Consumers Union Will Rate ‘Aggressiveness’ of Treatment

Published August 1, 2008

Consumers Union, publisher of Consumer Reports, has joined a growing list of organizations offering consumers information on hospitals and health care efficiency.

The 3,000 hospital facilities included in the ratings will be given a score between zero and 100 based on “aggressiveness of treatment,” calculated by a patient’s time spent at that hospital and the number of visits. Lower scores indicate a facility requires less time and fewer visits to the hospital, while higher scores indicate a higher intensity of care.

Consumers Union is a nonprofit advocacy organization that supports a single-payer health care system in America, and some experts are wary of its proposed ratings system.

Concerns About Methodology

“There are wide variations in treatment across regions,” said Devon Herrick, Ph.D., a senior fellow at the National Center for Policy Analysis. “I suspect the average person equates more care with better care.”

Yet that assumption is of questionable value, Herrick notes. “I can easily see people choosing hospitals that treat patients more aggressively even though more intense treatment has not been shown to improve outcomes,” Herrick continued. “In this regard, the Consumers Union Web site will have the opposite effect of what they hope will occur.”

John R. Graham, director of health care studies at the Pacific Research Institute, says it is difficult at this point to determine the exact effect of such reports on consumers and on the health care industry in general. He maintains people should instead be concerned with how these reports can aid individual health care consumers in choosing providers and services.

“The real question is whether it is good or bad for Jane Doe when she tries to compare hospitals when she needs a procedure,” said Graham. “Only Jane Doe can answer that.”

Reliable Evidence Needed

Kalese Hammonds, a health care policy analyst at the Texas Public Policy Foundation, says increasing the knowledge people have about their health care providers is generally a good thing. However, like Herrick, she is concerned about the methodology used in rating the hospitals. Instead of being based on frequency of care and length of visit, she argues for rankings that concentrate on outcomes instead of inputs.

“Anything that can give more knowledge and choice to consumers is a good thing,” said Hammonds. “However, it is important that you have good evidence that is reliable and that rankings are based on levels of success or some value judgment from the people providing the information for the report. Reports of this nature are beneficial, but it is really important that people know how this information is gathered and what criteria the rankings are based on.”

Applies Only to Elderly

Greg Scandlen, director of Consumers for Health Care Choices at The Heartland Institute, was even less optimistic about the value of the report, in part because the Consumers Union ratings are based largely on Medicare data, meaning they could be skewed toward information useful only to elderly individuals.

“They will offer information on the ‘intensity of care’ during the last two years of life for nine conditions,” Scandlen said. “I can’t see that it will provide consumers with any useful information.

“Is ‘intensity’ good or bad?” Scandlen continued. “How does a consumer know when his or her ‘last two years of life’ begins?”

The Zagat Survey Company and WellPoint offer a similar service that uses a wider range of information. (See “Insurer, Survey Firm Partner to Create Physician Evaluation Tool,” Health Care News, May 1, 2008.)

Elisha Maldonado ([email protected]) writes from California.