OM in the News: Measuring Health Care Quality
“The goal of tying more Medicare payments to the quality—not the quantity—of health care by 2018 has intensified the debate over how ‘quality’ is defined and measured,” writes The Wall Street Journal (Jan. 31-Feb.1, 2015). Many doctors, hospitals, insurers and cost experts want to move away from the myriad quality metrics that largely measure process–toward broader measures that assess patient outcomes. This week, the National Quality Forum submitted recommendations on 199 performance measures to the U.S. Dept. of Health and Human Services. The goal is to better align measures among various programs and replace narrow process-oriented metrics with “measures that matter.”
Some doctors question whether the measures that exist can adequately measure quality. And there is little agreement on what measures matter most or are more likely to produce good value. “Measurement fatigue is a real problem in hospitals,” said a Dartmouth medical prof. “But, to me, the only metric that matters is, did you get better?”
As of last year, 33 federal programs asked providers to submit data on 1,675 quality measures. State, local and private health plans use hundreds more. Hospitals and doctors stand to lose millions in Medicare payments for missing filing deadlines or improvement benchmarks in programs that track hospital-acquired infections, readmissions and electronic-record use. The Centers for Medicare and Medicaid Services wants to move toward more quality measures “that matter most to patients and clinicians,” and note that some already had an impact on outcomes. Central-line bloodstream infections have dropped by 50% since hospitals were required to report them, and 150,000 fewer Medicare patients were readmitted to hospitals within 30 days of discharge in 2012-2013 under a federal program holding them accountable. More than 2,600 hospitals will see their Medicare payments cut 1- 3% this year—a total of $428 million— for not reducing 30-day readmissions sufficiently.
Classroom discussion questions:
1. What are the advantages and disadvantages of setting quality metrics?
2. Why do doctors oppose some of the quality measures?