Cheryl Clark | November 20, 2014
The Government Accounting Office says CMS websites “lack relevant information on cost and provide limited information on key differences in quality of care, which hinders consumers’ ability to make meaningful distinctions among providers based on their performance.”
Federal disclosure of quality and cost information that’s necessary to help patients make informed choices about their healthcare is fraught with “critical weaknesses” that limit their use, in part because what is publicly available is heavily influenced by providers, not consumers.
That was one of many criticisms the Government Accountability Office made in its report of the Centers for Medicare & Medicaid Services lack of transparency in cost and quality data on its websites, hospitals, nursing homes, dialysis centers, physicians, home health agencies, and provider charges.
Among some of the key problems with CMS’s current websites, the GAO said, is that the tools on CMS’s “Compare” websites “lack relevant information on cost and provide limited information on key differences in quality of care, which hinders consumers’ ability to make meaningful distinctions among providers based on their performance.”
CMS “has taken some steps to expand access to cost and quality information for consumers, but has not established procedures or metrics to ensure the information it collects and reports meets consumer needs,” the GAO said. It added that CMS’s process for developing and selecting measures “has been heavily influenced by the concerns of providers rather than consumers.”
As an example, the GAO pointed to the National Quality Forum’s Measure Application Partnership, which has been contracted by CMS since 2011 to develop measures used for comparative quality reporting and payment.
“Although the inclusion of consumer organizations in the MAP gives consumers an opportunity to influence measure selection, both a CMS official and a MAP member said that the concerns of provider organizations, which command greater technical expertise on measurement methodology and therefore are better prepared to advocate for their own selection preferences, tend to take priority,” the GAO said.
The lack of consumer-accessible comparison tools leave payers and patients unable to know what they’re getting for their money.
The GAO reported, however, that GAO representatives were told by CMS officials that “making changes to the tools is complex and resource-intensive, and that they have received feedback from providers that are strongly opposed to organizing the tools’ information in rank order according to provider performance.”
Wide Variations in Cost
The GAO picked three common medical services delivered in hospital inpatient units, ambulatory settings and hospital outpatient departments to compare: maternity care, laparoscopic gallbladder surgery, and magnetic resonance imaging of the lower back, in Boston, Indianapolis, and Denver respectively.
The report, which was requested by Congress, pointed to the variation in cost of maternity care at selected hospitals in Boston—all of which rated highly on several quality indicators—and which ranged “between $6,834 and $21,554” in July 2014. But that information is tough for consumers to obtain or understand in a meaningful way, the GAO report says.
Additionally, for ambulatory surgical centers in the Denver area, gallbladder surgery ranged between $3,281 and $18,770 (for which consumers would pay between $3,281 and $6,954 in out-of-pocket costs.)
But in hospital outpatient departments, the same service ranged from $17,791 to $40,626 (for which out-of-pocket costs would range from $6,758 and $11,325.) And an MRI of the lower back in Indianapolis acute care hospitals would range from $277 and $5,184 (with out-of-pocket costs ranging from $277 to $2,637).
Out-of-Pocket Costs Not Provided
The GAO report says the federal sites should show what patients have to pay out-of-pocket, at least for Medicare fee-for-service beneficiaries, but they do not. The GAO says it was told by a CMS official that CMS doesn’t provide out-of-pocket costs “because the agency does not have information on what beneficiaries would pay when they have coverage other than, or in addition to traditional fee-for-service Medicare, as many beneficiaries have.”
However, the GAO said, CMS does have “the information necessary to create estimates of what Medicare beneficiaries likely would pay for different treatments and procedures, based on payment levels the program has set for each provider and the cost-sharing provisions” under traditional fee-for-service Medicare.
The lack of out-of-pocket cost information limits consumers’ ability to make informed choices, the GAO said.
“Because none of the tools contain information on patients’ out-of-pocket costs, they do not allow consumers to combine cost and quality information to assess the value of health care services or anticipate the cost of such services in advance.”
4 GAO Recommendations
1. Include in the CMS Compare websites, to the extent feasible, estimated out-of-pocket costs for Medicare beneficiaries for common treatments that can be planned in advance.
2. Organize cost and quality information on the CMS Compare websites to facilitate consumer identification of the highest-performing providers, such as by listing providers in order based on their performance.
3. Include on the CMS Compare websites the capability for consumers to customize the information presented, to better focus on information relevant to them.
4. Develop specific procedures and performance metrics to ensure CMS’s efforts to promote the development and use of its own and others’ transparency tools adequately address the needs of consumers.
The GAO further said that the CMS websites do not use clear language and symbols, don’t summarize or organize information to highlight patterns, and don’t enable consumers to customize how the information is presented to them.
CMS said it plans to add five-star ratings, similar to ratings it gives to Medicare Advantage health plans, to its tools by 2015.
Source: Health Leaders Media
http://www.healthleadersmedia.com/print/FIN-310507/Medicare-Cost-Quality-Data-Tools-Weak-Says-GAO