Patient awareness of health care report cards gradually increases

UNIVERSITY PARK, Pa. -- A recently published study indicates chronically ill patients are becoming more aware of comparative doctor and hospital performance reports though growth is slower than expected.

Dennis Scanlon, professor of health policy and administration and director of the Center for Health Care and Policy Research at Penn State, and co-authors said their study shows there was no significant change in public awareness of hospital quality reports between 2008 and 2012 among chronically ill patients. At the same time, there was a moderate change in awareness of physician quality reports.

The findings come at a time when the federal government, the Robert Wood Johnson Foundation, commercial health plans and other stakeholders have invested significantly in making comparative health care quality information available to the public and providing consumers the tools needed to make effective choices about their health care.

Specifically, the U.S. Patient Protection and Affordable Care Act of 2010 mandated the Centers for Medicare and Medicaid Services create a physician comparison website to go along with its pre-existing hospital and nursing home comparison sites.

“There’s a large focus on producing these reports with the right intention of getting consumers more engaged, much like we do with ratings for restaurant meals or automobiles, but I think the evidence suggests we still have a lot of work to do,” said Scanlon.

“Certainly it does not take awareness in 100 percent of the population to drive improvement in quality, but most producers of these reports would hope to reach a majority or more of the targeted population," Scanlon said.

Researchers found the number of report cards produced for both hospital quality and physician quality increased between 2007 and 2012. A random survey of nearly 12,000 chronically ill patients across a number of regions and nationally showed awareness of physician report cards increase modestly, from 12.8 to 16.2 percent of the chronically ill population on average.

There are significant variations in the level and the change of awareness across certain communities. Some areas experienced greater increases in awareness of quality reports. In Minnesota the change in awareness of doctor quality information now approaches one quarter of the chronically ill population, going from 14.4 percent to 22.10 percent of the population over the four-year time frame.

The authors also found that patients with specific chronic diseases such as diabetes and hypertension varied in the degree to which awareness of doctor quality reports changed, increasing in Minnesota by more than 11 percentage points for patients diagnosed with depression, for example.

According to Jim Chase, president of Minnesota Community Measurement, a non-profit focused on developing and disseminating health care quality measures for providers in the state, “the upward trend in awareness is encouraging given the considerable effort we have put into making this information transparent and available."

"However, the fact that only about one-quarter of the chronically ill adult population is aware suggests that much work remains to achieve the level of consumer activation and engagement we seek,” Chase said.

Researchers concluded that in order to increase awareness among chronically ill patients, more attention should be paid to approaches for dissemination of hospital and physician report cards, and that lessons might be drawn from ratings of other products and services that are known to be used more frequently by consumers.

Additionally, according to Scanlon, the growth of high deductible and narrow network health insurance plans that require more upfront and out of pocket contributions from patients is likely to make credible information on price and quality variation more sought after. 

The article, “Are Healthcare Quality ‘Report Cards’ Reaching Consumers? Awareness in the Chronically Ill Population,” appears in a March 2015 issue of The American Journal of Managed Care. It was produced as part of the evaluation of Aligning Forces for Quality, a Robert Wood Johnson Foundation program.