quality ratings

Health plan quality improves, while federal payers lag

Anne Zieger — Fri, 03 Oct 2008 14:36:25 -0400

Over the last nine years, the quality of care delivered to patients enrolled in health plans submitting data to the National Committee for Quality Assurance has continued to improve, though federal payers are lagging behind, according to a new NCQA report. The NCQA accredits and measures health plans using a list of clinical measures tracking how often appropriate care is delivered. Nearly half of 202 million Americans in the commercial insurance market are enrolled in plans that measure quality and report to the NCQA. Data for this year's report came from 2007 and tracked 845 plans.

According to the report, commercial plans that submitted HEDIS data (Healthcare Effectiveness Data and Information Set) showed increases on 44 of 54 quality measures, including asthma med management, blood pressure control and postpartum care for infants. Private Medicare plans also showed improvements, including in management of medications and treatment after heart attacks. However, traditional Medicare plans only showed improvement for 24 of 45 measures, and Medicaid on 26 of 52.

To learn more about the report:
- read this Modern Healthcare article (reg. req.)

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Consumers Union plans to rate hospitals

Thu, 29 May 2008 06:59:58 -0400

The venerable organization behind the popular Consumer Reports magazine has announced that it's getting into the hospital ratings act. The publisher, Consumers Union, already offers assessments of health-insurance plans, drugs and even some medical treatments, and is considering ratings of physician and elder groups. Its planned hospital ratings are the first step in a program to expand its healthcare ratings services.

Consumer Reports will rate about 3,000 facilities, and will include graphs showing ratings of care intensity and quality of care for nine serious conditions such as cancer and heart failure during the last two years of life. It also will include features reflecting average out-of-pocket costs for physician visits during the last two years of life for the nine conditions. The data will be drawn from the Dartmouth Atlas Project.

To learn more about the planned ratings:
- read this Wall Street Journal article (sub. req.)

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Study: Care at safety net hospitals lagging

Wed, 14 May 2008 06:59:55 -0400

Care at safety net hospitals is of significantly lower quality than hospitals that don't serve the poor and underserved, according to a new study appearing in the Journal of the American Medical Association. The study, which looked at data collected between 2004 and 2006 from 3,665 safety-net and non-safety-net hospitals, concluded that hospitals serving a low percentage of Medicaid patients had far more improvement in quality over time than safety-net facilities.

For example, while safety-net hospitals improved heart attack care by 2.3 percentage points, hospitals treating a low volume of Medicaid patients improved heart attack care by 3.8 percentage points, researchers said. Generally speaking, hospitals with a high volume of Medicaid patients saw CMS quality ratings drop from 10.1 percent in 2004 to 2.8 percent in 2006, while non-safety-net hospital ratings climbed from 13.6 percent to 19.7 percent.

To address this gap, the government should offer safety-net hospitals funding specifically targeted to improving care quality, rather than focusing solely on what levels they've already achieved, researchers said.

To learn more about the study:
- read this HealthDay News piece

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CO bill would set standards for physician rating, tiering

Fri, 02 May 2008 06:59:55 -0400

Colorado's governor is considering a bill that would require the state's health plans to disclose the data and methods they use to create physician tiers. In so doing, the state would follow the lead of New York, which has taken aggressive steps to regulate physician rating programs, including proposed legislation and a model standard set by the state attorney general.

With tiering programs, health plans rank physicians based on their preferred quality ratings, then offer members discounts for those who only see the highest-rated tier of physicians. In addition to demanding transparency on what they're doing, the Colorado bill would set standards for how data is used, requiring, for example, that plans utilize risk-adjusted data, base grades and ratings at least partly on nationally-recognized quality standards.

To learn more about the bill:
- read this AMNews article

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SPOTLIGHT: Consumers trust web health info, but not quality data

Mon, 28 Apr 2008 06:59:52 -0400

A new study suggests that while consumers are comfortable using the web to search for health information, they're not as comfortable with sites that provide quality data. In fact, they trust health information 80 percent of the time, but trust quality data only 40 percent of the time, according to researchers. This is partly because patients simply aren't used to reading quality data, but also because they aren't sure quality ratings are relevant to their needs, they concluded. Article

Tenet finally back on track

Mon, 17 Mar 2008 07:59:58 -0400

Things seem to be looking up for once beleaguered Tenet Healthcare these days. After years of financial and legal troubles, the company's stock is taking a turn for the better, according to the Chicago Tribune. Admissions rates have been rising since Tenet's fourth quarter ended, while the Department of Health and Human Services has given the company quality ratings since changing management and closing investigations. "Regarding the turnaround, based on the 4Q07 results, it's no longer a question of 'if,' but 'when,' we will see that translate into positive earnings and cash flow," said Sheryl Skolnick, senior vice president of CRT Capital Group LLC. All of this is a far cry from its $900 million settlement with the Justice Department for problems including billing fraud that marred 2003.

For more on Tenet's rise from the ashes:
- read the Chicago Tribune article

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Errors force BCBS of TN to postpone doctor ratings

Tue, 11 Mar 2008 07:59:55 -0400

Dogged by complaints that its data was inaccurate, BlueCross BlueShield of Tennessee has put its planned doctor rating program on hold. During a 60-day review period BCBS gave doctors, the physicians came back with many complaints about inaccuracies. For example, the data sometimes suggested that they didn't perform certain tests, even though the doctors had such tests documented in their own records. In such cases, the health plan has been allowing doctors to submit their records to supplement the claims data it uses for ratings. After it responds to doctors' questions and concerns, BCBS of Tennessee still expects to publish physician quality and cost data, which will be available to privately-insured members through a secure web connection.

Unlike its health plan brethren in New York, BCBS of Tennessee doesn't have to live up to any regulatory or legislative standards in compiling the data. It will be interesting to see whether this furor raises calls to create standards such as those proposed by New York Attorney General Andrew Cuomo and the New York state legislature. My bet is that such state-driven guidelines are likely to pop up in other states soon, and I'm betting Tennessee will be no exception.

To learn more about this controversy:
- read this article from The Tennessean

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Some Calif. hospitals at odds with rating system

Tue, 12 Feb 2008 06:59:56 -0500

A year ago, a coalition that included hospitals, health plans, physicians and consumer advocates launched a site designed to help consumers judge the quality of care at California hospitals. The site, CalHospitalCompare.org, measures hospitals on a range of clinical and patient satisfaction measures. However, as the site expands, some hospitals are beginning to back off, refusing to supply information on new categories like the frequency of respirator complications and ICU mortality. Meanwhile, about 35 of the 250 hospitals targeted by the coalition have chosen not to participate in the project, citing, among other reasons, the cost of collecting the data. That being said, other hospitals are using the data as a spur to create quality improvement programs in areas where they're weak.

Actually, I'd argue that having all but 35 hospitals participate is a pretty good track record for the site, given the complex issues involved in public reporting. But report card efforts, ultimately, don't make a lot of sense unless virtually all providers participate--so clearly, this one has a ways to go.

To learn more about the project:
- read this Venture County Star piece

Related Articles:
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SPOTLIGHT: Leavitt seeks "Travelocity" for healthcare

Tue, 12 Feb 2008 06:59:52 -0500

Well, even he admits that we're miles away from this point, but someday, HHS secretary Mike Leavitt would like to see the industry establish a "Travelocity for healthcare" which would provide price and quality information as fluidly as the travel site. In Leavitt's mind, the site would include quality ratings (assigned by Medicare, naturally), drawing on information from the physician's own electronic medical record. Article

BCBS of TN plans to share doctor ratings, prices

Thu, 07 Feb 2008 06:59:57 -0500

BlueCross BlueShield of Tennessee, the state's largest health insurer, said this week that it plans to begin offering doctor quality ratings and cost data to consumers in April. The Blue plan will offer its members secure online access to data on how much doctors charge for an array of procedures, as well as ratings on whether their patients got the right treatments and tests for some conditions.

The plan is stirring up the same objections here that it has in other states, notably that the health plan will steer patients to cheap doctors regardless of quality, that the data itself (drawn from claims) may be flawed, and that ratings may make doctors who take on the sickest patients look bad unfairly.

In a nod to recent physician rating guidelines issued by the state of New York's attorney general, BlueCross has incorporated some of the state's best practices, including disclosing how doctors are ranked, and giving the physicians a chance to appeal inaccurate ratings. However, it looks as though a few other key aspects of the New York model, including external ratings audits and using risk-adjusted data, aren't part of BCBS of Tennessee's plans.

To learn more about the health plan's approach:
- read this piece from The Tennessean

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