 |
The 130th Annual Meeting of APHA |
|
The 130th Annual Meeting of APHA |
Dana B. Mukamel1, David L. Weimer2, Jack Zwanziger, PhD1, Alvin I Mushlin3, and Shih-Fang Huang Gorthy1. (1) Department of Community and Preventive Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (585) 275-1985, dana_mukamel@urmc.rochester.edu, (2) University of Wisconsin Madison, 1255 Observatory Drive, Madison, WI 53706, (3) Weill Medical College of Cornell University, 411 East 69th Street, New York, NY 10021
Quality report cards are becoming increasingly common in health care markets. Their publication is motivated by the need to improve patients’ access to information about quality with the expectation of increasing market efficiency and providing positive incentives for quality improvement. This study of the publication of the New York State Cardiac Surgery Reports was designed to assess the effect of the reports on the probability of referral to a cardiac surgeon and on the importance of implicit signals for quality. The probability of choosing a cardiac surgeon was modeled within the McFadden utility maximization framework, by estimating conditional logit models. The models included an explicit, publicly reported quality measure – the surgeon’s risk adjusted mortality rate (RAMR); implicit quality measures – predicted RAMR (based on publicly observed information), price, experience of the surgeon, loyalty of the referring physician to the hospital, and patient characteristics. It included all 151 cardiac surgeons and 13,442 Medicare fee-for-service CABG patients in New York State in 1991 (pre-publication period) and 1992 (post publication period) and their referring physicians. Analyses were based on Medicare inpatient and physician part B claims. Higher published RAMR (lower quality) was associated with a lower probability that the patient will choose the surgeon. Publication of the reports was also associated with a significant decline in the importance of two implicit quality signals – price elasticity became negative in the post-report period; the association of surgeon’s experience with probability of being chosen decreased by 50% between the two periods. The marginal effect of publishing RAMR information tended to increase with education, it was weaker for blacks and for those not seeking a second opinion. This study suggests that published quality rankings substitute, at least partially, for indirect signals for quality, signals on which patients have relied prior to publication of the reports. For black patients in particular, publication of the reports eliminated some of the disparities in access to low RAMR surgeons. These findings support the continued publication of quality report cards. They suggest that quality report cards can improve the referral process, create positive market incentive for providers to offer high quality care and eliminate some of the informational barriers that racial minorities might be facing.
Learning Objectives:
Keywords: Quality of Care,
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.