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Bush Administration Pushes Quality, Price Transparency
Health and Human Services Secretary Mike Leavitt told participants at a recent health care technology symposium that the federal government plans to identify 10 to 12 markets with high medical costs and, in the next several months, join with major employers to determine the cost of care at area facilities. (Leavitt's comments expand on an announcement he made to the Commonwealth Club of California that Medicare, Medicaid, the Department of Defense, and the Office of Personnel Management will compile non-personalized claims information and release it in sufficient detail to provide price and quality data for each hospital and doctor.) The cost estimates would be based on insurance claim data and—though the current focus is on hospital costs—would likely expand to include providers. Another aim of the initiative is to gather quality data, again starting at the hospital level, based on standards such as those developed by the Hospital Quality Alliance, a public-private partnership involving the Centers for Medicare and Medicaid Services, and industry groups such as the American Hospital Association and the American Medical Association. Leavitt said officials would ask employers to pool claims data, adopt electronic medical records and health care quality standards, and give employees the option of setting up health savings accounts to save for future medical expenses.

Despite the push for this information, a Interactive health care poll (subscription required) found that 55 percent of 2,123 adults surveyed said they would not be willing to pay higher insurance premiums to access higher-quality medical groups and hospitals. However, only 13 percent opposed insurers paying this quality surcharge to providers for them, with 33 percent in favor.

Also, the Medicare program has turned down a request from the Business Roundtable, which represents 160 of the nation's largest companies, to provide data on the cost and quality of health care provided by physicians nationally. The New York Times reports that administration officials say they are constrained by a 1979 federal district court decision that blocked the disclosure of information about Medicare payments to individual doctors, as "prohibited by the Privacy Act." Consumer groups and labor unions are also pushing for the data's release.

State-Level Quality Data Online
The Agency for Healthcare Research and Quality (AHRQ) last month launched a Web-based tool with state-level measures of health care quality that are comparable regionally and nationally. State Snapshots uses data from the 2005 National Healthcare Quality Report (NHQR) and the 2005 National Healthcare Disparities Report (NHDR) to help states better understand their performance, identify areas that need improvement, and set priorities for state quality improvement initiatives. A state's overall ranking is based on 15 representative health care quality measures selected from the NHQR. Information is also viewable according to a state's strongest and weakest measures, types of care provided, and setting of care. There also is a summary of a state's performance in the treatment of diabetes, including quality, disparities, costs, and lives associated with diabetes.

In addition, states continue to release their own quality data. Last month, California became the fourth state to report cardiac bypass surgery outcomes, releasing death rate information for all hospitals in the state that perform the procedure in the first mandatory California Report on Coronary Artery Bypass Graft Surgery (CABG) 2003 Hospital Data. Later this year, an additional report will provide information on individual surgeon outcomes.

AHRQ Report Examines HIT Costs, Benefits
An AHRQ analysis of the evidence for health information technology (HIT) released earlier this month concludes that HIT has the potential to make the delivery of health care safer, more effective, and more efficient. But Costs and Benefits of Health Information Technology, prepared by RAND's Evidence-based Practice Center, also found that most providers need more information about how to successfully implement the technology. Based on studies from 1995 to January 2004, the report examined the implementation of HIT systems in four areas: costs and benefits in pediatric care, impact of electronic health records on ambulatory care, costs and cost-effectiveness of implementing electronic health records, and HIT's ability to make care more patient-centered.

This review found most HIT successes occurred primarily within large health care systems that were able to devote substantial resources to creating their own systems. The authors suggest that more data are needed to determine how to put health IT to work in small health care settings such as physicians' offices and hospitals. The American Health Quality Association (AHQA) is among those with initiatives in this area. About 3,000 physician practices have signed up for HIT assistance from their local Quality Improvement Organizations through a national program AHQA launched eight months ago.

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