ACA: And Now for the Details By David Pittman, Washington Correspondent, MedPage Today Published: May 30, 2013 With the final pieces of the Affordable Care Act (ACA) getting underway, the next step for a better healthcare system should be increased transparency, health reform advocates said. While the landmark 2010 healthcare law made efforts to collect and disseminate price and quality data, more action is needed to give patients and providers price and quality information to help make better decisions, according to Bob Kocher, MD, former special assistant to President Obama for healthcare and economic policy, and Ezekiel Emanuel, MD, PhD, chair of medical ethics and health policy at the University of Pennsylvania in Philadelphia. "All data on price, utilization, and quality of healthcare should be made available to the public unless there is a compelling reason not to do so," the authors wrote in a piece that appeared online in the Annals of Internal Medicine. "The transparency imperative is part of the foundation for a post-ACA healthcare system that achieves better quality and cost control." Under what they call the "transparency imperative," more data and information would shift decisions and competition toward the ability to deliver better value. "Transparency is essential for patients to consume care from providers who deliver greater value," the authors wrote. "For providers, transparency is essential for risk-based reimbursement models to work. It is also the best approach to overcome local monopoly pricing power by providers." Physicians and hospitals will need price and quality information to operate in shared-savings payment models like accountable care organizations, where they must identify high-value providers who can help deliver savings and meet quality goals, Kocher and Emanuel said. There are a number of steps the healthcare industry can take to encourage and mandate greater transparency. For example:

• The Centers for Medicare and Medicaid Services can open access to Medicare data • All payers should be required to make claims data publicly available to enable quality measurement • The federal government can increase the penalties for patient re-identification to ensure privacy protection • States can require providers to disclose prices to patients before elective care • Health plans and employers can maker greater use of transparency tools • Prices should be transparent to providers in shared-savings models to enable cost management

The healthcare industry has typically shunned or been slow to adopt transparency of prices, quality, and utilization, creating a large barrier to making such data more available, Kocher and Emanuel wrote. For example, the American Medical Association sued Medicare in 1979 to block the release of data on the number of Medicare procedures, citing physician privacy. Kocher and Emanuel said utilization information is "critical for informed patient decision-making." Not having good quality data has prevented cost-effective providers from making market share gains. While few good quality metrics exist, publicly released data such as Medicare's Hospital Compare database is mostly vague and therefore of limited help. "Few patients have any knowledge of prices for any healthcare service, from a laboratory test to surgery," the authors wrote. "More important, obtaining such information is almost impossible." It's also difficult to make prices open, Kocher and Emanuel admit, as services are often comprised of many different inputs and commercial payers are "almost completely opaque." "Unfortunately, transparency is not necessarily [health plans'] top priority," the authors wrote. "They try to keep costs down by negotiating rates instead of providing information and guiding patients to better-value providers." Primary source: Annals of Internal Medicine Source reference: Kocher RP, Emanuel EJ "The transparency imperative" Ann Intern Med 2013; DOI: 10.7326/0003-4819-159-4-201308200-00666.