by Elizabeth Hofheinz, M.P.H., M.Ed., August 23, 2019
While competition drives business and healthcare, when it comes to the latter, consumers have little chance of making an informed decision on quality, says Jon J.P. Warner, Chief of the Shoulder Service at Massachusetts General Hospital.
“You can go online to look at most products and services, and in 10 seconds you can find information that compares prices for a variety of products and services. Sadly, that is not the case with healthcare.” 
“In general, there is little attempt to measure outcomes and be transparent in healthcare. It is a situation where people and insurance pays for service but not necessarily for quality of that service. In many instances, brand identity drives service with the expectation of quality but no confirmation that the outcome of treatment will be reliable.”
“Our team examined the top 30 U.S. News and World Report-ranked orthopedic programs in order to determine what information was available on the websites organizations, and to what extent there was transparency reporting of outcomes. We found that only 27% of these programs did anything along those lines.”
As for getting the word out about this issue, Dr. Warner notes, “It is not popular to publish on lack of measurement and transparency because it doesn’t fit with the narrative of ‘all is well in medicine. In fact, it may not be an advantage to measure and report on outcomes that may not be as good as a brand might suggest”
“When it comes to surgery, there are many hidden parts of the iceberg. Take the example of someone who has experienced little or no relief from treatment and needs further care. That person is largely in the dark of what to do next. Many patients are now going more and more to the internet but have a difficult discerning where they are likely to receive the best solution for their problem. In fact, the number one thing patients look for is confidence and reassurance. If patients could check the websites of orthopedic programs and the providers in them and find out a provider’s complication rate, infection rate, and readmission rate for a given procedure then they could make a truly informed decision. Unfortunately, we are nowhere near making that a reality for the general public.”
There also seems to be a perverse incentive that lack of information may also suite the strategy of marketing and hope that all providers at a big brand name institution can yield the same outcome for a given procedure.
So, what will it take to move the needle on this? Dr. Warner: “Such motivation for measurement and transparency will have to occur via rewards or penalties. Currently, insurance payments reward procedures regardless of the outcome so there is no direct correlation to the value delivered to the patient. As an example, researchers examining a prostate cancer center in Germany measured all patients and found that they achieved a complication rate that was 1/5 the rate of the rest of Germany. This was a Harvard Business School case study. That is a competitive advantage. There is better value, more business, and the facility can command more in terms of price.”
“We need to establish a culture of measurement in the U.S. which would drive critical inspection and the desire to improve through measurement while at the same time, essentially identifying the low and high performers. Then we could make information available to the public about the quality of care at a given facility and any approaches being used to reduce complications. And ultimately, that could be used in negotiating with insurers.”
Dr. Warner, who on six occasions has undergone orthopedic surgeries, knows that he is fortunate to have an inside track. “I know the questions to ask, I know the importance of surgical volume, and I know where to go. The public does not have those advantages.”
Dr. Warner’s ideal world? “For many routine procedures, we wouldn’t accept insurance, but instead have payment contingent upon a successful outcome. Healthcare providers would charge a fair rate and we would guarantee the outcomes…”
Anyone listening? Anyone?