NICK JACOBS | Openness needed in health care

By NICK JACOBS
For The Tribune-Democrat

August 02, 2008 07:04 pm

— Having dealt with insurance companies, car dealers, computer sales specialists, stock brokers and any number of other professions, it is obvious to me that any steps toward transparency would significantly move us in the right direction, toward truth, justice and the American way. But none of these topics raise as much passion as conversations about transparency in health care.
About a year ago, I was informed that a retirement policy endorsed by a former employer had gone bad, and, subsequently, it had cost me five years of my personal savings.
When we realize that we have lost hard earned money, the result is anger, disillusionment and frustration.
However, when we realize that a loved one has lost his or her ability to walk because of a lack of information needed to make an appropriate clinical decision, the passion becomes significantly more extreme.
We talk a lot about transparency in health care. But, not unlike most professions, the complexity and intricacies of the profession’s jargon keep all but the most learned individuals from sorting through the risks and rewards of each clinical decision.
Do you want coated or uncoated stents? Should you try controlling this situation with medication, open heart surgery or angioplasty?
Will I do better with 20 milligrams of cholesterol medicine or 40 milligrams. What are the potential side effects of this new drug?
These are complex sometimes life-and-death questions. Simple transparency is not necessarily the answer here.
Let’s be candid and face the stark realities of transparency. Patients are, by and large, the least prepared to demand greater quality.
Usually we are facing these hard-hitting decisions when we are experiencing a health crisis.
Shopping for the best of anything at that time is difficult, if not impossible. To further complicate things, the power of an individual to influence transparency as weighed against that of an insurance company, all levels of government, and the myriad of professional societies is infinitesimal.
Sara Collins, PhD., and Karen Davis, PhD., in their article “Transparency in Health Care: The Time Has Come,” written for the Commonwealth Fund, describe the fact that higher patient cost-sharing and high deductible health plans are the wrong prescription; that price information is of little or no value; and that the current state of information is inadequate.
They do suggest that the following steps should be considered:
• Medicare should take a leadership role in requiring more transparency.
• A national quality coordination board should be established.
• Continued investment in health information technology must be embraced.
• Fundamental changes should occur within current payment methods.
• Health savings account legislation to reduce potentially harmful effect on vulnerable populations should be enacted.
They conclude that price transparency is a good beginning – but only a beginning. 
We all have the right to question and to look for outcome results. We also have the permission to get the information needed to help us make informed decisions about our futures.
Additional transparency in health care might facilitate the improvement of performance and quality by providing hospitals and physicians with the additional information necessary for benchmarking their work. It would assist patients as they attempt to make more-informed decisions regarding their potential care.
Finally, transparency would improve quality and efficiency by encouraging private insurers and public programs through providing necessary information to them to make necessary decisions.
Transparency is not the end-all, but it is a solid start.

Nick Jacobs is president of both the Windber Medical Center and Windber Research Institute, and the author of a new book, “Taking the Hell Out of Healthcare: A Patient’s Guide to Getting the Best Care.”

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