Press Release


Embargoed Until Contact

March 05, 2012

Sue Ducat
Director of Communications
(301) 841-9962
sducat@projecthope.org

   

PUBLIC REPORTING ON QUALITY AND COSTS

 

The March 2012 issue of Health Affairs explores its successes and limitations as well as ways in which public reporting could be improved

 

Bethesda, MD -- Medicare's seven-year public reporting initiative for hospitals, Hospital Compare, had no impact on reducing death rates for two key health conditions and just a modest effect on a third. That's the conclusion of a just-released study that raises questions about the initiative's ability to improve the quality of care provided by the nation's hospitals.

 

The study, published in the March issue of Health Affairs, showed that Hospital Compare produced no reductions beyond the existing trends in improvement of care of heart attacks and pneumonia. Authors found that hospitals might have improved on thirty-day mortality rates during the study, but attribute the change to ongoing innovations in clinical care--and not to any effect related to public reporting. At the same time, the researchers found a modest improvement in mortality rates for heart failure; though, they can't prove that this was related to the public reporting initiative.

 

The findings help inform the ongoing debate about Hospital Compare, whose measures, critics say, do not necessarily reflect quality of care provided at hospitals. Study authors say this is one of the strongest studies to suggest that Medicare's public reporting effort made little or no impact on quality--at least using the current set of metrics.

 

"The jury's still out on Medicare's effort to improve hospital quality of care by posting death rates and other metrics on a public website," says lead author Andrew M. Ryan, an assistant professor of public health at the Weill Cornell Medical College in New York City. "Additional studies must prove that public reporting does in fact push hospitals to raise the quality of care standard," he said.

 

Hospital Compare was created to help Medicare patients rank or judge hospitals and other health care providers based on standards of care. The program allows consumers needing hospital care to go on a website and look for a hospital that meets or exceeds expectations when it comes to quality of care.

 

However, researchers have yet to definitively show that this kind of report card results in steps by hospitals that bring down death rates or address other factors that go into quality of care. In addition, it is unclear if consumers take advantage of the information to make the best choice about hospital care, Ryan said.

 

To try to answer those questions, Ryan and his colleagues used Medicare claims data from 2000 to 2008 to estimate the effect of Hospital Compare on thirty-day mortality rates for heart attacks, heart failure, and pneumonia. The team also looked for evidence that consumers used the information on the website to choose hospitals with a high quality-of-care ranking.

 

Ryan says further study must be done to demonstrate that the improvement in mortality rates for heart failure was really related to Hospital Compare and not to a yet unknown factor, one that was not adequately ruled out by the study.

 

Past surveys have suggested that quality report cards like Hospital Compare are underused by patients and ignored by referring physicians. This study adds to that evidence suggesting that consumers at least did not seem to be checking the Medicare website to make more informed choices about where to check in for an elective procedure.

 

"This study does have limitations," Ryan said. "We looked at thirty-day mortality and not other outcome measures that might yet prove to be important in judging a hospital," he said.

 

The US Agency for Healthcare Research and Quality supported the publication of this and several other papers in the March issue on the subject of public reporting. Public reporting of providers’ performance has been a key development over the past decade in efforts to improve the quality of health care and lower its cost. It’s been widely assumed that by making this data public, underperforming providers will be motivated to improve, and consumers will use the information to pick the highest-quality providers offering care at the best value.

 

In its March issue, Health Affairs is releasing a cluster of articles about public reporting. As these papers demonstrate, however, the actual evidence about how much public reporting has spurred quality improvement or prompted consumers to make better choices is mixed.

 

The U.S. Agency for Healthcare Research and Quality (AHRQ) supported the publication of these papers.

 

Two papers describe the successes of public reporting efforts.

 

  • Maureen A. Smith of the University of Wisconsin-Madison’s School of Medicine and Public Health and colleagues studied Wisconsin physician groups and clinics that have publicly reported their performance on diabetes care since 2004. They found that groups and clinics that adopted formal focus on one or more diabetes metrics in response to public reporting were more likely than other clinics to adopt diabetes improvement interventions. Public reporting helped drive both early implementation of a single intervention and ongoing implementation of multiple simultaneous interventions.

  • Gary J. Young, director of the Center for Health Policy and Healthcare Research at Northeastern University in Boston found that multistakeholder regional collaboratives have led the way in producing public reports about health care providers’ performance. Young conducted a study of eight of these collaboratives in Massachusetts, Oregon, California, Washington State, Ohio, Minnesota, Wisconsin, and Indiana. He found that they have built trust and cooperation among stakeholders, improving provider performance and enabling consumers to choose providers that best meet their needs.

 

Three papers detail some of the limitations of public reporting and areas where it has not lived up to expectations.

 

  • Medicare’s seven-year public reporting initiative, Hospital Compare, is the subject of analysis from Andrew M. Ryan of Weill Cornell Medical College in New York and colleagues. They found that it had no impact on reducing death rates for heart attack and pneumonia and only a modest reduction in mortality for heart failure. The study raises questions about the initiative’s ability to improve the quality of care in US hospitals.

  • Americans aren’t alone in not taking stock of quality reports when they choose their providers. Britain’s Quality Care Commission has investigated lapses in quality at individual hospitals, which often are well-covered by the news media. Anthony A. Laverty of Imperial College in London and colleagues analyzed admissions trends for nonemergency care at three of these hospitals. They found that the investigations had no impact on admissions in two of the hospitals; at the third, there were only short-term declines, and six months later admission volume had returned to normal. Clearly, information alone will not change consumer choices.

  • In California, an eight-year collaborative that has produced a report card on the quality of care offered by the state’s hospitals is at a crossroads. Stephanie Teleki and Maribeth Shannon of the California HealthCare Foundation, writing in a “Grantwatch Profile,” recount how the California Hospital Association’s board of trustees has voted to withdraw from the initiative for several reasons, including the increasing availability of hospital performance data from a variety of sources, such as the Centers for Medicare and Medicaid Services’ Hospital Compare website.

 

The remaining four papers discuss ways to improve how public reporting is disseminated and communicated. Research shows that consumers are more interested in the quality of health care than in its cost, and assume that low-cost providers are also low quality.

 

  • Judith H. Hibbard of the University of Oregon and colleagues performed an experiment to test ways in which consumers could be encouraged to pick providers who were “high value”—that is, they offered both high quality and lower costs. They studied how roughly 1,400 employees responded to different presentations of quality and costs for physicians and hospitals. They found that if consumers were given very clear information that signaled that a provider was high quality, fears that lower-cost providers gave substandard care were overcome, and consumers were more likely to make high-value choices.

  • Anna D. Sinaiko at Harvard School of Public Health and colleagues looked at why public “report cards” about health care providers have not had more impact on consumer choices and what improvements can be made. They interviewed experts and stakeholders attending a 2011 AHRQ Summit on Public Reporting for Consumers in Health Care and found widespread agreement that the reports weren’t sufficiently user-friendly. Future efforts that incorporate advances in measurement, data collection and information technology to deliver a consumer-centered report card can help report cards achieve their desired impact.

  • The problems with current efforts to publicly report the performance of health care providers may go beyond the way the information is communicated to the consumer. Mark W. Friedberg and Cheryl L. Damberg of the RAND Corporation offer a five-point methodological checklist to improve the methods used to generate the performance scores that are the basis for these reports. They believe that if public reports clearly explain how reporting entities address each checklist item, this increased transparency should improve the underlying integrity of provider profiling efforts and, in turn, improve care and help patients find the best providers.

  • With changes in health care delivery ahead, consumers may demand more information about providers’ quality. Standardized measures are going to be needed to help patients choose clinicians who provide the best care, and to arrive at those measures, data will have to be collected from many sources. Harold S. Luft, director of the Palo Alto Medical Foundation Research Institute in California, proposes the creation of a public-private data aggregator, which would receive data from payers, and indirectly from patients, about care from providers and which would be funded through fees charged to commercial users, such as health plans. An independent and neutral partner, he says, will be able to help meet this expected demand while protecting patient confidentiality.
 
 
About Health Affairs
 

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at www.healthaffairs.org. Read daily perspectives on Health Affairs Blog. Download weekly Narrative Matters podcasts on iTunes.