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Vital Signs

Cost of services is part of transparency at DHMC

If you put the word "transparency" into the news search engine LexisNexis, virtually all the hits have to do with international affairs. But that was the word chosen by the Institute of Medicine (IOM) in a 2002 call for an overhaul of the domestic health-care system. The IOM's "Crossing the Quality Chasm" report challenged hospitals to improve the quality of care, reduce medical errors, and increase "transparency" about their performance.

Dartmouth-Hitchcock not only didn't have to ask what the IOM meant by transparency but was poised to respond. "DHMC and DMS have a long history," says executive vice president Paul Gardent, "of measuring performance in the interest of quality improvement."

This approach, based on work at Dartmouth's Center for the Evaluative Clinical Sciences (CECS), rests on the underlying principle of informed patient decision- making. "Given our historic interest, and the call by the Institute of Medicine," Gardent continues, "we needed to embrace transparency and to become a national leader in transparency." (See here for a story on a related effort.)

Post charges: The latest step in that process came a few months ago, when DHMC became one of the first medical centers in the country to post charges for its services on its Web site.

But back to the beginning: After the IOM report came out, DHMC set three goals—to provide better information to patients to help them make healthcare decisions; to increase trust in DHMC's role as a charitable, nonprofit organization; and to stimulate improvement in the quality of care. "We define quality broadly," Gardent says, "to include clinical outcomes, as well as patient satisfaction and cost of services."

Putting flesh on the bones of those simple-sounding goals took some time, however. Melanie Mastanduno, a clinical measurement analyst at DHMC, says that administrators spent about 15 months answering the question "How would transparency look?" Based on information and opinions from national consultants, patient interviews, and focus groups, DHMC decided to create a Web site that would give patients accurate and honest data about the Medical Center's performance. "Our mission is to continually improve the science of clinical practice," she says, "and we believe that

This is the new Web site where DHMC posts charges for its services and links to
information to help patients determine payment options specific to their situations.

publishing both health information and quality reports is a valuable tool in that mission."

Quality reports: The site, which can be reached by going to www.dhmc.org and clicking on "Featured Section: Quality Reports," went live a year and a half ago. Most recently, in February of this year, charges for services —including office visits, diagnostic tests, and surgical procedures—were added to the site. DHMC is not only one of the first institutions to publish its charges, Mastanduno points out, but one of the few to represent "the full retail price," including the charge for both hospital and doctor services.

In the "Quality Reports" section of the site, people can, for example, click on breast cancer and learn that the five-year survival rate for patients with Stage 1 breast cancer who were treated at DHMC is 93%, compared with a national average of 87%. They can check the numbers of previous patients who have chosen specific treatment options, such as lumpectomy, mastectomy, or simultaneous breast reconstruction and learn about the satisfaction rates of each group of patients. "A Typical Patient's Journey: The Comprehensive Breast Program" offers a step-bystep guide from

diagnosis to treatment options.

And clicking on the new "Charges for Health Care Services" section reveals, for instance, that a low-complexity new-patient office visit costs $94, a bilateral diagnostic mammogram costs $413, and a breast biopsy costs $6,700.

Further, the site provides information about payment options and financial aid for medically necessary services for patients who are under- or uninsured. Those who do have insurance are directed to a toll-free phone number that allows them to talk with a financial counselor to determine their out-of-pocket expenses ahead of time.

Improvement: "We are in the business of continual improvement," Mastanduno says. She would like to see more diseasespecific information on the site. And, she adds, "we would love it if there were a calculator patients could use that would let them input their insurance information and give them a read-out of their expenses."

In the meantime, patients are noticing the new information. In April alone, Mastanduno says, there were 450 hits just on the "Charges for Services" link.

Catherine Tudish

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