Over the years, with such large gaps in hospital safety and quality, many public and private payers have been pushing for greater hospital accountability through clinical quality measurement and reporting initiatives.
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However, due to the growth and variety of quality measures, reporting requirements and transparency efforts over the last 20 years, it has become increasingly difficult for payers to determine which quality measures are important, how to interpret the quality information and how to present the information in a useful way to consumers, according to Emily Carrier, senior researcher at the Center for Studying Health System Change (HSC).
A recent policy analysis from the National Institute for Health Care Reform (NIHCR), written by Carrier and other researchers from the center, reviews the various types of quality measurements and discusses ways in which payers can help make quality information more available, reliable and usable.
“Our paper was trying to serve as a beginning to the conversation,” said Carrier. “We discuss what is out there – the types of quality measurements there are and what their strengths and weaknesses are.”
Carrier explained that generally hospital quality measures assess specific attributes of care that are widely agreed upon to signify good practice, and in some cases, also assess patient outcomes directly.
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“In some cases, these quality measures were very well studied and it was clear that providers and patients will see an improvement in someone’s health,” she said. “With others, you don’t always see an improvement – the outcomes of patients just don’t improve with some process measures. You may think you made an improvement in someone, but did you? Outcomes measure will tell you the punchline.”
Within the report, it’s also explained that poorly designed or prematurely implemented measures could have serious unintended consequences. “For example, a measure aimed at promoting timely administration of antibiotics to emergency department patients with pneumonia was criticized as encouraging physicians to prescribe antibiotics too liberally without a confirmed diagnosis,” according to the report.
Overall, Carrier believes that purchasers need to consider both quality and cost when creating an active purchasing strategy, particular when there seems to be a lack of a definitive link between a high performance on quality measures and improved patient outcomes that ultimately lead to lower healthcare costs.
The report also says that payers should pay attention to quality metrics that measure patient experience and overall indicators and service-line specific measures relevant to their covered population’s cost and utilization.
Carrier suggested that payers should get together with their peers and other business groups to determine a common approach for making sure that quality measures are reported in the same manner.
“It’s more efficient and it is a way to get the highest quality data,” she said. “It’s hard to measure certain aspects of healthcare. Getting together to have a consistent approach to measurement is one thing that can be done.”
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