Access to cost and quality data could help physicians succeed in value-based care

By Steve Burrill, vice chairman, US health care leader, Deloitte LLP

Most physicians probably know how much it will cost their patients to park in the hospital’s lot, or what they will pay for a cup of coffee in the cafeteria. But few physicians can help their patients find low-cost laboratory or imaging options in the neighborhood, or point patients to a high-value rehab or skilled-nursing facility, according to the results of our 2018 Survey of US Physicians. If our industry is to successfully migrate to value-based care models, physicians likely need greater access to cost and quality information so they can help patients get more value from the health care system.

A majority of physicians have access to information about their own productivity as well as their performance on quality measures, according to our survey results. However, just 14 percent of the 624 physicians we surveyed said they have access to quality data for the physicians or facilities where they refer patients. Moreover, only 9 percent of surveyed physicians said they are able estimate out-of-pocket costs for their patients.

Cost information could impact physician decision making

Information about care quality, productivity, and cost can influence the decisions physicians make. More than 70 percent of survey respondents said such cost data was valuable, particularly at the point of care. Of the physicians who have access to cost data, more than 60 percent said that knowing what a patient would pay out-of-pocket had compelled them to reconsider or change how they practice. By contrast, just 39 percent of physicians who don’t have access to this information thought that having it would influence their decision making.

But simply providing clinicians with data might not be enough. Health systems that share some cost data with their physicians agree that the information can influence practice patterns. But they note the data must be paired with education. Certain types of cost data, and the way it is reported, can be complicated. To use the data appropriately, physicians should understand how it was collected, and it should be presented in a way that helps physicians choose the most appropriate and affordable treatment option.

While having cost and quality information won’t necessarily lead physicians to make more cost-effective decisions, some anecdotal evidence suggests it could have a positive effect. Consider these examples:

• The Texas Hospital Association (THA) piloted a program where electronic health records (EHRs) are used to share relevant cost data with physicians at a large academic hospital. Physicians see patient-specific, real-time hospital wholesale costs for medications, labs, and imaging. The hospital compared physicians who used the enhanced EHR against their historical behavior and against physicians at the same hospital who did not have access to the data. After a little more than two months, the program saved the hospital $430,444 in costs related to medications, labs, and imaging. More than 50 THA member hospitals are now participating in the initiative.¹
• A 2017 study published in The Journal of the American Osteopathic Association found that emergency health care professionals have an inadequate understanding of the costs associated with routine care provided in the emergency room. The study is based on a survey of 441 emergency medicine professionals that asked them to identify the cost of care for three common presentations: abdominal pain, dyspnea, and sore throat. The authors of the study concluded that education related to costs, such as through computerized physician order entry, “is likely to improve efficiency and decrease costs to the patients as well as the health care system overall.”²
• While clinicians feel a sense of responsibility around the cost of care that they prescribe to patients, they often don’t feel they have “the tools to know, the time to discuss, or the ability to impact how much things cost,” according to a survey of 571 clinicians, clinical leaders, and executives commissioned by the University of Utah Health. According to the survey results, 86 percent of respondents said physicians lack the training needed to discuss cost considerations affecting their patients. The study also found that while physicians feel responsible for the cost of care, they do not feel accountable for it.³

To reconsider treatment decisions, physicians who responded to our survey said data would need to be accurate, actionable, and easily accessible. They call for:

• Measures that they can impact or are within their control (78 percent) 
• Measures relevant to their service line or specialty (68 percent), particularly among specialists 
• Specific action steps (56 percent) 
• Data/information at the point of decision-making (43 percent) 
• Reports accessible through regular practice workflow (39 percent) 

According to the results of our survey, most physicians are willing to manage health care costs. However, to successfully manage costs for the health system and patients, they likely need more complete information about the costs of treatment options. Experience suggests that supplying this data to physicians, whether independent or employed, can help improve their performance. All physicians are increasingly being measured by payers, including the Centers for Medicare and Medicaid Services (CMS), on their utilization and cost performance. Providing physicians with actionable cost and quality data could help them make more informed decisions and could lead to lower costs for health systems and patients.

Endnotes

¹ IllumiCare, Inc., Texas Hospital Association (https://www.illumicare.com/large-hospital-study/) 
² National Center for Biotechnology Information, US National Library of Medicine (https://www.ncbi.nlm.nih.gov/pubmed/28556857) 
³ NEJM Catalyst and University of Utah Health (https://catalyst.nejm.org/buzz-survey-university-of-utah-health-1-cost-care/) 

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