A post by Andrew Barna

So we are all on board with price transparency in healthcare, right? Well maybe it is not so simple. Apparently, a John’s Hopkins study has found that specialized cancer facilities have higher costs at the time of service, but they “yield lower cost per quality-adjusted life year” in the long-run. That is a mouthful, but in a nutshell, it means you are going to pay more for cancer treatment at a Sloan Kettering or a M.D. Anderson, but you will probably live longer and with a better quality of life. I think this would make sense to most Americans – you get what you pay for – but the picture is not so clear when you look at hospital/physician comparison websites.

Most of the websites I have seen have been pulling quality data from the CMS quality demonstration project. This is not a bad start. The CMS measures cover some of the highest volume procedures and they draw attention to practices that promote better outcomes. And by “better outcomes,” they mean you are more likely to leave the hospital alive. I am not knocking the CMS measures. I think the CMS Demonstration project, as well as the IHI campaign, have created systematic improvements in patient safety and outcomes… but…these measures do not necessarily give consumers an indication of the long term value of the services they are purchasing.

Let’s go back to our health economics class. The value of a healthcare intervention is measured in terms of lengthened life or improved quality of life. Indeed, this is how a lot of medical research is done. One treatment is shown to have better long term impact than another. But by their very nature, the CMS measures focus on short-term outcomes that can be measured during your hospital stay. So on one of the hospital comparison websites you could find out that the in-hospital mortality rate for your heart procedure is lower at Hospital A rather than Hospital B. OK, easy choice go with Hospital A. But what does that outcome mean relative to cost. Are you willing to pay an extra $5,000 for less of a chance to die? Or could you save a $1,000 and take a tenth of a percent in additional risk? Now the decision is not so clear. We aren’t typically equipped to make such a call.

Americans are expert consumers and we want to know every detail about what we are buying. I won’t even buy a CD until I know how other people who like similar music like that CD. When we have the right information about what we are purchasing, we make better choices (I should say that we make choices that we are happier with). Granted that purchasing healthcare is not equivalent to purchasing a CD, but it is not different on this point. The more that hospitals can demonstrate their overall and long-term value, the more consumers will make better choices.

Post Script: I just received the spring copy of Frontiers of Health Services Management and the featured topic is “Price Transparency: Meeting the Market Demand for Clarity”. So as I read the articles, I am sure I will be writing posts retracting the comments above. Hey Tony, your old boss Richard Clarke wrote the lead article. It looks good from the summary.

by Nick Jacobs

Let me begin this week’s post with a disclaimer. On the anniversary of my father’s death, I decided that I would take one shot at our readers to help me help the people that I love. Consequently, this is not a light column, but please continues to read it.

It started with a pesky cough. The cough came from what everyone thought was the remnants of a nagging chest cold. My parents were on their first extended vacation to Florida with her brother and sister in law. Dad had just turned 56 years of age, and both of their kids were out of college, married and doing just fine. For the first time since 1941, my folks had both freedom and a few extra dollars to enjoy life a little.

Dad had stopped smoking at or around 1964, ten years earlier, when the new surgeon general had the backbone to declare that smoking was “bad for your health.” Dad had smoked since he was a teenager, and, because his life had been filled with numerous unexpected challenges; a terrible accident that resulted in a broken back, the job challenges created by a collapsed economy, the loss of twin sons and some very unsophisticated and difficult bosses in a number of impossible jobs, he had hung onto those cigarettes as his 20 best friends each day.

I was only about 26 when he returned from his vacation and was diagnosed with a tumor, an unknown tumor in his lung. Over the next few months he went through various tests, but finally, he was urged to have an exploratory surgery on that lung. We followed him to the hospital for his surgery. It was scheduled for 6:30 AM, and when they wheeled him out, we all hugged and smiled and knew he would be okay. Four and a half hours later, we were told that, indeed, he was not okay. He had a very rare type of lung cancer that was extremely aggressive. They had removed his lung.

We were shocked. We were horrified. We were devastated. The journey to his death took us through 18 months during which we experienced, sorrow, depression, misery, hopelessness and desperation mixed with deep love, hope and strength.

He was a wonderful man. As his cancer spread first to his bones and then to his other lung, he looked me in the eyes time after time and said, “If only I had known, I would never have smoked, ever. I want to stay here with all of you.”

He left us about two months after my daughter was born. He did get to hold her, and love her, but he never got to influence either her or my son. He wasn’t there to provide his knowledge, kindness, guidance, love and his emotional support for any of us. He was not there to help anyone, and, most importantly, he was not there to enjoy our family as it grew and prospered. Why? Because the tobacco companies had mastered the art of combining just the right mixture of ingredients to contribute to an addiction that some have said is worse than that of heroin.

So why did I write this? I wrote this because I have friends and family members who, thirty two years later, are smoking. Holding my father in my arms as he died from an addiction that was manifested upon mankind by corporate America was sad, wasteful, and painful, but watching it happen to people who I love who, unlike my father, know without a doubt that more men and women die from lung cancer than any other type of cancer each year is unbearable.

In 2002, lung cancer accounted for more deaths than breast cancer, prostate cancer, and colon cancer combined. In that year, 100,099 males and 80,163 females were diagnosed with lung cancer, and 90,121 males and 67,509 females died from lung cancer. We also know that tobacco smoking is by far the leading cause of lung cancer. More than 87% of lung cancers are caused directly by smoking. Don't quit out of fear. Quit because of love. We love you.