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Hospital Quality Measures Continue Their Long Journey

By Tinker Ready  
   April 28, 2016

We're trying to fix a profoundly dysfunctional healthcare system. We need a way to incentivize quality. To do that, we have to find a way to measure quality and safety. Why is it taking so long to get this right?

I've been at this for a long time.

I remember sitting at a Washington D.C. press conference about Medicare's release of hospital mortality rates—30 years ago. Back then, what we now know as the Centers for Medicare & Medicaid Services was called the Health Care Financing Administration (HCFA). Ronald Reagan was president. I was young. And data was small.

The effort was a first pass at measuring hospital quality. Consumer groups welcomed the move; hospitals opposed it, saying the measures didn't adjust for severity of illness. HFCA admitted it was a crude first step and needed to be refined.  

They tried, but within five years, they had given up.

Last week, that scenario replayed in miniature. Hospitals complained, members of congress lobbied and CMS decided to delay its planned update of hospital star ratings.

But CMS is no longer the only organization rating hospitals. On Monday, the Leapfrog Group released its latest patient safety report, complete with mortality measures.

So, the long journey to measuring the quality of care continues, and promises to stall once again, for better or worse.  My Twitter stream, inbox, reading list, and, thus, this column have been filled with complaints about the relevance and volume of quality and safety measures such as mortality rates.

Related: Processing Quality Measures Costs $40K Per Physician Per Year

There are too many; they produce conflicting results; they are redundant; they vary from payer to payer; they're not based on science and they make measure compliance, such as zero readmissions, the goal, not better care.  And they add to costs. Two people I talked to last week made the case that value-based payment programs should be put on hold until we figure out how to accurately measure value. 

Driven by Politics, Money

Many of these complaints are valid. Still, the cliché that keeps crossing my mind is this: No good deed goes unpunished. We're trying to fix a profoundly dysfunctional healthcare system. We need a way to incentivize quality. To do that, we have to find a way to measure quality and safety.  

Why has this been so hard to get right?

Let's go back to D.C.  Despite their halos, many of the players in the healthcare reform debate are driven by politics and money, not good policy.  Lots of people are making money off the way the healthcare system is now, including most hospitals.

Since Medicare and federal programs drive so much in healthcare, providers and their suppliers have armies of lobbyists on Capitol Hill. Their goal is to protect their share of the more than $1 trillion dollars [not a typo] that the feds will spend on healthcare this year.  

Politics also played into last week's CMS decision to hold back on releasing its hospital data, data that critics say punishes hospitals that serve low-income patients.  Leah Binder, the head of the Leapfrog Group, noted that 60 members of the Senate, who can't agree on anything else, agreed that they "need to be nice to hospitals. So they sent a letter and they put a lot of pressure on CMS, and that works in Washington."

Tinker Ready is a contributing writer at HealthLeaders Media.

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