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Last week we examined the increased emphasis on pay-for-performance mechanisms under the new Affordable Care Act, including the ties between pay-for-performance and reporting of outcomes measures.  The Kaiser Family Foundation has now released a useful webcast of an event – co-sponsored by the Alliance for Health Reform and The Commonwealth Fund – delving further into the details of reporting systems: Public Reporting of Quality Outcomes: What’s the Best Path Forward?

Reporting of quality measures will increasingly form the basis of CMS payments – it’s estimated that by 2017, 9% of all Medicare payments will be adjusted based on reported quality metrics.  With this in mind, the panel set out to examine the following questions – is public reporting accurate?  Are consumers using the information?  And are there any downsides to the practice?

Watch the event webcast, but here are some key take-away points:

One of the motivators for requiring public reporting is the consumer engagement aspect – the idea that a prospective patient, when presented with information on hospital quality indicators, will make a decision to seek care at a higher performing hospital.  This practice in effect would reward high quality hospitals with a greater market share. 

This is a nice idea, but it turns out that there is little evidence that healthcare consumers are actually responding to public information about adverse medical events, such as healthcare-associated infections.  One possible reason, explained Gerry Shea of the AFL-CIO, is that discussions about how to make healthcare decisions are not adequately integrated into the patient-provider relationship.  Perhaps as patients better understand quality measures and their implications for patient experience, they will be more likely to base decisions on them.  Until this information is better communicated, however, the relationship between transparency and consumer engagement will remain unfulfilled.

If consumers aren’t using the data, is there still value to providing it?  The answer seems to be yes.  Simply, reporting forces hospitals to focus attention on their adverse medical events. And even if it doesn’t influence consumer behavior, research suggests that it could influence providers.  Giving feedback on performance – particularly when that performance is linked with financial incentives – can be a powerful motivator for behavior change, though there is still a great deal of research to be done on effectively structuring such incentive programs.

David Share (Blue Cross Blue Shield, Michigan) provided some counter-perspective to pinning our health reform hopes on public reporting, discussing several potential pitfalls of reporting systems.  Pointing out that reporting measures are currently very narrowly focused, he reminded the audience of the need to look at quality on a population level.  Additionally, care needs to be taken to ensure that information on quality measures is presented in a way that is understandable to consumers, and not overly technical.  We also need to watch that public reporting mechanisms do not incentivize hospitals to turn away sicker or higher risk patients for the sake of maintaining quality rankings.

To inspire confidence, said Nancy Foster of the American Hospital Association, reporting measures need to satisfy a few requirements.  They need to be sound – for example, we know that using claims data and administrative codes for disease surveillance (instead of simply for billing, which is their intended purpose) leads to inaccurate results.  They need to be actionable – hospitals and providers need to know that there is an evidence-based path to improvement.  They need to be fair and mindful of context – a safety net hospital with low levels of treatment adherence should not be penalized for higher levels of hospital readmissions.  And finally they need to be important – measuring what we intend to measure and in fact linked with improved patient experiences.

“We’re in the midst of significant transformations in healthcare delivery systems today in the U.S.,” said Anne-Marie Audet of The Commonwealth Fund.  “Now more than ever we need data and information about the progress we’re making and trends over time.  Information is really a key lever to transformation and high performance.”

Now onto making sure that the best information is used to improve patient care.

Image credit: Flickr: wcm1111