Hospital executives can lead transparency movement

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Transparency of healthcare costs and outcomes rests on hospital leaders' shoulders.

A JAMA Internal Medicine study released Monday offered some disappointing news that hospitals are still struggling to provide pricing information. More than 100 U.S. facilities could not provide a consistent quote for a hip surgery, FierceHealthFinance reported. And for those that could, prices ranged from $11,100 to $125,798.

One way to curb variation is a cultural movement that comes from the top of the chain. At California's Scripps Health, CEO Chris Van Gorder has led a campaign to reduce "unnecessary variation," he told Kaiser Health News.

For example, Scripps Memorial Hospital in La Jolla used to require doctors to deliver nitric oxide to patients of cardiac valve and coronary artery bypass graft procedures. But the health system realized that Mercy Hospital in San Diego didn't. By eliminating the requirement (although a physician can still order it) and standardizing care across the system, Scripps saves $400,000 per year, Kaiser Health News noted.

"There isn't a doctor that doesn't believe he's doing the best thing" for the patient, Gorder said about care delivery. "But there's enormous variation in the way physicians practice."

Last year, the American Board of Internal Medicine Foundation called attention to variation by pinpointing the top sources of unnecessary care. The "Choosing Wisely" list encourages providers to think before prescribing antibiotics for chronic sinusitis or ordering chest X-rays prior to outpatient surgery, for instance.

According to the American College of Physicians, unnecessary tests total up to $250 billion a year.

Another way to standardize care with evidence-based medicine is by embedding decision-support tools for physicians in electronic health records, according to Commonwealth Fund President David Blumenthal, who shepherded the EHR transition at Boston's Partners HealthCare.

"Physicians have been rarely excited about change … but they have an intrinsic desire to do job better," Blumenthal  previously said at the Society of American Business Editors and Writers (SABEW) conference.

Making the best practices available at the point of care delivery, as well as releasing data on outcomes and prices, could curb the unnecessary variation.

For more information:
- see the Kaiser Health News article

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