Research has found significant variation in health-care outcomes and costs. To address this, health-care providers, consumer groups, payers, and the government have created measures to assess individual provider and health system performance. The goals of these measures are to provide the public with data they can use to make better choices, to measure and reward top performance and to identify performance gaps.
Holding providers accountable for results is admirable, but today’s application of performance measures is seriously flawed, requiring a hard stop to regroup and work toward a consensus driven approach.
The typical health system accepts patients from dozens of payers, including multiple commercial plans, Medicare and Medicaid, each of which has its own performance measures.In the public sector, there are more than 500 different state and regional quality measures, only 20% of which were used by more than one program. Private insurers contribute their own unique evaluation measures to the mix, with their requirements amounting to more than 550 additional performance measures.
Quality scorecards such as those published by Consumer Reports or U.S. News & World Report, are designed to help consumers make better decisions around care providers and services, but have unfortunately created their own set of complicating factors. Recent analysis by Health Affairs points out that these public tools fail to “agree on hospital rankings within any diagnosis, even when using the same metric.” This, in part, may explain why fewer than 25% of all consumers use quality data to make decisions, and even fewer change their provider of choice based on what the data indicate.
The reality is that there is no consistent set of measures that consumers can use to compare performance across health plans, let alone across providers.
Not only does measure proliferation lead to consumer confusion and provider “measurement fatigue,” it’s also a source of enormous inefficiency in health care. One health system in the Northeast reports that it uses 1% of all service revenues just to collect and report the disparate measures required by payers and quality reporting organizations. Still others report that the burden associated with collecting and reporting disparate measure sets is disproportionate to the ultimate financial reward, which is why 40% of physicians would rather suffer a 1.5% pay cut than participate infederal quality reporting programs.
Clearly, something’s got to give.
While the energy around measurement is commendable, fragmentation and disconnected development efforts are creating diminishing returns and even problems for providers and care itself. Physicians are now spending more than 16% of their work week on administrative and data collection tasks, which leads to career dissatisfaction, as well as rushed visits, long wait times and overcrowding in many care settings. In the hospital, the Association for Professionals in Infection Control and Epidemiology reports that infection preventionists spend more than five hours a day collecting and reporting quality measures at the expense of activities that may directly avert the spread of dangerous germs.
It’s time for commercial and government payers to come together and create a consistent, uniform framework for measure development and application, as opposed to proliferating measures that contradict each other. There is pent-up demand for credible, actionable information that points to opportunities to improve care quality, particularly at the individual practitioner level.
And although America’s Health Insurance Plans (AHIP), the national group representing commercial insurers, has taken steps to address this problem, we need to advance progress here, and take steps to include the input of providers across the care continuum.
Physicians and health systems have long advocated for a more simplified, streamlined approach to measurement. Without the development of a common, consistent framework, providers will continue to struggle with measurement proliferation and data collection, distracting them from patient care.
To quote a physician that recently spoke with me, “we can’t continue to spend as much time doctoring to the measures as we do doctoring to our patients.”
Susan DeVore is president and CEO of Premier Inc., a health-care performance improvement alliance of 3,000 U.S. community hospitals.