A majority of hospitals reported incorporating performance on publicly reported quality measures into their quality improvement efforts, however many hospital leaders expressed concern about the clinical meaningfulness of quality measures, the ability to draw inferences about quality from them and the potential for "gaming" the system to improve them, write Peter K. Lindenauer, M.D., M.Sc., of the Baystate Medical Center, Springfield, Mass., and colleagues.
Public reporting programs are a strategy of the Centers for Medicare & Medicaid Services (CMS) to improve outcomes for hospitalized patients. Performance measures are published on CMS' website. Another goal of publicly reporting quality measures is to encourage improvement efforts. The authors conducted a survey to describe hospital leaders' attitudes toward the publicly reported measures.
How the Study Was Conducted: The authors mailed a 21-item questionnaire from January through September 2012 to senior hospital leaders from a sample of 630 hospitals. A total of 380 (60.3 percent) hospitals responded.
A total of 87.1 percent of the hospitals reported incorporating performance on publicly reported measures into their annual goals. More than 70 percent of hospitals agreed with the statement that "public reporting stimulates quality improvement activity at my institution" for mortality, readmission, process and patient experience measures. However, less than 50 percent of the hospitals agreed with the statement that measured differences among hospitals were clinically meaningful for mortality, readmission, cost and volume measures. Between 45.7 percent to 58.6 percent of hospital leaders also were concerned that a focus on publicly reported quality measures could lead to neglect of other important topics and there was a similar concern among 32 percent to 57.6 percent of hospital leaders about hospitals trying to "game" the system by changing documentation and coding to show improvement rather than making actual changes in clinical care.
"Our study indicates that quality measures reported on the CMS' Hospital Compare website play a major role in hospital planning and improvement effort. However, important concerns about the clinical meaningfulness, unintended consequences and methods of measurement programs are common."
In a related commentary, Lara Goitein, M.D., of Christus St. Vincent Regional Medical Center, Santa Fe, N.M., writes: "In my view, current policies, although well intentioned, tend to make performance measurement an end in itself rather than a means to better care. The solution cannot be more or different measures: the problem is inherent to imposing performance measurement without regard to the context. For performance improvement programs to succeed, practicing clinicians should be actively engaged and the connection between measurement and improvement ensured. ... The CMS and other health insurers should shift their focus from the reporting of quality measures to the process of improving quality, as previously suggested by Werner and McNutt."
Explore further: Financial Incentives to Improve Quality Skating to the Puck or Avoiding the Penalty Box?
More information: Paper: JAMA Intern Med. Published online October 6, 2014. DOI: 10.1001/jamainternmed.2014.5161
Commentary: Failure of Public Reporting and Pay-For-Performance Programs, JAMA Intern Med. Published online October 6, 2014. DOI: 10.1001/jamainternmed.2014.3403
Medical Xpress on facebook
Related Stories
Quality of care measures improve performance
Mar 04, 2013
Public reporting of how physicians and hospitals perform in quality of care measures leads to improved care for patients. A collaborative team of researchers led by Geoffrey C. Lamb, M.D., professor of internal medicine at ...
Study examines patient experience at safety-net hospitals
Jul 16, 2012
A study suggests that safety-net hospitals (SNHs), which typically care for poor patients, performed more poorly than other hospitals on nearly every measure of patient experience and that could have financial consequences ...
Hospitals that mostly treat Medicaid patients have made smaller quality performance gains
May 14, 2008
Hospitals that predominantly treat poor and underserved patients (often referred to as safety-net hospitals) have made smaller improvements in quality performance measures in recent years compared to hospitals that do not ...
Study examines hospital readmission and mortality rates for Medicare patients
Feb 12, 2013
In a study that included data on nearly 3 million hospital admissions for Medicare beneficiaries with heart attack, pneumonia or heart failure, researchers failed to find evidence that a hospital's performance on the measure ...
Financial Incentives to Improve Quality Skating to the Puck or Avoiding the Penalty Box?
Mar 12, 2014
(Medical Xpress)—In a Viewpoint published in the March issue of JAMA, Researcher Jeremiah Brown of The Dartmouth Institute for Health Policy & Clinical Practice and colleagues, Hal Sox and David Goodman, question whethe ...
Recommended for you
Stigma can hinder access to health care for the poor
3 hours ago
In a study of 574 low-income adults, many felt stigmatized when receiving medical care. This stigma was most often the result of interactions with clinicians that felt demeaning, rather than an internalized sense of shame ...
Less than half of Canadians exercise to relieve stress
4 hours ago
A research study out of McMaster University has found that only 40 per cent of Canadians exercise to cope with stress.
Institute recommends brief counselling and as-needed nalmefene to help people with alcohol dependence
7 hours ago
The drug nalmefene, which can help people dependent on alcohol cut down on the amount they drink, has been recommended in final draft guidance by the National Institute for Health and Care Excellence (NICE).
Wealthy parents increased spending on children during recession
10 hours ago
While a recession is typically a time when everyone from families to corporations tighten their belts, high-income parents actually increased spending on their children during the Great Recession, according ...
Asia grapples with food safety as incomes rise
12 hours ago
Every morning, food samples are laid out on a long table at a pristine laboratory run by a German firm in Singapore—but they're not meant for chefs or gourmets.
New study finds lack of adherence to safe handling guidelines for administration of antineoplastic drugs
Oct 03, 2014
A new National Institute for Occupational Safety and Health (NIOSH) study, published online in the Journal of Occupational and Environmental Hygiene, found that recommended safe handling practices for workers who administer antine ...
User comments
© Medical Xpress 2011-2014, Science X network
A majority of hospitals reported incorporating performance on publicly reported quality measures into their quality improvement efforts, however many hospital leaders expressed concern about the clinical meaningfulness of quality measures, the ability to draw inferences about quality from them and the potential for "gaming" the system to improve them, write Peter K. Lindenauer, M.D., M.Sc., of the Baystate Medical Center, Springfield, Mass., and colleagues.
Public reporting programs are a strategy of the Centers for Medicare & Medicaid Services (CMS) to improve outcomes for hospitalized patients. Performance measures are published on CMS' website. Another goal of publicly reporting quality measures is to encourage improvement efforts. The authors conducted a survey to describe hospital leaders' attitudes toward the publicly reported measures.
How the Study Was Conducted: The authors mailed a 21-item questionnaire from January through September 2012 to senior hospital leaders from a sample of 630 hospitals. A total of 380 (60.3 percent) hospitals responded.
A total of 87.1 percent of the hospitals reported incorporating performance on publicly reported measures into their annual goals. More than 70 percent of hospitals agreed with the statement that "public reporting stimulates quality improvement activity at my institution" for mortality, readmission, process and patient experience measures. However, less than 50 percent of the hospitals agreed with the statement that measured differences among hospitals were clinically meaningful for mortality, readmission, cost and volume measures. Between 45.7 percent to 58.6 percent of hospital leaders also were concerned that a focus on publicly reported quality measures could lead to neglect of other important topics and there was a similar concern among 32 percent to 57.6 percent of hospital leaders about hospitals trying to "game" the system by changing documentation and coding to show improvement rather than making actual changes in clinical care.
"Our study indicates that quality measures reported on the CMS' Hospital Compare website play a major role in hospital planning and improvement effort. However, important concerns about the clinical meaningfulness, unintended consequences and methods of measurement programs are common."
In a related commentary, Lara Goitein, M.D., of Christus St. Vincent Regional Medical Center, Santa Fe, N.M., writes: "In my view, current policies, although well intentioned, tend to make performance measurement an end in itself rather than a means to better care. The solution cannot be more or different measures: the problem is inherent to imposing performance measurement without regard to the context. For performance improvement programs to succeed, practicing clinicians should be actively engaged and the connection between measurement and improvement ensured. ... The CMS and other health insurers should shift their focus from the reporting of quality measures to the process of improving quality, as previously suggested by Werner and McNutt."
Explore further: Financial Incentives to Improve Quality Skating to the Puck or Avoiding the Penalty Box?
More information: Paper: JAMA Intern Med. Published online October 6, 2014. DOI: 10.1001/jamainternmed.2014.5161
Commentary: Failure of Public Reporting and Pay-For-Performance Programs, JAMA Intern Med. Published online October 6, 2014. DOI: 10.1001/jamainternmed.2014.3403
Medical Xpress on facebook
Related Stories
Quality of care measures improve performance
Mar 04, 2013
Public reporting of how physicians and hospitals perform in quality of care measures leads to improved care for patients. A collaborative team of researchers led by Geoffrey C. Lamb, M.D., professor of internal medicine at ...
Study examines patient experience at safety-net hospitals
Jul 16, 2012
A study suggests that safety-net hospitals (SNHs), which typically care for poor patients, performed more poorly than other hospitals on nearly every measure of patient experience and that could have financial consequences ...
Hospitals that mostly treat Medicaid patients have made smaller quality performance gains
May 14, 2008
Hospitals that predominantly treat poor and underserved patients (often referred to as safety-net hospitals) have made smaller improvements in quality performance measures in recent years compared to hospitals that do not ...
Study examines hospital readmission and mortality rates for Medicare patients
Feb 12, 2013
In a study that included data on nearly 3 million hospital admissions for Medicare beneficiaries with heart attack, pneumonia or heart failure, researchers failed to find evidence that a hospital's performance on the measure ...
Financial Incentives to Improve Quality Skating to the Puck or Avoiding the Penalty Box?
Mar 12, 2014
(Medical Xpress)—In a Viewpoint published in the March issue of JAMA, Researcher Jeremiah Brown of The Dartmouth Institute for Health Policy & Clinical Practice and colleagues, Hal Sox and David Goodman, question whethe ...
Recommended for you
Stigma can hinder access to health care for the poor
3 hours ago
In a study of 574 low-income adults, many felt stigmatized when receiving medical care. This stigma was most often the result of interactions with clinicians that felt demeaning, rather than an internalized sense of shame ...
Less than half of Canadians exercise to relieve stress
4 hours ago
A research study out of McMaster University has found that only 40 per cent of Canadians exercise to cope with stress.
Institute recommends brief counselling and as-needed nalmefene to help people with alcohol dependence
7 hours ago
The drug nalmefene, which can help people dependent on alcohol cut down on the amount they drink, has been recommended in final draft guidance by the National Institute for Health and Care Excellence (NICE).
Wealthy parents increased spending on children during recession
10 hours ago
While a recession is typically a time when everyone from families to corporations tighten their belts, high-income parents actually increased spending on their children during the Great Recession, according ...
Asia grapples with food safety as incomes rise
12 hours ago
Every morning, food samples are laid out on a long table at a pristine laboratory run by a German firm in Singapore—but they're not meant for chefs or gourmets.
New study finds lack of adherence to safe handling guidelines for administration of antineoplastic drugs
Oct 03, 2014
A new National Institute for Occupational Safety and Health (NIOSH) study, published online in the Journal of Occupational and Environmental Hygiene, found that recommended safe handling practices for workers who administer antine ...
User comments
© Medical Xpress 2011-2014, Science X network
0 comments:
Post a Comment