|March 05, 2012||
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. Its 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.
Three papers detail some of the limitations of public reporting and areas where it has not lived up to expectations.
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.
|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.