Health Care Quality Measures––Drinking from a Fire Hose of Data
August 23, 2016 | By: Andy Carter
Do health care leaders count data measures instead of sheep to get to sleep? Or, are those data measures actually keeping them up at night?
Health care providers are transitioning to a value-based payment (VBP) model that rewards value and care coordination–—rather than volume and care duplication. Quality measures are an integral part of determining success; but they can pose many challenges too.
The VBP model puts the focus on the right priorities, but the process is akin to drinking from a fire hose. So much good and useful information can be lost in a gush of data, not all of which contributes to achieving core goals.
There are hundreds and hundreds of different data measures being used by Medicare, Medicaid, commercial insurers, and accreditation bodies. This data helps calculate provider accountability, payments, financial penalties, and rewards.
But the measure requirements are not all aligned among payers, and this lack of consistency has resulted in confusion and complexity for the reporting providers.
Measures generally fall into four broad categories:
- Structure—Staffing, staff capabilities, and availability of resources
- Process—The extent to which providers give patients specific services that are consistent with recommended care guidelines
- Outcome—Patients’ health as a result of the care they received
- Patient experience—Feedback about patients’ experiences of their care
The measures, both federal and state, range from how well a provider controls high blood pressure for diabetes patients or manages follow-up instructions for heart patients, to how well doctors and nurses communicate with patients.
A Daunting Amount of Data
A single example tells a good story. One Pennsylvania hospital that is contracted to provide care with ten payers is managing 177 measures. As if 177 measures are not overwhelming enough, consider this:
- Of those 177 measures, 119 are unique–—they are not duplicated in other contracts
- All ten contracts measure blood sugar levels control, but use three different definitions of how to meet the measure
- There are 14 composite measures that capture 67 measures—Composite measures are roll-ups of individual measures and are scored as all or nothing
This is an overwhelming amount of data to collect, code, and analyze. As a result, there is a great deal of confusion about:
- What is being measured
- How it should be measured
- What the results of the measurement effort show
And, the time and cost is equally daunting.
Results from a Health Affairs survey revealed that physician practices each week spend more than 15 hours per physician to track and report quality measures for Medicare, Medicaid, and private health insurers, at an estimated cost of about $40,000 per clinician annually—at least $15.4 billion a year.
There is growing discussion among hospital leaders, doctors, scholars, and provider associations about a better approach.
They propose maintaining the integrity of VBP, but reducing the number of measures to a minimum set of outcomes that are better aligned for each important medical condition. Those measures could be standardized across the country.
In addition, hospitals respond to the unique quality improvement needs of their patient populations. If a hospital has successfully driven its infection rates down, but sees a dramatic need to improve medication safety, it should have the flexibility to shift its focus to this new quality initiative.
These approaches would:
- Speed up measurement
- Allow providers to collect and share data about outcomes more efficiently
- Allow providers to focus on areas of concern
- Increase care improvement
Making Progress—State Innovation Efforts Present Opportunities
We have seen steps in the right direction.
HAP supports collaboration with and among payers to create a core set of measures that could be adopted universally to drive health care improvement.
We are fully immersed in the Health Innovation in Pennsylvania (HIP) Plan, being driven by the Department of Health. Measurement alignment is one of the key priorities in our work in this effort.
A logical proving ground is at the state level as Medicaid and commercial payers continue to embrace VBP as the model for payments.
At the federal level, the Core Quality Measures Collaborative is seeking to promote alignment of quality measures for physicians for the treatment of heart disease, cancer, and other common conditions. These same considerations should be bridged to the hospital community.
There are many indicators in public policy discussions that suggest we all want to do the right thing. We want to focus on the good and useful data that leads to greater accountability, better coordinated care, and improved care outcomes. But instead of a fire hose, we would prefer to drink from a water fountain.