Paying for value, meaning for lower cost and better patient outcomes, is the new mantra for Medicare and other payers. Quality measures have been criticized for several reasons, including whether they are adequately risk-adjusted and whether they really measure quality. Researchers have tried to evaluate quality measures using multiple methods. A new paper at the National Bureau of Economic Research uses data on Medicare patients who are admitted to a hospital following emergency ambulance transport (about 25% of all Medicare hospital admissions) from 2008 to 2012 to evaluate the accuracy of quality measures, since ambulance company selection is basically random and ambulance selection of the hospital to which the patient is delivered is typically is not affected by patient choice, although it may be affected by ambulance company affiliation with a hospital system. (NBER Paper) The quality measures used were process ones regarding delivery of certain care; patient satisfaction scores; 30-day readmission rates; and 30-day mortality rates.
The analysis found that hospitals with higher compliance with process of care standards had lower mortality rates; that hospitals with lower patient satisfaction higher rates of readmissions and mortality, and that lower mortality and readmission scores were in fact associated with lower rates of mortality and readmissions among the studied population of patients admitted through emergency ambulance transport. At a high level, institutions at the top of the quality ratings had about a 15% lower readmission rate and mortality rate. It should be noted that results on process measures have risen to near the top and variation has become compressed since their introduction, so it is not clear how much value they have. I am always leery of using patient satisfaction as an indicator of quality. And mortality and readmission rates have their issues as well. Tracking patients’ actual health and functional status over an extended period of time, including during acute episodes of care, would be the most useful indicator of the quality of the health care system. But this study can provide some comfort that the quality measures currently being used for hospitals may actually reflect meaningful differences in patient outcomes.