Hospital groups lean towards transparency

For the past decade, SA’s JSE-listed private hospital groups have quietly invested resources in measuring the quality of their services, but until very recently most of this information was shielded from public scrutiny.

This is slowly beginning to change as investors, medical schemes and consumers clamour for greater transparency.

Life Healthcare, Mediclinic and Netcare are all taking steps to publish consumer-friendly information about their hospitals online, replacing the high-level aggregate data buried in their annual reports with more detailed disclosure.

"We believe it is important to report our quality and safety results publicly, whether positive or not," says Life Healthcare nursing and quality executive Sharon Vasuthevan.

At first sight, this appears to be a good thing.

Scrolling through Mediclinic’s website reveals that patients rate the food, the rooms and the nurses at Panorama in Cape Town’s northern suburbs higher than they do at its facility in Brits, and that the medication error rate at its Sandton site is seven times lower than it is in Morningside.

Life Healthcare goes a step further, enabling comparison between facilities on a wider set of safety outcomes such as hospital-acquired infection rates, falls and pressure sores.

Netcare has yet to begin releasing this kind of data online, but plans to do so by March.

Probe a little deeper, however, and it quickly becomes apparent that a patient can’t compare facilities run by different hospital groups in the same region — such as those within striking distance of where they live or work — because each group is determining for itself which indicators to report on.

Nor is it possible for a consumer to determine from these sources whether a specific orthopaedic surgeon or cardiac unit has performed better or worse than its peers.

Despite the limitations of publicly available data for consumer decision-making, releasing information that enables even basic comparisons between facilities within a group puts pressure on underperforming hospitals to up their game, says Percept CEO Shivani Ranchod. "It’s a journey. It starts internally, often in quite a defensive way, and then matures into sharing the information with the world. Putting it on a website signals accountability," she says.

SA’s two biggest medical scheme administrators, Medscheme and Discovery Health, say more detailed data is disclosed behind the scenes and they work closely with the private hospital groups to ensure they get value for money.

But their efforts are hampered by a lack of an industry-wide agreement on what to measure and how to do it — and the absence of a national electronic patient record system to track patients moving between facilities.

"Until we have common definitions, we can’t compare the hospital groups," says Medscheme executive director for health management Lungi Nyathi.

Administrators are also constrained by the fact that they only have access to claims data, which lacks the details captured by the hospitals, she says.

For example, a patient’s clinical notes would grade the severity of a pressure sore from 1 (discoloured) to 4 (necrotic), but the ICD-10 coding system used for billing schemes does not enable this level of distinction.

Discovery Health CEO Jonathan Broomberg says ideally hospitals should regularly report to an independent entity, so that their performance can be gauged over time.

A good starting point would be globally accepted indicators such as in-hospital mortality rates, hospital-acquired infections and "never" events such as operating on the wrong limb, he says.

Discovery Health uses the data it has on private hospitals to exclude from its networks facilities that do not perform sufficiently high volumes of procedures, and for the past two years has been directing patients to the facilities with the best outcomes in hip and knee replacements, he says.

"Even if members are not explicitly aware of it, the net result is that a member will end up at a good quality centre of excellence."

Mediclinic’s chief clinical officer Stefan Smuts concedes the information provided to patients and medical schemes has its limits, but says the industry is hamstrung by the Competition Act.

Rival hospitals are wary of sitting around a table and agreeing on quality measures for fear of being accused of collusion, he says.

The Competition Commission’s health market inquiry, which published its final report in September, consistently raised concerns about the dearth of information on the quality of care provided to patients in the private sector.

It recommended that the government set up an independent body, called the outcomes measurement and reporting organisation, to which private hospitals would report on agreed-upon clinical outcomes.

As an interim measure, it suggested that this work be carried out by the Health Quality Assessment association, but no concrete action has been taken so far.

Part of the reason for this is that the Competition Commission has yet to develop guidelines governing what kind of information can be discussed collectively, says the inquiry’s director Mapato Ramokgopa.

In the meantime, private hospitals are pressing ahead with their own projects, limited though they are to benchmark themselves.

"We committed to investors that we will put more clinical outcomes in the public domain," says Netcare’s medical director Anchen Laubscher.

"We believe it is the right thing to do, to be transparent."