What’s More Useful Than Hospital Pricing Data?
By Data Nerd
An HIStalk reader challenged my recent post, “Hospital Pricing Data: Another Step Down the Rabbit Hole” by asking what healthcare data should be publicly available to help consumers make better choices, not just from CMS, but from providers and private insurers.
I cannot fault anyone for their enthusiasm. Trust me when I say I know how demoralizing it is to come up with a data solution that just doesn’t fit the need. That’s precisely why I felt compelled to speak out on the subject. After setting high hopes and expectations of the analytical possibilities from data in CMS’s pipeline, the solution fell drastically short of what I had hoped it would accomplish when it was finally released.
Having said that, the ideal data solution for me as a consumer would use the same or similar claims data sources, but aggregate the data two different ways to come up with a predictive solution that can be tweaked to assist the patient in their own cost containment efforts. This type of solution would involve:
- Risk-adjusted cohorts. Grouping the data not just by DRG, but by patients with similar risks (age, co-morbidities, etc.) to chart out the most likely course of treatment for someone of my age and health facing the same diagnosis. Ideally, this dataset would include all payer types, but the next-best offering that is within CMS’s reach is to combine Medicare and Medicaid datasets to account for a broader age distribution. Data would not be aggregated by hospital, simply by patient characteristics across the country.
- Once we have an idea of possible treatment routes, we can then couple that with charge data. And, yes, I want that broken down by procedure at each hospital. Like there is no such thing as bad data, there is no such thing as too much data. I’ve never seen OSCAR’s backend, so I’m not sure if it’s possible to break apart every claim and get a procedure-level charge, but I do know with the data as it is today, claims with only one procedure can be isolated and charges or reimbursements tend to have low standard deviations. Since I am not insured by Medicare or Medicaid, knowing what hospitals charge or are reimbursed by CMS does me very little good, though. I would need my own insurance company’s network rates with the hospital to analyze how soon I’ll meet my annual deductible, etc. Or, if I have the luxury of time to make a decision, evaluate if I’d be better served investing in an HSA and initializing treatment in the next fiscal year. But, for the millions covered under Medicare and Medicaid, such an analysis based on the data today would assist in forecasting when deductibles will be met and/or what other amounts will not be covered during the course of treatment.
- In the event that I have a long-term illness or a more drawn-out treatment plan, I would want an analysis of whether or not it would behoove me financially to have different procedures performed at different facilities. Outcomes data would be useful here as well.
All of these data components would need to be dynamically updated and processed, probably using software to evaluate each step of the way, much like the way a simple tax form is completed online. Play with one number and see how it affects the final bill, and in this case assess the risk factor involved in hospitals with poorer outcomes. Ideally, the solution would also interject preventative challenges over time to help the patient meet their health goals in a way that saves the health system money as well, but that is more the quantified-self realm than the (current) data realm.
So, to recap the data offerings that would satiate my current appetite for price transparency:
- Claims data, aggregated by DRG and patient characteristics to obtain expected procedures
- Claims data, aggregated by hospital and procedure charge
- Combine these two alongside insurance reimbursement rates to give a patient’s total estimated personal expense at every hospital
- Hospital procedural outcomes data to evaluate cost savings and determine at which hospital(s) to have the necessary procedures performed
This is the type of data that would be useful to me as a consumer.