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Public Reporting Can Boost Healthcare Quality—Locally

 |  By jfellows@healthleadersmedia.com  
   May 08, 2014

An ambitious project by the Robert Wood Johnson Foundation has been able to make the connection between public reporting and healthcare quality improvement in specific communities.

Organizations that rate doctors and hospitals want to believe that the public ratings, rankings, grades, and stars they issue help improve quality and safety as well as inform patients, but for the most part, those reports are mere snapshots in time and do not play a part in driving quality improvements inside the walls of a hospital.

"We love being recognized in the Top 100 hospitals," says Dan Varga, chief clinical officer and COO for Texas Health Resources, which has begun publishing its own quality and safety report for consumers and clinical staff.


Hospital Rankings: The More, the Murkier


"We love being recognized by The Joint Commission. We love having our Leapfrog scores rank up near the top in the [Dallas/Fort Worth] metroplex, etc., but it's not something we're sitting with our clinical leaders and saying, 'Okay, this is what we think the Leapfrog methodology is, or the Healthgrade's methodology is, let's try to get that fifth star this year.' "

 

Ouch.

An argument can be made that quality at hospitals is in fact rising because scorecards like Leapfrog's and The Joint Commission's Top Performer on Key Quality Measuresboth show gains in their individual indicators. But whether large-scale quality improvements can be directly linked to these national scorecards has yet to be demonstrated.

An ambitious project by the Robert Wood Johnson Foundation, however, has been able to make the connection between public reporting and quality in specific communities. Called Aligning Forces for Quality, the 10-year, $300 million project is focused on improving quality for patients, reducing racial disparities, and developing models of care.  


How Making Hospital Quality Data Public Affects Providers


Initially, the focus was on ratcheting up outcomes at physician offices, and included four pilot sites. There are now 16 sites in 14 states (two are in Ohio and Michigan), and hospitals are also included. One of the requirements of sites participating is that they begin measuring outcomes. Most sites use a mix of nationally recognized measures and those developed at the community level.

Additionally, the findings have to be publicly reported. Instead of comparing physicians to those that are in another state or halfway across the country, it makes more sense to look across the street, says Anne Weiss, team director and senior program officer at RWJF.

"Healthcare is local," says Weiss. "I think one of the things about doing something community-wide and joining forces is it sets a table for everyone else who is delivering care in the community."

Working Together in Wisconsin
The Wisconsin Collaborative for Healthcare Quality (WCHQ) is one of the 16 sites participating in the AF4Q. WCHQ was not developed specifically for the project, but its goals are the same: to improve healthcare quality in local communities by measuring outcomes and sharing them with payers, hospitals, health plans, and medical groups.

"The presence of the word 'collaborative' is not accidental," says Chris Queram, president and CEO of WCHQ. "It's a philosophy that collaboration around evidenced-based metrics that are validated, audited, and accepted, are an apples to apples comparison and drives improvement."

WCHQ began participating as an AF4Q site in 2007. It began developing metrics its members four years earlier in 2003. The first indicators were for diabetes care and management, and Queram says a workgroup met weekly putting in hours and hours of "sweat equity."

The goal was to use evidenced-based indicators accepted by clinicians that captured data for all patients, not just those enrolled in a commercial health plan or Medicare, which Queram says is a shortcoming of using CMS data to benchmark outcomes.

Inclusive Metrics, 'Irrespective of Payment Source'
"To take nothing away from the good intentions of CMS, they only represent a subset of a practice," says Queram. "Medicare can be a stubborn set of the population where performance is hard to move. The strength of our measures is we take a lot of pride in building metrics inclusive of all patients irrespective of the payment source. It's represented in data we report, so interventions are holistic, directed at a single standard of care to improve care for all patients."

WCHQ's initial quality indicators for diabetes has grown to more than 30 for physician groups and five for hospitals.

Most of the physician indicators were developed by WCHQ, and includes screenings for breast and cervical cancers, tobacco use, osteoporosis, and others. Three of the five hospital indicators WCHQ uses were developed by the Society of Thoracic Surgeons (STS) and two were developed by the American College of Cardiology (ACC).

When physicians first began keeping track of their outcomes, Queram says they were surprised.

"We began to hear anecdotally that the conversation among the groups was beginning to change because there was data to show if performance matched perception," he says, adding that doctors were discovering they weren't as good as they thought. "They were then motivated to seek performance improvement."

Measureable Improvements
The gains made are traceable to beginning of the WCHQ's 2007 participation in the RWJF project. They're also publicly available in their report. Not only are patients (and other physician groups) able to see the performance of physicians, they can also compare it historically, without having to click to another screen. The data is side by side, year over year. That's missing from most other quality scorecards aimed at the consumer.

One of the biggest quality achievements WCQH points to is that 50% of primary care providers have improved in four diabetes-related quality measures within two years, as well as colorectal screen rates.

"We are confident in the gains made because we have rigorous data audit to ensure it is reliable," says Queram. "Participation is also completely voluntary, so we have to work very, very hard to have a value proposition that is useful to our organizations, and that hinges on the metrics we feed back to them for improvement."

Queram says 38 physician groups participate in the WCHQ representing about 60% of physicians licensed to practice in Wisconsin. The main metro areas are represented, and it's hoping to grow representation in the northern part of the state that is very rural. Queram also hopes more small to medium-sized primary care practices begin participating.

The collaboration happens informally, through information sharing among providers, but also formally. Six times a year, WCHQ hosts a one-day collaborative assembly that brings together consumer, administrative, clinical, and payer perspectives.

Tying Public Reporting to Quality
The big payoff for WCHQ was when the Medical College of Wisconsin studied diabetic patients who were seen in practices participating in WCHQ and found that public reporting on outcomes increased the likelihood a physician practice would implement interventions shown to be improving diabetes outcomes.

"Public reporting drives quality," says Queram.

At the local level.

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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