Public Reporting: What Do Consumers Really Need?
November/December 2013
Editor’s Notebook
Public Reporting: What Do Consumers Really Need?
The authors of our cover story, “Healthcare-Acquired Infections—How Effective is Public Reporting?” report that 32 states plus the District of Columbia are currently required to report rates of hospital-acquired infections (HAIs) in their states. Govednick, McGuckin, and their co-authors review the background for reporting HAI rates and evaluate different methods of reporting the data. They also discuss whether or not consumers are aware the information is available and, if yes, do they use it? Through their study, funded by the RWJF’s Public Health Law Research Program, they found wide variation in how states gather and report the data and a lack of consumer engagement.
Incidence rates for HAIs are just one of many pieces of information we hope citizens will use as they engage in a revolution that, among other things, casts patients as consumers, urging them to shop for value. The revolution is driven by financial necessity, if not moral imperative, and will continue regardless of what happens with Obamacare. All aspects of healthcare in the United States, including the role of consumers, will experience change as we gradually face up to the effects of high cost and low quality. High-deductible health plans and tiered pricing for hospitals are just two examples of market dynamics that give consumers more “skin in the game,” whether they like it or not.
Where available, the state-mandated infection rates discussed in this issue are among the better pieces of information consumers can use while shopping for hospital services. The data are based on fairly reliable measures, at least compared with other quality indicators that consumers may use. Hospital rankings issued by private entities—such as the Leapfrog Group, HealthGrades, U.S. News and World Reports, Consumer Union, and The Joint Commission—make for catchy headlines in local newspapers and hospital ads, but many question the data on which they are based. Published ratings often trigger rebuttals and angry reactions from hospitals and confuse the citizens they purport to inform.
Charles Ornstein, senior reporter for ProPublica, wrote in a recent series that healthcare journalists are wary of these hospital ratings because the data are unreliable. Reporters Ornstein interviewed commented on problems with the data and offered advice for journalists trying to make sense of hospital ratings, which the average citizen, especially when dealing with illness or injury, would find difficult to implement.
Many of us are asking similar questions about hospital data and ratings currently available: Do consumers use this information? Is it helpful? Many consumers, when they’re actively in “patient” mode, in need of care in the near term, cannot spend time researching their options, many feel that their providers and insurers make the choice for them, and many wouldn’t trust the data even if they knew how to go about researching the question. To make good use of this investment in reporting and transparency, we may need to take a step back and begin with better education of citizens, the end users, and hope that they demand better information—more reliable and relevant—to support their decision-making.