Zeke Emanuel: Why this for-profit, physician-owned hospital is a model of transparency

'All medical facilities' should be required to follow lead, Emanuel says

Hoag Orthopedic Institute's "totally transparent" approach to quality and price data should become standard in the industry, prominent health policy expert Zeke Emanuel writes in Fortune.


Emanuel, an oncologist and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, says that Orange County, California-based Hoag should by all accounts "have a terrible reputation."

It's a for-profit, physician-owned specialty hospital—the kind, he says, that typically only focuses on high-profit procedures, while "dumping" patients who are uninsured, on Medicaid, or high-risk to community hospitals.

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But Hoag's model is different: It's a joint venture established between the physicians and a not-for-profit community hospital in the area. Last year, Hoag provided more than $1 million in charity care, and it's estimated to provide over $2 million by the end of 2015.

An industry leader

Emanuel says the hospital is also unique across the entire industry as a leader in publicizing its price and quality data. Every year, Hoag produces an Outcomes Report, which is "filled with graphs, charts, and data that would thrill a policy wonk," Emanuel says.

Emanuel calls the hospital "maniacal about collecting data, and using it to drive infections to zero, patient experience and perceptions of care to 100%, and pain and functional outcomes ever higher."

Hoag doesn't advertise its services. It just puts out the report and lets it speak for itself and believes "superior performance is advertising enough," Emanuel says. The report includes:

  • The number of operations performed in the past three years, broken down by type;
  • Surgical site infections, other complications, and readmission rates;
  • How patients scored their pain and ability to be active after knee surgery, and
  • Quality improvement projects in the hospital, such as reducing the need to use general anesthesia for during knee surgeries to improve recovery time.  

The hospital also lists the "comprehensive prices" for its surgical procedures online, and has posted its quality data on its website since 2012, Emanuel says.

"Not surprisingly," Emanuel adds, "It is consistently at the tippy top nationwide."

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Improvement still needed

Even though Hoag is a leader in health care transparency, Emanuel says it still has room for improvement. The hospital only operates five days a week and uses capital-intensive ORs only about a third of the week.

Emanuel also says Hoag should break its report data out by surgeon and host its pricing data on its website, rather than on an external website hosted by the Orthopedic Surgery Center of Orange County.

But even with some room for improvement, Hoag's efforts should be lauded, Emanuel says.

"Hoag shows that transparency on price and quality in medicine ... can be done," he points out. And he calls on physician leaders to have "the courage to put all their data up on the web," adding that patients need the information to best shop around for care.

"We should require all medical facilities follow Hoag's lead," Emanuel concludes (Emanuel, Fortune, 11/11).

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