DOES PUBLIC REPORTING HAVE AN IMPACT ON HEALTHCARE DISPARITIES? A SYSTEMATIC REVIEW OF CLAIMS AND EVIDENCE GAPS

Purpose: Public reporting (PR) of the costs and quality of healthcare providers was a feature of healthcare reforms in the US aimed at reducing healthcare disparities. While no evidence currently linking PR and disparities in outcomes, we aimed to synthesize a broader set of evidence, including subjective claims to better understand the potential impact of PR on disparities.

Methods: We conducted a systematic review all papers discussing the impacts of PR on disparities, whether original data was presented or not. We extracted all qualitative and quantitative data and claims linking PR and disparities.

Results: Of the 1970 records identified, 9 articles were relevant. Five records were theoretical in nature and proposed recommendations to improve the PR methods including measuring disparities and targeting the design of programs towards minority populations. Evidence showed an overall negative effect of PR on disparities with the greatest magnitude exemplified in an observational nursing home study in which publicly reported quality data on resource constrained nursing homes drove many homes out of the market. Another study showed a similar size effect on disparities in that “black-serving” hospitals performed statistically significantly worse on more than half the patient safety indicators and had higher rates of death among surgical patients. Using MedPAR files, a CMS enforced PR method showed black and Hispanic Medicare beneficiaries were readmitted more frequently than white beneficiaries. A study on a state-level PR program showed that provider performance rates between differently insured populations were significantly varied on 92% of reported measures indicating a large effect on disparities related to payment.

Conclusion: The evidence on the potential association between PR and disparities is limited given, with only four empirical studies identified, although a range of claims can be identified in the literature. Recommendations to publicly report disparities, reward improvement on quality measures in addition to achievement, and conduct stratified analyses to compare similar providers may improve PR mechanisms in reducing disparities. Demographic and socioeconomic characteristics of patients can help providers target healthcare and allow report cards to judge providers appropriately given their patient demographic. Measuring disparities is the first step to uncovering the mechanism by which they are exacerbated. It has been recommended that these be incorporated in quality report cards to incentivize providers to reduce disparities.