Robert Velazquez MD

Empowering consumers in their health care decisions

Transparency is critical in transforming health care. It is a driver for growth and improvement and fosters trust and accountability as we deliver value to our patients. Transparency enables empowered decisions for those we serve while driving continuous improvement.

The goal of transparency is providing access to information. With most patients – most consumers – there’s a knowledge imbalance. They don’t know what things cost or what their options are when it comes to services or providers. This is where transparency comes in to play.

Annual surveys and safety grades

There are existing performance surveys and safety grades for hospitals through organizations like The Leapfrog Group, which has a voluntary annual survey. Nearly half of all U.S. hospitals, including OSF HealthCare hospitals, voluntarily provide data for the survey, which is the gold standard in evaluating hospital performance on quality, safety and resource use. Facilities are evaluated based on national performance measures. The data can tell consumers a lot about a hospital, and if it provides safe, high-quality care. Areas addressed are inpatient care management, medication safety, infections, high-risk surgery, cancer surgery, maternity care and pediatric care.

Not only does the survey help inform consumers regarding their health care purchasing, it also provides hospitals with the opportunity to benchmark their respective progress.

The Leapfrog Hospital Safety Grade is another metric that allows consumers to see how well their preferred hospital does in protecting patients from errors, accidents, injuries and infections. It uses a simple letter grade, which are issued twice a year.

While these measurements may not be understandable to the general consumer, they are helpful to OSF HealthCare as it gives us the opportunity to create our own set of metrics and standards. Our Ministrywide commitment to quality standards has the biggest impact on patient outcomes.

Star ratings and reviews of providers

When someone goes online to make a purchase, the reviews and star ratings of a product can influence whether they buy a specific product or service. Health care is no different.

At OSF HealthCare, we recently added star ratings to our online directory of providers. The Patient Rating score is based on responses given during the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) survey. This survey is a standardized tool to measure patients’ perception of care provided by physicians in the office setting. Responses are measured on a 10-point scale and then translated to a 5-point scale in order to display results for a 5-star rating.

Comments are also gathered from the same survey and displayed in their entirety with the exception of any language that may be considered slander, libel or contain private health information. That information is removed prior to publishing the comments.

While most consumers still rely on a word-of-mouth recommendation for a doctor, those who may be new to a community can go out to our online directory and look at the ratings and see what kind of comments have been written. Consumers will use that information just as they would consider online recommendations before buying a book or seeing a movie.

We’ve found that, in general, providers are pleased with the star ratings and reviews because it validates their commitment of the level of care they provide their patients. Some may not be pleased because they’re seeing that people perceive them as not providing the level of care they thought they were giving their patients and that is what drives improvement.

Public information on health care costs

African-American couple on a couch surfing the web on a tablet.

As of January 1, the Department of Health and Human Services, Centers for Medicare & Medicaid Services, requires hospitals to make their standard prices public. These charges are posted online at osfhealthcare.org.

OSF supports the intent of the new pricing transparency rule from CMS and agrees patients should be more informed about the cost of health care and their out-of-pocket expenses. OSF is committed to making the cost of health care easier to understand by providing individual patient estimates for procedures and hospital stays.

For example, take a hospital stay for pneumonia. A patient would have to add up all the charges listed related to a typical treatment for pneumonia, but the charge will not be the price the patient ultimately pays. Factors impacting the actual price to a patient include the contract the patient’s insurer has with the hospital, the design of the patient’s insurance benefit and where the patient is on their deductible or maximum annual out-of-pocket spending for the insurance benefit.

More information available

Our own efforts and innovation in transparency provide a much more accurate estimate and patient-friendly experience. To this, we recently expanded a price request tool on our website. This tool is a fillable form where patients provide their basic information, such as their insurance carrier and the OSF HealthCare facility where they would be having a procedure. They then receive an estimate from our Financial Clearance Center within one business day. Whether using the form or phone number, our patients can get a detailed and accurate picture of what they will pay.

Providing patients with meaningful information

A push for transparency is one of many new, proactive areas of focus for our Ministry as we strive to transform health care to improve the lives of those we serve. This is about recognizing how transformation of health care is not only inevitable, but necessary. It’s necessary because our patients’ expectations are changing and transforming.

A day doesn’t go by without seeing some new story about the quality and safety or rising costs of health care. We need to openly share that information to help patients, consumers, make informed decisions. OSF HealthCare is excited to be able to continue to empower our patients with meaningful information that will guide them in making the best health care decisions for themselves and their families.

About Author: Ralph Velazquez

Ralph Velazquez, MD, is Chief Medical Officer for OSF HealthCare. He began his career with The Sisters of the Third Order of St. Francis in 1994. Dr. Velazquez’s responsibilities include leading the development of the clinical strategy and goals for OSF HealthCare, and is also responsible for initiatives that enhance clinical performance and practice standards across OSF.

Dr. Velazquez oversees Academics/Research, Accountable Care, Care Management Services, Managed Care, Quality/Safety, Telehealth, Clinical Documentation Integrity and the Credentialing Verification Organization.

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Categories: Industry Perspectives