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Healthcare Agenda: May 27 - 30, 2003

Tuesday May 27, 2003
Afternoon Session: 1:30 p.m. – 5:00 p.m.

Quality and Consumer Information: Overview
Quality of care has been extensively studied by health care providers and health services researchers. What is known about the quality of care provided in the United States? What measures (whether structure, process, or outcome) correlate with the quality of care that is delivered and how predictive are these measures? What institutions help ensure the quality of care delivered in the United States, and how effective have they been? How do employers factor quality into the equation when designing benefits? How do payors (both private and public) factor quality into their coverage decisions and their design of delivery options? What information is available to employers and payors in making such decisions? What are the economics of information provision and use in health care? What is the significance of the widespread use of process-based measures of quality?
 
Panelists:

Thursday May 29, 2003
Morning Session: 9:15 a.m. – 12:30 p.m.
Afternoon Session: 2:00 p.m. – 5:00 p.m.

Quality and Consumer Information: Hospitals
Information is an important component of a well-functioning market. What information do hospitals provide to consumers concerning the quality of the goods and services they offer? Is the type and amount of the information that hospitals provide concerning quality adequate to allow consumers to make well-informed purchasing decisions among hospitals? If not, what additional information do consumers need or want to make such decisions and why are hospitals not already providing it in the marketplace? Does the quantity and quality of the information that consumers would find helpful depend on the nature of the underlying condition (i.e., acute v. chronic) and treatment (i.e., surgical v. medical; curative v. palliative; elective v. medically necessary)? What is the state of the art with regard to measures of hospital quality, whether structure, process, or outcome? In particular, would the disclosure by hospitals of their nosocomial infection rate, or the type of physician who will be providing care (e.g., does the hospital use hospitalists and intensivists), or of medical professional staffing levels (e.g., nurses) assist consumers in making well-informed purchasing decisions? What are the risks of relying on (and disclosing) process-based measures of hospital quality? How would competition on quality measures affect costs, prices, and decisions by payors and customers? How does compensation affect quality? Can compensation be harnessed to enhance the performance of hospitals?
 
Morning Session Panelists:
Afternoon Session Panelists:
  • Suzanne Delbanco, The Leapfrog Group
  • Nancy Foster, American Hospital Association
  • Irene Fraser, Agency for Healthcare Research and Quality
  • Stuart Guterman, Center for Medicare and Medicaid Services
  • Arnold Milstein, M.D., Pacific Business Group on Health
  • Anthony Tirone, Joint Commission on Accreditation of Healthcare Organizations
  • Woodrow Myers, M.D., WellPoint Heath Networks

Friday May 30, 2003
Morning Session: 9:15 a.m. – 12:30 p.m.
Afternoon Session: 2:00 p.m. – 5:00 p.m.

Quality and Consumer Information: Physicians
Health services research has documented enhanced outcomes for certain procedures when physicians perform a high volume of such procedures (volume-quality relationships). Other research has demonstrated considerable geographic variation in physician practice patterns, without demonstrable effects on outcome. When care is provided at academic medical centers, treatment is routinely provided by physicians at all levels of training, but some have argued that patients do not realize that treatment is provided by less experienced practitioners. Other research has demonstrated that many patients do not receive the care they desire in the last few months of life, even after they have executed a living will or a durable power of attorney. What are the consumer information implications of these results? Should physicians disclose to potential patients the existence of volume-quality relationships and the number of such procedures they have performed? Should physicians disclose the existence of geographic variation in practice patterns to potential customers? What is the nature of disclosure to patients who receive care in academic medical centers about who will be providing their treatment? What is the nature of disclosure to patients about end-of-life care, living wills, and durable powers of attorney? How effective has the Patient Self-Determination Act been in enhancing disclosure to patients about end-of-life care, living wills, and durable powers of attorney? Does the failure to adequately disclose any of this information or to adhere to patient preferences in the delivery of health care goods and services raise consumer protection issues? How would competition on such measures affect costs, prices, and decisions by payors and consumers? Are there other measures that consumers would find helpful in determining which physicians to patronize? Does the quantity and quality of the information that consumers would find helpful depend on the nature of the underlying condition (i.e., acute v. chronic) and treatment (i.e., surgical v. medical; curative v. palliative; elective v. necessary)? What is the state of the art with regard to measures of physician quality, whether structure, process, or outcome? How does compensation affect quality? Can compensation be harnessed to enhance the performance of physicians?
 
Morning Session Panelists:
  • Stuart Bondurant, M.D., American Association of Medical Colleges
  • Christine Crofton, Agency for Healthcare Research and Quality
  • Charles Darby, Agency for Healthcare Research and Quality
  • Andrew Kumpuris, M.D., Washington & Lee University
  • LaMar McGinnis, M.D., American College of Surgeons
  • Arnold Milstein, M.D., Pacific Business Group on Health
  • Margaret O'Kane, NCQA
  • Reed Tuckson, M.D., UnitedHealth Group
Afternoon session:
 
Opening Remarks:
Commissioner Thomas B. Leary
 
Panelists: