discharged.

To read the hospital guide, go to spitalguide/index.htm.

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