National Quality Forum
In the past, neither hospitals nor practicing physicians were accustomed to being measured and judged. Aside from periodic inspections by the Joint Commission (for which they had years of notice and on which failures were rare), hospitals did not publicly report their quality data, and payment was based on volume, not performance.
Physicians endured an orgy of judgment during their formative years – in high school, college, medical school, and in residency and fellowship. But then it stopped, or at least it used to. At the tender age of 29 and having passed “the boards,” I remember the feeling of relief knowing that my professional work would never again be subject to the judgment of others.
In the past few years, all of that has changed, as society has found our healthcare “product” wanting and determined that the best way to spark improvement is to measure us, to report the measures publicly, and to pay differentially based on these measures. The strategy is sound, even if the measures are often not.
Continue reading “Measuring the Quality of Hospitals and Doctors: When Is Good Good Enough?”
Filed Under: Hospitals, THCB, The Business of Health Care
Tagged: ABIM, Arnie Milstein, Bob Wachter, Hospitals, Joint Commission, Leapfrog Group, Medicare, National Quality Forum, Patient Safety, Physicians, Quality, readmission penalties, Readmissions
Apr 1, 2013
The tendency of government to impose crude performance metrics on hospitals is a well known phenomenon, but its use is growing as jurisdictions look for ways to cut their budgets. The latest example is found in Massachusetts.
As reported by the MA Hospital Association:
Governor Deval Patrick’s FY2013 state budget proposal includes $40 million in rate cuts for hospitals. A significant portion of these cuts would be made through highly questionable policy changes. One of the more troubling policies would double penalties on hospitals for re-admissions that occurred in 2010.
The 2012 MassHealth acute hospital RFA – the main contract between the state and hospitals serving Medicaid patients — introduced a new preventable readmission penalty for hospitals that MassHealth determined had higher-than-expected preventable readmission rates.
Inpatient payment rates for 24 hospitals were reduced by 2.2% in FY2012. Now the administration is proposing to double the penalty to 4.4% in FY2013. There are so many things wrong with this. First, as I have reported in the past:
Even if the readmission rate is the right metric to use for comparison purposes, we don’t have a model that would accurately compare one hospital to the others. This suggests that the time is not ripe to use this measure for financial incentives or penalties. It might give the impression of precision, but it is not, in fact, analytically rigorous enough for regulatory purposes.
Continue reading “Simple, But wrong, Approach on Readmissions”
Filed Under: Uncategorized
Tagged: hospital readmissions, National Quality Forum
Mar 25, 2012
With unsustainably high costs and tremendous gaps in quality and patient safety, the health care system is ripe with opportunities for improvement. For years, many have seen quality measurement as a means to drive needed change. Private and public payers, public health departments, and independent accreditation organizations have asked health care providers to report on quality measures, and quality measures have been publicly reported or tied to financial reimbursement or both.
Throughout the Affordable Care Act (ACA), quality measures are tied to reimbursements in multiple programs. It is critical that the Department of Health and Human Services (HHS) move forward with a strategy for measure harmonization that will accommodate local and national needs to evaluate outcomes and value. Additionally, a standard for calculation measures such as the use of a minimal data set for the universe of measures should be considered.
The field of quality measurement is at a critical juncture. The Affordable Care Act (ACA)—which mentions “quality measures,” “performance measures,” or “measures of quality,” 128 times—heightened an already growing emphasis on quality measurement. With so much focus on quality, the resource burden on health care providers of taking and reporting measures for multiple agencies and payers is significant.
Furthermore, the field itself is being transformed with the continued adoption of electronic health records (EHRs). Traditional measures are largely based on administrative or claims data. The increased use of EHRs create the opportunity to develop sophisticated electronic clinical quality measures (eQMs) leveraging clinical data, which when linked with clinical decision support tools and payment policy, have the potential to improve quality and decrease costs more dramatically than traditional ones. Innovative electronic measures on the horizon include “delta measures” calculating changes in patient health over time and care coordination measures for the electronic transfer of patient information (i.e., hospital discharge summary or consultant note successfully transmitted to the primary care physician). Additionally, traditional data abstraction methodologies for clinical data require labor intensive, chart review processes, which would be eliminated if data could be electronically extracted.
Continue reading “The Melody Of Quality Measures: Harmonize And Standardize”
Filed Under: THCB
Tagged: Affordable Care Act, EHR, electronic clinical quality measures, HIMSS 2012, Measure Applications Partnership, National Quality Forum, Quality, quality measures
Feb 21, 2012
By BOB WACHTER
Earlier this month, the National Quality Forum released its revised list of “Serious Reportable Events in Healthcare, 2011,” with four new events added to the list. While the NQF no longer refers to this list as “Never Events,” it doesn’t really matter, since everyone else does. And this shorthand has helped make this list, which will soon mark its tenth anniversary, a dominant force in the patient safety field.
The NQF was founded in 1999 at the recommendation of Al Gore’s Presidential Advisory Commission on healthcare quality. For its founding chair, the organization selected Ken Kizer, a no-nonsense, seasoned physician-administrator who had just done a spectacular job of transforming the VA system from the subject of scathing articles and movies into a model of high-quality healthcare, a veritable star in patient safety galaxy.
Kizer’s original charge at NQF was to develop a Good Housekeeping seal-equivalent for quality measures (“NQF-endorsed measures”). But soon after he arrived, Kizer added another item to the NQF’s wish list: the creation of a list of medical errors and harm that might ultimately be the subject of a nationwide state-based reporting system. As Kizer said at the time,
This is intended to be a list of things that just should not happen in health care today. For example, operating on the wrong body part [or] a mother dying during childbirth. That’s such a rare event today that it’s generally viewed as something that just shouldn’t happen. Now, there’s probably going to be an occasion now and then when it happens and everything was done right, but it’s so infrequent that it means you have to investigate it every time it occurs. So “never” has quotes around it in this case. Now, wrong-site surgery is a different story—that should never happen. There’s no way that you should take off the right leg when you’re supposed to do the left one. So in this case, never really means never.
Unsurprisingly, the items on the list quickly became known as “Never Events.” Twenty-seven of them were announced in 2002, and the list was expanded and revised four years later. (This primer, written by my colleague Sumant Ranji for our patient safety website, AHRQ Patient Safety Network, is the best description of the list and some of its policy implications.) Continue reading “Never Say Never (Events)”
Filed Under: Uncategorized
Tagged: AHRQ, Ken Kizer, National Quality Forum, Never Events
Jul 2, 2011