Healthcare cost and quality data transparency
updated 8.21.2017
In 2012, HPIO released its first Health Data Transparency Basics publication which provides an overview of the availability of transparent, accessible health data and discusses how access to information on price and quality impacts consumer choice, quality of care, health care spending and health outcomes. Due to growing interest in the topic, HPIO released a second iteration of the publication in 2016, Healthcare Data Transparency Basics, which explores the rationale for healthcare price transparency, the challenges it presents and potential policy approaches at the state level to increase transparency.
This resource page provides resources for federal, national, state and local-level healthcare cost and quality datasets, tools and reporting, as well as information on organizations setting healthcare quality standards.
Price transparency legislation in Ohio
Ohio Revised Code (ORC) 5162.80 requires healthcare providers to provide to a consumer a reasonable, good-faith estimate of expected medical charges prior to a consumer receiving a product, service or procedure. Information to be provided to a consumer according to the law includes:
- The amount a provider will charge a consumer or consumer’s health plan issuer
- The amount the health plan issuer will pay for the product, service or procedure
- The difference in amount, if any, the consumer or other responsible party would be required to pay
Under the law, health plan issuers are required to provide the above required information to a provider within a reasonable time of the provider’s request.
ORC 5162.80 originates from healthcare price transparency provisions included in Ohio House Bill 52 and signed into law on June 30, 2015. HB 52 called for the establishment of a Health Services Price Disclosure Study Committee to evaluate the impact and feasibility of these requirements and provide recommendations on operationalizing health plan issuer price and cost information disclosures to consumers. Based on the Committee’s recommendations, the Ohio Medicaid director was required to adopt rules regarding HB 52’s pre-service price disclosure requirements by July 1, 2016.
Per HB 52, ORC 5162.80 went into effect on January 1, 2017. However, to date, no rules to carry out ORC 5162.80 requirements have been adopted by the Ohio Medicaid director.
Given the considerable ambiguity around the new healthcare price transparency requirements and the lack of promulgated rules, a number of organizations, including the Ohio Osteopathic Association, the Ohio Hospital Association and the Ohio State Medical Association, filed suit seeking an injunction to prevent the state from implementing the new law. A preliminary injunction preventing the state from implementing or enforcing ORC 5162.80 was granted and the next hearing regarding lifting the injunction is scheduled for Sept. 26-27, 2017. Notably, Gov. John Kasich’s proposed 2018-2019 Executive Budget called for repeal of the law, however the law was not repealed in the final enacted state budget.
Healthcare cost and quality datasets, tools and reporting
Federal departments and agencies
Department of Health and Human Services (DHHS)
Health System Measurement Project
The Health System Measurement Project is a web-based tool launched by HHS that allows policymakers, providers and the public to track the performance of the nation’s health care system and compare national trends to state and regional trends. The Health System Measurement Project contains measures related to access to care, cost and affordability, prevention and health information technology and are drawn primarily from existing publicly available datasets maintained by the federal government.
HDI is a large-scale, public-private effort started and led by HHS to release data, encourage innovative application development in the public and private sectors and catalyze change to improve community health. The site, HealthData.gov, provides access to many datasets and tools that have been gathered from agencies across the federal government.
Health Resources and Services Administration (HRSA)
UDS contains annual data reported by HRSA-funded health center grantees at the individual, state and national levels. Grantees are required to report data on patient demographics, services provided, clinical indicators, utilization rates, costs and revenues. In Ohio, special populations are covered in the following programs: Health Care for the Homeless, Migrant Health Centers and Public Housing Primary Care.
The Centers for Medicare and Medicaid Services (CMS)
Hospital Compare is an online tool for comparing the quality of care that hospitals provide. This includes over 4,000 Medicare-certified hospitals, of which over 130 are Veterans Administration medical centers. The quality measures are developed by the Hospital Quality Alliance (HQA), a public-private partnership established in 2002. Quarterly reporting is mandatory for all acute care hospitals in order to receive the annual Medicare inflationary payment update.
Nursing Home Compare is an online tool for comparing the quality of care provided by every Medicaid or Medicare-certified nursing home. It rates nursing homes based on health inspection reports, staffing data and quality measures.
This is an online tool for comparing the quality of care that Medicare-certified home health agencies provide. It provides a list of U.S. home health agencies, services provided and quality measures. The information comes from home health agencies that have voluntarily agreed to submit quality information.
This is an online tool for comparing the quality of care that dialysis facilities provide. It provides a list of U.S. dialysis facilities, services provided, quality measures and resources.
The CMS Dashboards are designed to improve public understanding of Medicare and Medicaid programs by simplifying and making data more accessible.
Medicare Provider Utilization and Payment Data
Files contain service volumes and Medicare payment data for inpatient and outpatient hospitals, physicians, Part D prescribers, and other suppliers.
The Center for Disease Control and Prevention (CDC)
National Healthcare Safety Network (NHSN)
NHSN is a secure, internet-based surveillance system that enables healthcare facilities to collect and use data about healthcare-associated infections (HAIs), adherence to clinical practices known to prevent HAIs, the incidence or prevalence of multidrug-resistant organisms within their organizations and other adverse events. Some states utilize NHSN as a means for healthcare facilities to submit data on healthcare-associated infections mandated through specific state legislation.
Agency for Healthcare Research and Quality (AHRQ)
Consumer Assessment of Healthcare Providers and Systems (CAHPS)
CAHPS is a comprehensive collection of standardized surveys that asks consumers and patients to report on and evaluate their experiences with health care.
Health Care Cost and Utilization Project (HCUP)
HCUP is a collection of both national and state-specific longitudinal databases containing all-payer, encounter-level information on inpatient stays, emergency department visits, and ambulatory care in U.S. (1988-present). These databases are created by AHRQ through a federal-state-industry partnership. These databases enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to health care programs and outcomes of treatments at the national, state and local market levels. This data is available to the public and to researchers for a fee.
The APCD Portal has not been updated since 12/20/14 except for Oregon and Utah’s APCD specifications. The Portal gives access to health care claims data systematically collected from payer sources. Databases are usually mandated by state and include data from medical, pharmacy, eligibility, provider, and dental claims from both public and private payers. Users can select metadata for multiple states and run comparisons. The system also includes patient and provider demographics.
Substance Abuse and Mental Health Services Administration (SAMSHA)
The Treatment Episode Data Set (TEDS)
TEDS includes records for about 1.5 million substance abuse treatment admissions annually. Facilities reporting TEDS data are those that receive state alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of substance abuse treatment.
Bureau of Economic Analysis
Health Care Satellite Account (HCSA)
HCSA redefines health sector output by amount spent on treating a specific disease rather than amount spent on tangible goods and services irrespective of disease. HCSA includes two statistical accounts of expenditure by disease (diabetes, cancer, etc.) instead of specific goods and services used in treatment (doctor’s visits, purchase of a drug, etc.) The first account uses data from the Medical expenditure Panel Survey (MEPS) which includes national survey data on detailed expenditure by disease. The second account is a blended account, which has combined information from many sources.
National organizations and partnerships
FAIR Health is a national, independent, not-for-profit corporation founded in 2009 to create and maintain a database of charge data for healthcare procedures and to offer consumers web-based tools to estimate out-of-network expenses for specific medical and dental services in their geographic area. Insurers nationwide use FAIR Health benchmarking data to establish usual and customary rates (UCR) for out-of-network reimbursement.
FAIR Health distributes the data from its database in the form of product modules and custom analytics, which are licensed for a fee to health insurance payers, providers, and other customers. Each data product module contains benchmarks for procedures and services within a particular category (such as Medical/Surgical, Dental, Anesthesia, Outpatient, etc.) FAIR Health data products are updated at least twice a year to incorporate newly-collected data.
FAIR Health makes its data available to consumers through free, web-based consumer cost-lookup tools at www.fairhealthconsumer.org. FAIR Health also has data available for licensure to researchers and policymakers at www.fairhealth.org/research. The Benchmark Modules data provides claims data regionally sortable by procedure, with both current and historical data available.
The Leapfrog Hospital Survey is an annual, voluntary public reporting initiative launched in 2001 to assess hospital performance based on four quality and safety practices, endorsed by the National Quality Forum (NQF), that are proven to reduce preventable medical mistakes. Consumers, health plans and hospitals can use data to identify areas of improvement and to compare hospital performance locally, regionally, and/or nationally.
HealthGrades is a healthcare ratings company that compiles outcomes data from dozens of independent public and private sources and translates it into report card ratings on providers, including specialists, hospitals, nursing homes and home health agencies. Quality and cost information is available to everyone.
Health Care Cost Institute (HCCI)
HCCI is a non-partisan, non-profit organization that provides information about health care utilization and cost through a large health insurance claims database. The database is available primarily to academics conducting research on utilization and cost.
Guroo is a website created by HCCI to provide free and publicly accessible cost and quality data. Data includes national, state and local information for 78 care bundles, a grouping of a health condition and the services typically provided for that condition.
Best Hospitals – U.S. News & World Report Rankings
U.S. News and World Report ranks the country’s best hospitals based on data for survival, patient safety, nurse staffing and more. The interactive online report ranks over 5,000 U.S. medical centers in 16 specialty areas. The report includes an Honor Roll for hospitals scoring very high in at least 6 specialties. Common Care, a Best Hospitals tool released in May 2015, provides data on how hospitals perform on select chronic health conditions and common elective surgeries. Rankings are also available for best children’s hospitals and best hospitals by procedure.
Consumer Reports is an editorially-independent not-for-profit organization that reviews and compares consumer products. The website includes ratings on hospitals and heart bypass surgeons, as well as guides on how to use the ratings and pick a provider. Hospital ratings include scores for safety, avoiding infection, avoiding readmission, avoiding C-sections and overall patient experience. Surgeons are rated based on complication rates, patient survival and other measures.
Peterson-Kaiser Health System Tracker
The Health System Tracker is a health care system monitoring tool developed by the Peterson Center on Healthcare and the Kaiser Family Foundation. The tool tracks how the U.S. health care system performs in terms of quality and cost of care. Updated information is available on trends, issues and drivers affecting system performance. Different parts of the system can be compared to one another, and the entire U.S. health care system can be compared to those of other countries. The Tracker also provides charts to visualize data and in-depth briefs answering questions.
Network for Excellence in Health Innovation (Report)
The Network for Excellence in Health Innovation (NEHI) is a non-profit, non-partisan health policy institute dedicated to using innovation to improve quality and lower costs of health care in the U.S. NEHI enables innovation by connecting multi-sectorial stakeholders to its independent research findings. The NEHI Transparency in Health Care report, posted on July 27, 2017, is a 9-step priority roadmap to greater transparency for health care consumers and decision-makers with a focus on health plans and providers.
Ohio
The Better Health Partnership is a collaboration of stakeholders who provide, purchase, pay for and receive health care with the goal of continuous health care reform and emphasis on primary care. The Partnership publishes data in public reports to motivate key players in the system to improve quality of health care and affordability in the Greater Cleveland region. The Partnership provides one-day summits for cross-systems learning of best practices and pilot programs for reform on payment and delivery system disparities identified in Better Health data.
Healthcare Collaborative of Greater Columbus
The Healthcare Collaborative of Greater Columbus is a non-profit, public-private partnership dedicated to facilitating understanding and collaborative learning between the private and public sectors. The Collaborative works to improve healthcare value through lowering costs and increasing quality. Their initiatives include building collaborations, using best practices, convening diverse stakeholders, coordinating transformative healthcare delivery and measuring the collective impact of these efforts.
The Health Collaborative is a merger of three non-profit organizations: the Health Collaborative, Greater Cincinnati Health Council and HealthBridge. The organization seeks to lead data-driven improvement initiatives in a neutral forum for stakeholders. The scope of their work includes technology, convening and engagement with the end goal of lower costs, quality care and healthier communities.
Ohio Public Health Data Warehouse
The Data Warehouse is an online tool created by the Ohio Department of Health for the public to obtain up-to-date health data. Data can be sorted into categories such as birth, death, cancer, infectious disease and mental health. Searches can also be filtered by key words for all categories or within each category.
Ohio Hospital Compare is a tool provided by the Ohio Department of Health Hospital Performance Measure Reporting. The database allows users to obtain performance data on hospitals, filterable by county, zip code, age group and specific medical conditions and procedures.
Ohio Hospital Price Disclosure Reports
The Ohio Department of Health requires that Ohio hospitals submit utilization and charges data for outpatient visits and the sixty most frequently diagnosed disease groups at their facility. Reports are available for each hospital through the direct link to Ohio Hospital Compare at this web page.
State Epidemiological Outcomes Workgroup
The State Epidemiological Outcomes Workgroup (SEOW) collects, analyzes and reports reliable data for communities to use for planning, monitoring and evaluating health initiatives in Ohio. In the past, SEOW has worked with data on substance use prevalence and incidence and has created valid indicators of alcohol and drug consumption.
This is a series of websites that provide information and communications pertaining to the health and social services fields. The Public Health site provides information on health indicators, assessment data, data widgets and interactive geomapping. Community health data can be retrieved for each county and major city. Data for each geographic area can also be compared to state and national targets for different categories.
Healthcare quality data standards
National Quality Forum (NQF)
NQF is a non-profit, non-partisan facilitator of health care quality improvements. NQF convenes stakeholders from the public and private sectors to establish priorities and ensures that NQF-endorsed standards are the standards used to measure the quality and efficiency the U.S. healthcare system. The website includes the quality positioning system (QPS), which allows you to search for quality metrics reviewed by NQF.
National Committee for Quality Assurance (NCQA)
NCQA is a non-profit organization that certifies, accredits and recognizes organizations that meet their standards through a review process. The NCQA also develops standards and measurements for health care organizations to weigh their own performance against.
The Joint Commission is an accreditation and certification entity. The Commission grants the Gold Seal to health care delivery organizations that demonstrate quality care and patient safety. During the accreditation review process, organizations learn about performance improvement strategies and web-based tools for transforming performance and finding customized solutions.
Health Effectiveness Data and Information Set (HEDIS)
HEDIS is a tool used by majority of U.S. health plans to review their performance based on 81 measured across 5 “domains” of care. Plans can be compared to one another directly for specific measures. Data reported to HEDIS is used by consumers to select the most appropriate health plans for themselves.
