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Brief analytical summaries or syntheses #39

Public reporting on quality and costs. Do report cards and other measures of providers’ performance lead to improved care and better choices by consumers ?

Summary

This paper examines whether public reporting of health provider performance leads to better consumer choices and improvements in care. Published in Health Affairs, the paper describes the theory behind public reporting, its evolution over time, and evidence of its ability to improve healthcare quality and lower costs.

Background

Public reporting is a strategy to address quality and cost in the healthcare system by providing consumers, payers, and healthcare providers, such as doctors and hospitals, with information about the performance of these providers and insurance plans. Public reports can allow for the comparison of costs, quality (such as rates of hospital-acquired infections), and how satisfied patients are with service. Advocates of public reporting believe that it helps consumers make informed decisions when choosing among physicians, hospitals, and health plans; that it guides employers and other purchasers when selecting insurance plans; and that it aids providers when making referrals to specialists. Providers and health plans, in turn, are motivated to improve their performance to protect their reputations and demand for their services. Publicly reported information may also be useful to policy makers when assessing system performance and value.

In the United States today, public reports are increasingly being developed and used by a range of actors, including federal, state, and local governments; hospitals and other health care institutions; professional associations; health insurance plans; employers; and consumers. The enactment of the Affordable Care Act of 2010 created a new context for these initiatives by framing a national strategy for quality improvement, including through public reporting.

Analysis and results

The Centers for Medicare and Medicaid (CMS) collects data on performance measures from providers participating in the Medicare, Medicaid, and Children's Health Insurance Program. CMS posts comparative provider-specific information about hospitals, doctors, nursing homes, home health agencies, and kidney dialysis facilities at www.healthcare.gov Ce lien s'ouvrira dans une nouvelle fenêtre.. The amount of information CMS posts varies by type of provider. The most- reported information at the national level is for general hospitals and is available at www.hospitalcompare.hhs.gov Ce lien s'ouvrira dans une nouvelle fenêtre.. CMS also maintains www.medicare.gov Ce lien s'ouvrira dans une nouvelle fenêtre., which provides information allowing consumers to compare the Medicare Advantage and Part D drug plans available in their area. The Affordable Care Act also called for public reporting of performance measures on quality, cost, and other metrics. Public reporting will be used for insurance plans that will be offered through new state-level health insurance exchanges starting in 2014. About half of the states currently have public reporting programs in place. The information collected varies considerably from state to state, by health condition, and by process and outcome measures reported.

Some of the more prominent of these organizations include the National Quality Forum (NQF), a nonprofit organization that works with providers, consumer groups, and governments to establish and build consensus for specific health care quality and efficiency measures, and the National Committee for Quality Assurance, which evaluates and accredits health insurance plans based on quality and value.

Conclusion

More work lies ahead if public reporting is to meet expectations and fulfill hopes that it can spur broad change in healthcare delivery. A survey of 29 experts and participants at AHRQ's 2011 national summit revealed that, while none doubted the value of public and private investments made in public reporting, most agreed that the information provided so far has had little positive impact on consumers' choices of health care providers.

The challenge, the experts said, is to make further advances in measurement, data collection, and use of information technology; deliver more consumer-oriented report cards; and accomplish these objectives within the constraints of limited public funding and providers' willingness to be subjected to such scrutiny.

Implications and recommendations

Although the concept of public reporting has broad support, its implementation has not always been met with approval — and there is at best mixed evidence about the degree to which it has sparked changes within health care or been used widely by consumers.

Skeptics of public reporting have a number of concerns, including about the accuracy and reliability of the information contained in the reports. For example, only 30 percent of physicians surveyed in 2005 believed that quality measures used in public reports were generally accurate. The costs associated with collection, analysis, and dissemination of data can be high, especially for physicians and providers who have not fully implemented electronic health record-keeping systems.

There is also potential for unintended consequences that might result from providers gaming their report card scores, for example, by declining to treat patients with serious conditions that might negatively impact their ratings. Similarly, there is a risk of misinterpretation by consumers if they do not understand the terms used, what an indicator is supposed to reveal about the quality of care, or whether high or low rates reflect good performance.

Despite the degree of investment in developing and implementing public reporting systems, the jury is also still out as to the extent, or even if, public reporting will improve quality and reduce health care costs.

Both supporters and critics recognize the need to address a number of issues in public reporting. These include choice of performance measures, data collection and system capabilities, formatting and content of reports, education and outreach to promote use of the information, and evaluation and continuous refinement to make sure that public reporting achieves its objectives rather than becoming an end in itself.

Consumer outreach and education are also keys to public reporting success. Consumers not only need to be aware of sources of information and how to access them, they need to understand how the information is meaningful.

Participants at AHRQ's March 2011 National Summit on Public Reporting for Consumers discussed ways to make consumers more aware of, and more inclined to use, public reports. Among strategies they suggested were ongoing campaigns to raise awareness of and demand for quality information among consumers. They also recommended engaging consumers through their providers, for example, by involving consumers and their families in practice redesign and improvement, and basing measure development on consumer needs, for example, by understanding their priorities and the information they value at specific decision points, rather than just relying on the data that are available and routinely collected. Finally, they recommended doing research on the best means to present results clearly to consumers and exploring alternative ways to deliver reports, such as through mobile technologies and automated telephone systems.

Source

Public reporting on quality and costs. Do report cards and other measures of providers’ performance lead to improved care and better choices by consumers ?