ACR Bulletin

Covering topics relevant to the practice of radiology

Making Data-Driven Decisions

In a changing medical landscape, patients are increasingly taking charge of their care.
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You can’t expect patients to make smart decisions if they don’t have information. But it also obviously changes the responsibilities for the providers.

August 07, 2019

This year’s Moreton lecturer wants to equip patients with the information they need to make the best decisions about their healthcare. And not just any information, says Ben Harder, managing editor and chief of health analysis at U.S. News & World Report, but good information — as in, information that comes from data.

“We had a small team that was working on hospital rankings with a data contractor, and I was watching what users were using on our website and realized that there was this enormous demand for more information about the hospitals,” Harder says, recalling changes that began about a decade ago. “So we shifted some of our resources to do more around the data and expand the scope of the rankings.”

The Bulletin spoke with Harder about what he wants the medical industry — and radiologists in particular — to know about the sometimes controversial rankings, and how practices can use them to help improve care.

Does the U.S. News Best Hospitals rankings provide a functional Yelp?

I don’t want to stop anyone from going to Yelp, but I don’t want that to be the sole source of information they’re relying on. Anecdotally, we hear that patients use many different resources, so it’s not as if they choose Yelp or U.S. News; they’ll look at U.S. News and then a bunch of other websites as well. And probably over time patients have gotten better — because we’ve all gotten better — at triangulating out personal truth from the information we encounter online.

Why should patients take charge of their care?

The shift toward consumerism in healthcare creates new responsibilities for each stakeholder in the ecosystem. If patients are responsible for picking their providers and paying for more of it than they’re used to, they need to understand the quality, cost, value, and choices, and be able to make an informed decision. You can’t expect patients to make smart decisions if they don’t have information. But it also obviously changes the responsibilities for the providers. So the clinicians then have the opportunity to provide data-based guidance to patients and also provide context and medical expertise.

What do you think about the push for price transparency in healthcare?

We get asked, “Why don’t you incorporate price and cost into the different ratings?” Again, it depends on the question you’re asking, which problem you’re trying to solve, and for whom. Ultimately, people whether patients or payers or both need to make decisions with both quality and cost in mind, and that’s the whole value equation. To do that, they need to have a good understanding of quality and cost. We’ve taken on the role of measuring quality because we can do that well.

What’s trickier for us to measure is cost. First, we simply don’t have good data on cost, because there’s not a lot of transparency around it. And even if we did, there’s a challenge when you talk about cost in healthcare: the cost to whom? To provide meaningful cost information to parallel our quality information would be difficult, because the total cost that each hospital charges for a product or service doesn’t necessarily tell the whole story of the cost for the patient. For example, while Hospital A may charge more in general for a hip replacement than Hospital B, the out-of-pocket cost for a patient at Hospital A may actually be lower based on a patient’s insurance and the insurance company’s relationship with the hospital. Quality is generally an attribute of a hospital, whereas cost is very individualized and dependent on the insurance relationship.

What do you want radiologists to take away from your lecture?

Measurement and public reporting — telling the public how different providers have performed — can be good. It can be done well or it can be done badly. So we should focus on how we can do measurement well, and how we can make sure that we crowd out whatever bad measurements may exist so that patients are using real information to make decisions and doctors are being evaluated fairly.