Hospital Quality Reporting

The Medicare value based purchasing initiative for hospitals is in full swing, and a number of other quality reporting and payment programs exist.  Do they have an impact and how can they be maximized is the subject of a brief from the National Institute for Health Care Reform.   (NIHCR Brief)   The authors first discuss the proliferation of different measures and reports and the confusion that this can cause for payers and consumers in sorting out what is meaningful.  They list several criteria for finding measures that should be considered important, including relevance to consumers to payers, validity in terms of really reflecting quality, accuracy and credibility of the results captured and the feasibility of collecting the data in an inexpensive and unobtrusive manner.  Perhaps the biggest difficulty is finding measures that actually correlate with better health status and outcomes for patients.  Structure, process and patient experience measures obviously do this less directly than actual outcomes.  The source of data can also have a bearing on the accuracy of the measure and the cost of collecting and reporting it.  Claims data, chart data, patient reported data and EHR data all have their limits.  Chart data should be the most reliable, but unfortunately coding efforts aimed at higher reimbursement tend to afflict the accuracy of those as well in this era of reimbursement maximization consultants.  And for many categories of patients or treatments, the number per year per hospital may be so small that statistical meaning is difficult to achieve.  What is most striking is that although hospitals are already subject to the value based purchasing program, it is still not clear through solid research how much what is being measured and reported matters to ultimate quality, and it is very apparent that except for unusually informed and health literate consumers, most information is not easily assimilated by patients or even by payers.