Challenges in Healthcare Quality Transparency Efforts in Respect to U.S. Medical Practices

Abstract

Healthcare transparency efforts are being encouraged across states, and across markets.  These efforts to report on the costs associated with healthcare and provider quality performance are aimed at providing consumers with information that will improve decision making.  Many of the current transparency approaches focus on cost comparisons.  Yet, evaluation of providers on cost only is inappropriate – quality must also be considered.  Additionally, transparency quality measures are increasingly impacting payment practices for providers.  Value-based payment systems are shifting traditional payment strategies from pay for quantity to pay for quality.

This paper reviews the key challenges to transparency reporting on quality in health care.  Reporting efforts are dependent on the type and accuracy of available data.  Most often, the available data are historical claims data.  Claims data have limitations as well as benefits.  Other important challenges center on strategic reporting decisions such as what type of providers to focus upon, what measures to use, and how to fairly adjust measure results for accurate representation.