The Burden of Hospital Quality Measures

Readers of the blog know I don’t always have nice things to say about hospitals and hospital systems, but I also try to be fair about any issue I think is handled in a wrong manner.  For example, we have severely criticized the construction of the hospital readmission penalty program.  Similarly, the myriad of quality and reporting programs imposed on hospitals, and other providers, is absurd and appears to have little value.  The Healthcare Association of New York State releases a report decrying the current state of quality measurement and suggesting improvements.  (HANYS Report)  To demonstrate how bad this measure lunacy has become, the report found that just for CMS, there were 33 different programs with 850 unique measures, only a third of which are used in more than two of the programs.  The National Quality Forum, the chief group responsible for evaluating measures, has endorsed 635 of them. And various payers and state regulatory groups and accrediting programs may pile on their own measures.

The harms from this focus on excessive measure use are obvious; administrative burden, waste of clinicians time that could be spent delivering patient care, confusing output and reports that policymakers, consumers and the providers themselves can’t use, and an inability to focus on quality improvement activities that might actually make a difference in patient care.  At some point, providers just give up.  The core recommendations for improvement include a commitment to use only a few key measures; all measures that are used should be consistent with evidence-based standards; the output should guide easily performed care improvement; and the output should be easily understandable by patients and other audiences who are trying to evaluate provider quality.  To some extent fixing the current situation also depends on better information systems; the current generations of EHRs and other health care systems is simply incapable of automatically collecting and reporting much of the data needed for quality measures.   What the current state of affairs really reflects is a well-intentioned government and academic effort gone typically amok.  But fixing it won’t be easy, as these agencies and other groups rarely collaborate well and are very defensive about the value of their work.