Those who don’t believe it may have trouble, and sooner than they think. With 70 million beneficiaries, the Centers for Medicare and Medicaid Services (CMS) sets the tone for healthcare quality in the U.S. In fact, Medicare beneficiaries comprise about one-third of those in a typical hospitalist’s practice. Since March 2008, the CMS Web site www.hospitalcompare.hhs.gov/ has reported hospital service data and soon will post cost comparisons.
“CMS is a payer we have to pay attention to (them),” says Patrick Torcson, MD, chair of SHM’s Performance and Standards Committee. “The CMS performance and quality agenda is specified at the statutory level as part of the Congressional record, and is very political. Therefore, that agenda right now is part scientific, part policy, and part methodology. There is a little something in it for everybody.”
Increasingly, quality measures are gradually, and insidiously, changing healthcare. For instance, Dr. Jha’s study found outcomes data did not greatly influence hospital market share, however, the surgeons with the highest publicly reported mortality rates were much more likely to retire after the release of each report card.2
Obstacles to Utilization
If these data can help us make educated healthcare decisions, why aren’t more people consulting them? To start, current measures aren’t sufficient, says Peter K. Lindenauer, MD, MSc, FACP, a hospitalist and associate professor of medicine at Baystate Medical Center in Springfield, Mass.
“The number of measures and the strength of the evidence that current process measures are based on are still quite limited,” Dr. Lindenauer says. “Moreover, it is unclear how much the structural and process measures that have remained the focus of most public reporting contribute to patient outcomes.” It’s difficult to make statistically meaningful comparisons across hospitals or providers. Those efforts are “hampered by inadequate risk adjustment and tend to be underpowered to detect statistically significant differences.”