Improving US Hospital Quality

For several years CMS has in essence forced hospitals to collect and publicly report data on process of care measures on admissions for heart attacks, heart failure and pneumonia.  A couple of years ago it began punishing shortfalls on these measures under the rubric of value-based purchasing.  Scores have supposedly improved and an article in the New England of Medicine examines whether these supposed improvements in quality have benefited all racial sub-groups equally.   (NEJM Article)   “Health equity”, like most forms of racially-oriented measurement, is an ideological exercise designed to ensure equal outcomes regardless of behavior, and often punishes organizations which serve a disproportionate number or racial minorities, hurting those institutions’ capabilities.  Reviewing a large number of hospitalizations for each diagnosis, the authors find improvement in the 17 processes of care studied, both overall and for each racial sub-group, with narrowing gaps in performance in regard to African-American and hispanic patients and Caucasian ones.  Mission accomplished.

Not a word from the bureaucrats and their ideological compatriots who drive these programs about whether real health outcomes are any better or what the cost to hospitals in compliance may be, much less whether demanding worship of these particular measures has distracted from quality issues that may be even more important.  In fact, other research suggests that health status and outcomes are not necessarily improved by all these process of care measures.  Meanwhile, our beloved federal government is hammering providers with a series of payment decreases for not meeting various “quality” requirements.  It may make the bureaucrats feel good; not clear it is really improving the quality of health care.