Section 120.23. Consumer guide.

 

(1)   Data sources. The consumer guide shall draw on the following data sources:

(a) Bureau of health information databases, including those related to inpatient stays, ambulatory visits, physician encounters, facility financial and services information and health care provider workforce data.

(b) Databases of other department agencies, including those of the division of health care financing and the bureau of quality assurance.

(c) Databases of other state agencies, including the office of the commissioner of insurance for information related to health plan finances, market conduct, complaints and grievances, and quality indicators.

(d) Other private sector information available through various websites.

(e) Federal databases, including those of the health care financing administration.

(2)   Contents. The consumer guide shall contain information on all of the following:

(a) How to find and choose a doctor, hospital, health care plan, nursing home or other health care provider.

(b) How to get health insurance or enroll in medicare, medical assistance, badgercare or family care and where to go with health care coverage or payment questions or problems.

(c) Where to learn about specific conditions, illnesses or injuries.

(d) Other websites and related information sources that provide information on health care questions.

(3)   Report dissemination. The department shall make available from the department's website an electronic version of the consumer guide at no charge. The department shall distribute a paper, summary version of the consumer guide at no charge to the governor, the legislature and a board-approved list of individuals and agencies. The department shall make the paper, summary version of the consumer guide available for purchase by others.

(4)   Suggested use of the consumer guide. Some suggestions for using the report are as follows:

(a) Health care plan. If available to the department, the following types of data for individual health care plans shall be contained in the consumer guide and may supplement consumers' age, health status, mobility and financial resources as important factors consumers should consider when selecting a health care plan:

1. Health plan costs, such as premium per member.

2. Affiliations of specific physicians, clinics or hospitals.

3. Satisfaction of enrollees with access to providers.

4. Satisfaction of enrollees with service locations.

5. Measures of financial strength, such as profit margins and administrative versus medical costs.

6. Clinical process and outcome measures, such as those required for accreditation by the national committee for quality assurance or participation in the Wisconsin medical assistance program.

7. History and trend information on complaints and grievances.

8. Consumer satisfaction core measures from the consumer assessment of health plans or other satisfaction surveys.

9. Accreditation status.

10. Years of operating experience.

11. Location of plans, service area of plan by county.

12. Health plan product lines.

(b) Health care provider.

1. If available to the department, the following information about a physician and a health care provider specified in s. DHS 120.15 (1) shall be contained in the consumer guide and may supplement other factors such as the consumer's age, health status, mobility and financial resources as important factors consumers might consider when selecting a health care provider:

a. Active status information.

b. License or certification status, if applicable, including date of initial licensure or certification, credential suspensions or revocations.

c. Medical education and training information.

d. Specialty, board certification and recertification information.

e. Practice information including name of practice, location, telephone number and hours spent at location.

f. Whether the provider renders services to patients insured through medicare or medical assistance.

g. Whether the provider accepts medicare assignment.

h. The names and addresses of facilities at which the provider has been granted privileges, if applicable.

i. Usual and customary charges for office visits, routine tests and diagnostic work-ups, preventive measures and frequently occurring procedures.

j. Health plan affiliations, if applicable.

k. Volume of surgical procedures for those specific procedures where the department has determined, based on existing scientific evidence, that surgical outcomes are related to volume of procedures performed, if applicable.

L. Types of conditions treated.

2. The department shall provide consumers with information regarding how to assess the information specified in subd. 1. and what additional questions consumers may want to ask the health care provider.

(c) Health care facility.

1. If available to the department, the following information about a health care facility shall be contained in the consumer guide and may supplement other factors such as the consumer's age, health status, mobility and financial resources as important factors in selecting a hospital, nursing home, hospice or other health care facility:

a. Facility type.

b. Location.

c. Ownership.

d. Medicare and medical assistance participation.

e. Number and type of medical professionals on staff.

f. Number of staffed beds.

g. Services provided.

h. Accreditation status.

i. Date of last inspection by the department.

j. Degree of compliance with medicare and medical assistance regulations.

k. Evaluation by consumers.

L. Membership in professional organizations.

m. If applicable, performance measures such as complication rates, volume of procedures, patient satisfaction and last report of facility surveys of care delivered.

n. Years of operation.

o. Costs.

p. Satisfaction of clients.

q. Measures of financial strength.

r. Affiliations with specific physicians, clinics or hospitals.

2. The department shall provide consumers with information regarding how to assess the information specified in subd. 1. and what additional questions consumers may want to ask the health care facility.

History: Cr. Register, December, 2000, No. 540 , eff. 1-1-01.

Note

The bureau of health information was renamed the the bureau of health information and policy. Microsoft Windows NT 6.1.7601 Service Pack 1 The bureau of quality assurance was renamed the the division of quality assurance. Microsoft Windows NT 6.1.7601 Service Pack 1