Its website discloses readmission rates, surgical site infections, and price.
Everyone is calling for transparency in prices for health care services.
If you could shop for health care services it is likely competition would
improve quality and lower costs. But, as we all know too well, health
care is not like shopping for computers, cars, or even electricians and
contractors. There are almost no price information and limited quality data.
One health care provider is not waiting for companies like Castlight to
solve the transparency problem, but has taken the initiative on its own.
Since 2012, it has posted its quality data on its web site for all the
public to see and has the comprehensive prices for all its surgical procedures
on a web site.
Hoag Orthopedic Institute is in Orange County, California—not a county
known for its progressiveness. Hoag produces annually a 45-page book on
the quality of its health care entitled the Outcomes Report. Of course
the book has the expected announcement of distinctions and awards as well
as the usual grateful patient testimonials. But that stuff is at the back
of the book. The first 30 pages are filled with graphs, charts, and data
that would thrill a policy wonk.
You can see how many hip and knee replacements and other types of operations
Hoag performed over the last three years. It’s valuable data, since
there is a volume-quality relationship—the more a surgeon does the
better he or she performs. More importantly, Hoag discloses its clinical
outcomes—readmission rates, surgical site infections, and other
complications. But who cares if there are no infections if most patients
don’t experience pain relief and don’t get back to playing
golf and other normal functions after their knee is replaced? Hoag discloses
those data too. For instance, the 2015 report shows that among the patients
who underwent knee surgery, the pain score on a validated measure went
from about 50 before the operation to 80 at nine months after (higher
is better). And on the question of getting back to sports and recreation,
scores went from about 25 to nearly 60, six to nine months after the operation.
Hoag also discloses their quality improvement projects, like the one to
minimize the need for general anesthesia during knee surgery allowing
for faster recoveries. They also tout their use of a new xenon light system
to reduce infections. The report even contains information about some
health interventions you don’t expect orthopedists to care about,
do, much less collect data on such as ensuring their patients get influenza
and pneumonia vaccinations. At Hoag, the immunization rates are above
97% for both compared to 90% nationwide.
And it is possible to get the comprehensive prices for the operations Hoag
performs. Go to
OSCOC.com and then click on the “cash rates” and you can see a table
with the global price if a person is self-paying for a procedure. A total
hip replacement is $20,250 and that includes the facility fee, the surgeon’s
fee, the hip implant, the anesthesiologist’s cost, overnight stay,
and a surgical assistant—everything but the rehabilitation. A partial
knee replacement is also $20,250 while a spine fusion is $38,000. (The
rehabilitation is not included since most self-paying individuals go back
to their hometowns, far away from Orange County, and get it there.) These
prices are right there for everyone to see.
Of course there are things to complain about. The quality data are not
broken out by individual surgeon. And patients report that Hoag can do
better in communicating about medications. And to get the pricing data
you have to go to OSCOC web site rather than the Hoag site. But the fact
is Hoag has released both its quality and price data on the web for the
world to see. Totally transparent. Not surprisingly, it is consistently
at the tippy top nationwide.
Why is Hoag different?
Hoag Orthopedic Institute should have a terrible reputation as a rapacious
money grubbing hospital. After all, it is a for-profit, physician–owned
orthopedic specialty hospital in southern California. These hospitals—which
typically focus on high-profit cardiology and orthopedic procedures—cream
off low risk, well-insured patients, dumping the high–risk patients
and those on Medicaid or with no insurance to community hospitals that
can no longer cross subsidize their care using revenue from the “good
paying” patients. Because of their questionable practices, the Affordable
Care Act prevented the creation of more of these physician-owned hospitals.
So again, why is Hoag is different? First, rather than maximizing revenue
by stealing the good patients from the local hospital, it is a joint venture
between the local, not-for-profit community hospital and the physicians.
And it actually cares for poor patients. For instance, 40% of its patients
have Medicare, and in 2014, Hoag provided over $1 million in charity care
including 300 operations for the underserved and in 2015 it is on track
to provide over $2 million in charity care. The website even tells patients
how they can get financial help for their surgery.
Second, the guiding principle of the hospital was that it would try to
prove that a “focused factory” for one largely elective specialty
could dramatically improve outcomes and reduce costs, making it the market
leader in value. Hoag never advertises. It only puts out its quality report
every year. They believe superior performance is advertising enough.
Third, the partners believe in themselves and are willing to compete on
quality and price. They are maniacal about collecting data, and using
it to drive infections to zero, patient experience and perceptions of
care to 100%, and pain and functional outcomes ever higher. Moreover,
Hoag is one of the few health care providers to do time motion studies
to actually determine true costs and identify inefficiencies to be eliminated.
They stock only 2 hips prostheses so competition among suppliers drives
costs down. They do rigorous pre-op care so no cases are canceled at the
last minute wasting expensive operating room time. No equipment is sterilized
between cases—they stock enough equipment just to roll in new sterile
equipment—reducing operating room turn around times and infections
from quick but inadequate sterilizations. They saw that there was variation
in the cost of rehabilitation without differences in outcomes, they shifted
care more to the lower cost outpatient setting.
Again things could be better. Hoag still operates only five day a week.
Capital-intensive operating rooms are used 55 hours a week—only
about a third of the time. Surely, they could be more efficient by operating
on Saturdays and Sundays just like most stores do. And they have not yet
been able to negotiate better rates on screws for spine operations.
But Hoag shows that transparency on price and quality in medicine is not
spine surgery. It can be done, not tomorrow or by the end of the decade,
but today, if only physician leaders had the courage to put all their
data up on the web. Patients need it to shop for medical care the way
they shop for other important and expensive products. We should require
all medical facilities follow Hoag’s lead.
To view the original Fortune article, please click