Report Cards on an Institution's Healthcare Quality Performance: The Hospital's Perspective

By Laurie Kunches, JSI Director of Clinical Research

Demands on hospitals to report on measures of care processes and outcomes have been intensifying recently. The overall goal is to provide useful data to the public for healthcare decision-making while motivating hospitals to continuously improve their performance. On the national level, the Medicare website is the primary clearinghouse for data on performance of individual hospitals. A portfolio of clinical measures is being analyzed based on relevant discharges from hospitals that voluntarily submit data, including a group of 10 "starter set" measures initially released in 2003. The current menu includes measures of heart attack treatment (7), heart failure care (4), pneumonia (7), surgery (7) and asthma in children (2). The incentive for hospitals to report this information is mainly financial, to become eligible for enhanced Medicare reimbursement. However, scoring high on these measures is a good public relations position and can be influential for negotiating with insurers and attracting top notch clinical and leadership staff.

The selection and specification of these indicators is an arduous process involving multiple stakeholders. The National Quality Forum convenes panels of experts to review the scientific evidence and develop the specific measures that are determined to be the most meaningful overall. Occasionally, measures are modified or removed from the list, but in general the volume of performance measures is growing rapidly. Collecting data to meet these demands is labor intensive, even when health information technology is available. Certain specialized data gathering tasks required in many states recently, such as healthcare-associated infection reporting and detailed patient-level data on heart surgery outcomes, are a challenge to fund because the complexity of the work leads to high personnel costs.

Many questions remain to be answered concerning the relative value of the "report card" approach to hospital performance. A recent study failed to confirm the supposed relationship between improved process measures for selected surgical patients (such as receiving antibiotics just before an operation) and other outcomes that reflect quality, such as length of stay and the surgical mortality rate. Also, the public may be surprised at how little effort is being devoted to confirming the accuracy of the reported information. Although hospitals clearly want to score high on the measures, most current reporting is effectively on the "honor system" and formal audits are not common. The Government Accountability Office found the Medicare approach to data verification to be unsatisfactory.

State Websites for Hospital Performance Reports:

Several States have hospital cards posted on the web (see right). By checking these sites, consumers can become educated and doing a thoughtful assessment of the information.

But a final word of caution: The Emperor may be scantily clothed…

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