Two new Web sites have been launched recently to help consumers make informed choices regarding price and quality of hospital services in New Jersey.
The two new sites are N.J. Hospital Price Compare www.njhospitalpricecompare.com and N.J. Hospital Care Compare www.njhospitalcarecompare.com. The New Jersey Hospital Association (NJHA) and its member hospitals launched both sites in April.
This effort adds to the growing number of states, hospital associations, insurance companies, and individual hospitals around the country that have launched similar "transparent" Web sites. All of this is in response to a new wave of consumerism – a belief that cost and quality transparency provides consumers with the tools needed to choose healthcare based on "value," or the best treatment relative to cost and quality.
NJHA president Gary Carter says "users (patients and healthcare professionals) can now look up individual New Jersey hospitals and see an array of information such as how many patients they admit each year, their average charges for certain procedures or how often their surgical patients developed infections."
Although it can be argued that the average consumer does not have the necessary experience to utilize such information, there is a growing sense that this will change over time. With the advent of Health Savings Accounts (HSA) and high deductible insurance plans, consumers are seeking out both price and quality information in an effort to spend their dollars wisely. Additionally, we could expect that the underinsured and uninsured population, which is consistently growing, will also be seeking price information in an effort to understand all their available options.
In the case of the New Jersey Hospital Price Compare site, consumers will be able to compare hospitals based on average charges and average lengths of stay (LOS). This resource will allow users to compare hospitals by county, by the number of beds, and by programs and services.
Since the Web site is new, the initial data represents publicly available hospital inpatient claims data for discharges from the 4th quarter of 2006. However, the site promises to increase its data set and eventually provide consumers with access to the most recent four quarters of data. The data is arranged by major diagnostic category (MDC) and diagnostic related groups (DRG), and yes, the site will provide definitions of these terms, as well as terms such as charges, teaching hospital, and top 25 DRGs. These are terms professionals in the healthcare industry take for granted, but for the average consumer can be confusing and misleading.
For example, the site defines "charges" as, "the published price that hospitals set as a starting point for negotiating with insurance companies, rarely the amount that patients actually pay. Roughly 10 percent or less of hospital claims statewide are paid at the charges rate."
Even after such a concise definition, the average consumer with insurance would still not know their actual out-of-pocket costs. In fact, the real test as to whether or not the consumer has any out-of-pocket cost at all depends on what is covered by their insurance. The level of insurance coverage will further determine if they pay a percentage of charges, a deductible, a co-insurance, or if they pay anything at all. And for those with no insurance – the 10 percent – the answer as to what discounts or options they have other than paying 100 percent of the published charges, is even more daunting.
In addressing the issue of the uninsured, Mr. Carter says, "unfortunately, uninsured self-pay patients are the one small group that ends up facing full hospital charges. No one intended to create this inequity for self-pay patients; it's an unfortunate byproduct of the health system's illogical reimbursement process."
Although the healthcare reimbursement system may be to blame, these new consumer-friendly Web sites will have to take on the task of addressing the expected out-of-pocket cost for both the underinsured and uninsured.
The NJHA site attempts this by providing three search options. The general option, geared toward the "average consumer," prompts users to select a hospital from a statewide list, then the MDC, and further helps them by narrowing down their search by selecting the DRG. The resulting report will list average charges, average charge per day, median charges, average LOS, and number of discharges for:
The other two options on the price compare site include a category search (based on MDC/DRGs) and a top 25 DRG search (based on individual hospitals top DRGs).
The NJHA Quality Web site, called Care Compare, allows users to compare certain quality of care statistics among participating New Jersey hospitals. The site defines quality as "when the hospital care fully followed all the guidelines and standards of appropriate care, based on medical research."
There are six search options provided to consumers to compare quality among hospitals. The first is an individual hospital summary that reports on:
The remaining search options on the Care Compare site are available for a specific county or all county bases. These include comparisons on the following: Birth (vaginal vs. cesarean), community-acquired pneumonia mortality, heart failure mortality, postoperative surgical infection and myocardial infarction mortality.
The source of the Care Compare data presented is also derived from publicly available data that is collected by the New Jersey Discharge Data Collection System for the period 2005.
While we should commend NJHA and the other organizations that are taking the lead in providing transparency to consumers, we should expect more sophistication and "compassion" in the reported information.
For example, in addition to providing price information on specific surgical procedures and outpatient services, sites could include links to participating insurance companies' Web sites that will further delineate potential out-of-pocket cost based on plan specifics. Sites could also include links to individual hospital Web sites, where the uninsured could view hospitals' compassionate billing guidelines and find phone numbers for their respective financial counseling offices.
Sources from NJHA say that they have yet to test market the new Web site to consumers, but will be monitoring consumer feedback and concerns in the weeks and months ahead. For now, at least, residents of New Jersey have an online source for hospital pricing and quality information. With enhancements planned for the future, they can expect even more.
Kevin Pleasant, Product Owner, Decision Support
