Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First was signed on June 24, 2019 with great fanfare.
a few more comments…
A noteworthy sentence from the executive order states: “Shoppable services make up a significant share of the healthcare market”.
is this truly the case?
The executive order cited a study mentioned in the president’s council of economic advisers 2019 annual report which claimed that ‘of the 100 highest spending categories of medical cases requiring inpatient care, 73% were shoppable.’
The executive order offers no direct link to either the report or the specific study, and I am unable to find online versions (admittedly I have pathetic computer skills, but something this important should be easily found on the web). So I don’t know how this number was determined.
Not unexpectedly, another group offers a radically different percentage. And while it comes from a hospital organization, (which certainly has biases of its own) they report less than 7% of healthcare spending comes from shoppable services.
While one number is supposedly applicable to inpatient care and the other to healthcare spending overall, it’s still a huge difference. Most likely, the true number is somewhere in between. My hunch is that it’s more towards 7% than 93%.
and here’s why
For something to be ‘shoppable’, the purchaser needs to have time to shop. So it either has to be for something purely elective or at minimum non-urgent. There’s no time for shopping in the middle of an urgent/emergent health issue. And obviously, there needs to be choice among different providers.
Cosmetic surgical services are an example of shoppable care. They are purely elective, allowing patients can take their time and consult with multiple providers. Payment is typically up front, so the cost is known ahead of time. Elective joint replacement or a non-urgent procedure, such as elective gallbladder surgery could also be deemed shoppable. However, individual patient characteristics may add variables that are difficult, if not impossible to take into account ahead of time- making cost estimates challenging or totally unrealistic. So what may have seemed a good deal, turns into something far more costly.
and Choice is becoming more challenging. Particularly in rural areas, where increasing hospital consolidation is leading to facility closures, there may only be one option in your town (if you are lucky).
And when you are lucky enough to have choices, knowing the quality of each option is a challenge all to itself. Because while the word quality is easy to say- and there are lots of ‘quality measures’ in medicine- there is controversy about how meaningful it all may be. Even something deemed high quality by the metrics may not translate into optimal patient outcome for a whole host of reasons.
And there’s more- but you get the idea. Basically, this stuff is way too complex, even for people in the medical field, let alone someone who is ill.
So I’m a bit underwhelmed by the impact of this executive order. The reality is, only following an honest examination and discussion about our current system, coupled with true political courage, will real change and improvement happen.
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