OPA Grading Medical Groups On Cost
California's Office of the Patient Advocate has released its annual report card for the state's physician groups, and has added an entirely new layer to the reporting by ranking the groups based on the cost of care.
For this year, the report cards' four-star rating system includes what a year of care from each group would cost for both the insurer and the patient, the latter in terms of co-payments and deductibles. The costs range from below $3,158 to more than $4,774. Medical groups in 39 of the state's 58 counties are included.
"The public reporting of total cost of care, alongside clinical quality and patient experience, at the physician organization level in California marks a milestone for healthcare transparency and shifting the focus from volume to value in healthcare," said Jeffrey Rideout, M.D., chief executive of the Integrated Healthcare Association, which gathered the cost data.
According to OPA Director Elizabeth Abbott, the costs include most of the facets of care, including hospitalizations and pharmaceutical costs, although mental health and some other services are excluded because they are often delivered by a range of providers outside of the physician's practice. That data had been gathered by the Integrated Healthcare Association, which collaborates with the OPA on creating the report cards.
“What I am trying to do is explain to consumers who ask those kinds of questions, this is an average cost of care,” Abbott said.
Abbott noted that the increasing out-of-pocket costs for consumers means they are more interested in what their care costs, and what specifically they are paying for.
“We felt we should include costs to provide the entire picture,” Abbott said.
The medical groups are divided among four different tiers for costs: Less than the $3,158 average; less than $3,915; less than $4,744, and more than $4,744.
Most of the medical groups fell along the tier below $4,744 -- 108 in total. Eighty-five were in the second tier, at less than $3,915. Another 28 were in the highest tier above $4,744.
Anthony Wright, executive director for the consumer advocacy group Health Access, believes the additional information is helpful.
“More transparency is always helpoful, but it needs to be simple and undertstandable for the average person,” Wright said. He added that many patients merely make choices based on their relationship with their physician, or how close their medical offices are to their home and workplace.
“It is also helpful for policymakers and payers to make decisions regarding which providers they should contract with,” Wright said.
Just 11 groups were in the lowest-priced tier below $3,158. All were located in Southern California, which tends to have a lower cost for care delivery than Northern California. Four of the medical groups are operated by the Permanente Medical Group, an affiliate of Kaiser.
Several of the medical groups declined to disclose their cost information. Abbott noted that many of them focus on patients with chronic illnessses such as AIDS, and that skews their costs accordingly.
Abbott said that the OPA may eventually grade hospitals and nursing homes on costs as well, but that such data was not yet readily available for analysis.
In addition to the cost data, the medical groups also receive star ratings on quality of care issues such as asthma and diabetes care, screening for cancer, preventing hospital readmissions and testing for lower back pain.
