By François de Brantes, MS, MBA and Neel Shah, MD, MPP
We recently returned from the National Summit on Healthcare Price, Cost, and Quality Transparency, where leading thinkers convened to discuss next steps in a growing movement to hold caregivers accountable for delivering better care at lower costs. Traditionally quality, cost, and patient experiences remained locked inside black boxes of individual patient-physician encounters. However, at the cusp of 2014, the window of opportunity to shine a light on physician performance appears to be permanently jammed open by public demand, payer pressure, and a technology marketplace that is eager and capable of making it happen. The summit message was clear: our early efforts to measure and report physician performance data are imperfect and need continued tinkering but they are here to stay. We would like to take a moment to describe what this means for individual physicians and those who are interested in bringing them along.
Spotlights are uncomfortable, unless you are a stage performer. Or a physician, honestly. Physicians are inherently competitive and like to shine – as long as he or she has reasonable opportunity to perform well. The first step to enabling this is to parse the pieces of the value equation that individual physicians can directly help. Many transparency efforts described at the conference aim at revealing arbitrary variation in consumer prices. This is important to uncover but in bringing physicians along we must remember that physicians don’t set prices from the bedside. Physicians do, however, determine utilization – which varies equally arbitrarily and is also a significant contributor to wasteful spending – as well as referrals, which have an increasing impact on consumers’ wallets. Professional movements such as the ABIM Foundation’s Choosing Wisely ® Campaign have started to assert guidelines on frequently overused tests. Physicians can and should be accountable to these, allowing for reasonable exceptions to every rule. On the other hand, widespread availability of prices on referred services remains elusive for most physicians, potentially putting them at odds with their patient’s financial interests.
As a result, we must create the right incentives to reward success. Patients are at financial risk for much of the total cost of care, and the incentives that drive their need for cost information might soon overwhelm their natural desire for quality information. To correct that imbalance, physicians might soon find themselves in a changed role that makes them not simply the stewards of their patients’ care, but also the stewards of their patients’ out-of-pocket expenses. To an extent, payment innovation, including bundled payments and total costs of care formulas, are engaging physicians in that dual role. Physicians engaged today in these programs are looking closely at the price of durable medical equipment, post acute care, facilities and ancillary services and making value-based decisions. That’s good for the patient, for the physician, and for those paying the medical bills.
As the industry transforms, the best sign of success will be the reduction in much of the variation that we observe today – the unjustifiable variability in prices, and the unjustifiable variability in utilization. And that simply won’t happen unless physicians embrace this dual steward role. We think they will because it appeals to their natural high sense of professionalism.
Francois de Brantes, MS, MBA is the Executive Director of HCI3 (Health Care Incentives Improvement Institute). As Executive Director of HCI3, Mr. de Brantes is responsible for setting and implementing the strategy of the organization. This includes supervising the implementations of Bridges To Excellence and PROMETHEUS Payment pilots, leading the development of new programs, and designing incentive efforts for employers, health plans and provider organizations.
Neel Shah, MD MPP (Twitter: @Neel_Shah) is the Executive Director of Costs of Care and an OB/GYN at Harvard Medical School. He is a Series Editor for “Teachable Moments,” JAMA Internal Medicine.