Price transparency may be catalyst for outcomes transparency in health care

In November 2019, the U.S. Centers for Medicare & Medicaid Services (CMS) finalized a rule requiring hospitals to make readily available prices patients might pay for common health care services and items. Despite the numerous policy reversals associated with the transition from President Trump to President Biden, the hospital price transparency regulation was one policy that transcended administrations. In an era when politicians seem to disagree for the sake of disagreeing, this is one area where common ground has been found, which is fortunate for everyday Americans seeking medical care. Indeed, with over 90 percent of Americans across the political spectrum supporting health care price transparency, it is clear that patients desire information that allows them to be more in control of their care decisions and dollars destined for health care expenditures. 

But the transition from health care price secrecy to transparency has been fraught with roadblocks. Research has estimated that greater than four out of every five hospitals have failed to comply with the regulation to date. However, the determination to refocus health care on patients and allow them the resources and insights needed to make their own health care decisions suggests that the policy — with its strong bipartisan backing — will likely prevail and hospitals across the United States will ultimately need to comply.

The resolve to agree upon and implement a major health care policy — such as hospital price transparency — demonstrates the desire of many bipartisan stakeholders to truly “move the needle” on health care transformation.

This comes not a second too soon. 

Recent national health expenditure estimates project continued skyrocketing growth at an average annual rate of 5.4 percent, leading to an estimated $6.2 trillion in health care spending by 2028.

Hospital price transparency will not — by itself — bend the spending curve and improve clinical outcomes for patients; however, the regulation may be the catalyst needed for further health care system innovation focused on reigniting patient-centered care and transitioning to a health care delivery model that emphasizes the optimization of value — defined as health outcomes achieved per dollar spent — for patients.

Ultimately, success in the hospital price transparency movement has fostered a greater sense of hope moving forward among those dedicated to driving real change in health care.

So where can we go from here?

I would argue the same reasons that led to the adoption of transparent hospital price regulations demonstrate the need for easily accessible and transparent outcomes information.

Patients deserve not only to know what a certain health care service may cost, but also what the potential benefit — or outcome — they may get from that service. 

To date, outcomes measurement and reporting has been inconsistent and generic, not focused on the outcomes most important to patients — nor the outcomes directly related to the given medical intervention of interest. For example, patients undergoing a total knee replacement seek care to improve physical function, decrease pain, and improve quality of life. Unfortunately, such data, which is able to be assessed using simple, validated patient-reported outcome measures (PROMs) and other means, are not typically available to patients. Further, the outcomes that are routinely measured tend to not be related to the total knee replacement itself (e.g., urinary tract infection rates). This should — and must — change.

Physicians in collaboration with patients and with support from legislators should make outcomes measurement not only routine, but also transparent for the most common conditions. While this may have been assumed to be too big of an “ask” only a short time ago, the evolution of price transparency directives demonstrate that change in health care can be accomplished now and on a bipartisan level.

By moving beyond just price transparency to focus on outcomes transparency as well, patients would then be provided more information needed to make the right health care decisions for them and their families. Physicians and health systems could then compete on what truly matters in health care: patient outcomes and the price to achieve those outcomes.

One could argue this would drive higher quality care, as the outcomes are no longer unknown or assumed to be generically “good.”

The logical next step beyond price transparency is outcomes transparency, and we must build upon the current momentum to achieve it. American patients deserve it.

David N. Bernstein, MD, MBA, MEI is a resident physician in the Harvard Combined Orthopaedic Residency Program at Massachusetts General Hospital, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, and Boston Children’s Hospital. Follow him on Twitter @DNBernsteinMD The views of this editorial are solely that of the author.