WASHINGTON – At a recent hearing on public reporting of hospital performance data, panelists agreed on the importance of measuring for quality, but not on which measurement standards to use.
Current data used to evaluate performance are limited to too small a number of determining factors, asserted Nancy Foster, vice president for quality and patient safety at the American Hospital Association. Ms. Foster served on the five-person panel at a forum titled “Public Reporting of Quality Outcomes: What's the Best Path Forward?”
In March, the Centers for Medicare and Medicaid Services published data on hospitals' incidents of eight conditions: foreign object remaining after surgery, air embolisms, blood incompatibility, late-stage pressure ulcers, falls and trauma, vascular catheter–associated infections, catheter-associated urinary tract infections, and manifestations of poor glycemic control.
The data present each condition per 1,000 discharges and include national rates of hospital-association conditions. The data were based on claims information submitted by Medicare patients from October 2008 through June 2010.
Ms. Foster maintains that the CMS data are not clinically sound. One example she gave was of hospitals with high reimbursement rates, so-called safety net hospitals that provide care to all individuals regardless of their ability to pay. These facilities, she emphasized, are generally located in communities that lack sufficient health care resources for the populations they serve.
“It shouldn't be a surprise to us that if they can't get their medications following discharge from the hospital, that if they can't get into the right physician office or rehab treatment or whatever else they need, those patients are going to come back to us in larger numbers than in communities where they have adequate access to all those kinds of resources,” Ms. Foster said.
Physicians will sometimes avoid treating patients who are sicker or on Medicaid because they are high risk and could make the hospital's public reports look bad, said Dr. David Share, vice president of Value Partnerships at Blue Cross Blue Shield of Michigan.
“Sometimes the way we measure [quality] actually forces providers to focus on cohorts of patients who aren't going to get the most benefit, but they'll focus there because they're concerned that they won't look good if they don't,” Dr. Share said. He added that lower-quality outcomes could also be based on a poor hospital system, not necessarily individual physician performance, which he said should be measured separately.
Gerald Shea, assistant to the president of governmental affairs for the AFL-CIO, Washington, argued that improvement is also a question of cost, which he said amounts to nearly $250,000 to test and institute a quality measure.
“We've been severely hampered in this enterprise by basically only being able to develop those measures when somebody came forward and said 'we'll pay to develop them.'”
There may be flaws in the current data from public reporting, but Mr. Shea said reports have increased awareness for quality care and encouraged significant changes within hospitals. Since 2000, hospitals have increased their attention on factors including readmission rates, the importance of collegial cooperation, and hospital-association conditions, he said.
The Affordable Care Act will require health exchange plans to publicly report on quality of care based on 65 measures.
“There's a lot of pressure now and a lot of opportunity to use public reporting and transparency as a true level to foster high performance in the country,” said Dr. Anne-Marie Audet, vice president for health systems quality and efficiency at the Commonwealth Fund. Systems continue to focus on ways to create better care and better health at a lower cost.
Thomas Scully, senior counsel at the law office of Alston & Bird in Washington, also served on the panel.