“While it’s easy to agree with the experts that Hospital Compare’s patient-safety measures are not ready for prime time, it’s no longer acceptable simply to say, ‘These metrics are irrelevant,’” Dr. Torcson cautions. “We also must be aware of the evolution and inexorable movement of the nation’s healthcare quality and safety agenda. SHM embraces the triple aim of providing better care to our patients, promoting better health of patient populations, and doing so at a lower cost.”
The Power of “Why?”
Despite its imperfections, Hospital Compare’s greatest value is the power of its transparency, which fosters healthy discussion among providers, patients, and payors, according to Anne-Marie J. Audet, MD, MSc, SM, vice president for Health System Quality and Efficiency for the Commonwealth Fund. “That transparency gets providers’ attention and leads them to make changes that can translate into better performance,” she says, noting how hospital care for patients with heart attack, heart failure, and pneumonia has steadily improved in recent years, with the worst performers in 2009 doing as well or better than the best performers in 2004.
“There are also examples of hospitals that have gone from a median of four central line-associated bloodstream infections (CLABSI) per 1,000 line-days to zero because they decided not to take the status quo as acceptable,” says Stephen C. Schoenbaum, MD, MPH, special advisor to the president of the Josiah Macy Jr. Foundation. Dr. Schoenbaum played a significant role in the development of the Healthcare Effectiveness Data and Information Set, or HEDIS.
“There is no such thing as a perfect measure in which some adjustment or better collection method would not affect the numbers,” he notes. “Ideally, you want any publicly reported measure to get the poorer performers to come up with a way to explain their result. Or, even better, to improve their result.”
Methodological criticisms of CMS’ new “Serious Complications and Deaths” measures may be justified, Dr. Audet concedes, but she also notes that rigorous validation and reliability testing of quality measures is an expensive process. “To get where we want to go in American healthcare, we need a more thoroughly supported measure development infrastructure,” she says.
“In the meantime, providers will be probing the implications of their numbers, asking why they got the numbers they did, and what can be done about it. This attention can only lead to improvement, both in the measures themselves and in the care delivered.”
Indeed, one of the hospitals that was listed as having a high rate of accidental cuts and lacerations in the new measures found most of those cuts had been intended by the surgeon but erroneously billed to Medicare under the code for an accidental cut. Even with its methodological flaws, the Hospital Compare data led to root-cause analysis and improvement in coding.
Hospitalists’ Role
Hospitalists, according to Dr. Torcson, will be critical to the successful performance of hospitals under the HVPB program, as experts in quality and quality-measurement adherence. Hospitalists care for more hospitalized patients than any other physician group, and many believe they are uniquely positioned to lead the system-level changes and quality-improvement (QI) efforts that will be required.
“Hospitalists and their hospitals, practicing in alignment, become champions for their patients,” Dr. Torcson says. “SHM supported the HVBP program, and we foresee that the alignment of performance and payment within the program will inevitably result in better clinical outcomes for our patients.”
Chris Guadagnino is a freelance writer in Philadelphia.