Jim Weinstein: How we can increase price transparency in health care

by Dr. Jim Weinstein

Note: This op-ed originally appeared in the New Hampshire Union Leader on Oct. 2, 2014


There has been a great deal of focus in recent months on hospital prices and the need for more public reporting — more transparency.

I couldn’t agree more, and that’s why Dartmouth-Hitchcock posts its prices for common procedures on its web site.

But knowing price only gives you one part of what one needs to know. Think about it: when you buy anything else, whether it’s a car or a washing machine, or a service like having your house painted, you want to know the price ahead of your purchase.

In addition though, you want to know about the quality and how it performs against other products on the market.

Most don’t automatically buy the cheapest car; most buy the one that gives them the most value for their money. You look at mileage, maintenance, reviews from over the counter products like Consumer Reports, you look on websites and talk to friends about their experience, and then you make your decision.

Unless you know the quality and performance of the product of interest, buying simply based on price is flying blind.

Well, today U.S. Health Care Airlines is flying blind.

Health Care Airlines has no instrument panels, no gauges to tell us how high we are flying, how much fuel we have and yet everyday, tens of thousands of patients and families are getting on board and trusting that they’ll get to their destination safely. Thankfully, most all do, because of the excellent training and skills of their physicians, nurses, and other health professionals.

In health care, our instrument panel is data. In a sustainable health system, data is critical to our ability to measure quality and deliver transparent value to the patients and families we serve.

Imagine if in addition to being able to obtain the price of any medical procedure you’re contemplating, you could get information about quality and actual outcomes. After all, we can look at the side of any cereal box and it will list what is inside; why not your health care system, your doctor, your hospital, or why not all three.

In a transparent sustainable health system, here are some questions every patient should be able to ask of me or any health care provider, to make a value-based judgment about where to have their surgery or treatment:

  • How many of these procedures or treatments did you do this year, last year?
  • What were/are your results/ outcomes at 3, 6, 12 and 24 months?
  • What percentage of your patients experience complications?
  • What is the average cost for the procedure you are recommending and what will be my personal out of pocket expense?
  • What do your patients say about how they do and how they feel about the results?
  • Can you show me data from your practice to help me answer these questions to help me make my decision?

It’s the last question that’s often most important. I would suggest that 9 times out of 10, your provider will have to answer no; he or she doesn’t have the data.

That’s where we’re flying blind.

Patients in most cases don’t have the information that allows them to make an informed choice/decision. It’s not that the physicians are trying to hide anything; most doctors and health providers don’t have the tools to collect and or share this important information.

That’s why at Dartmouth-Hitchcock we not only report our prices, but we report our outcomes — our results. And we include patient-reported outcomes – how the patient reports their perceived outcomes, their experience on how well they feel and/or function following their treatment and or procedure.

Sometimes the results aren’t as good as we’d like them to be, but the fact that we collect and share such information is a necessary ingredient if we are to have a truly transparent and sustainable health system. It is only because we collect and share this kind of information that we can improve and actually track those improvements. As the saying goes, “you can’t manage what you can’t measure.”

By all means, pricing transparency is essential in health care. But let’s not stop there. We need more transparency so patients can compare quality and outcomes to make a truly informed choice.

Dr. Jim Weinstein is president and CEO of Dartmouth-Hitchcock.