Inconsistent outcome measures hurt hospital payments

The move towards increased healthcare transparency has pushed hospitals to publically report adverse events. Yet the methods used to measure outcomes isn't standardized, leading to inaccurate quality incentive payments, according to a study published in today's issue of Journal of the American Medical Association.

Two researchers from John Hopkins Medicine say that "surveillance bias" is causing hospitals to be praised and/or punished for flawed quality measures, as hospitals looking at adverse medical outcomes find more signs of complications in their patients.

"People want to compare hospitals, but if the science can't keep up, maybe we're doing more harm than good when we report certain kinds of data," said Elliott R. Haut, MD, an associate professor of surgery at the Johns Hopkins University School of Medicine, in a statement.

In addition to giving misleading information to consumers who are selecting where to receive care, hospitals should be way of surveillance bias because it could cause CMS to withhold payments for not meeting certain standards.

For example, CMS will no longer pay the costs associated with treating patients who develop a deep venous thrombosis (DVT) after certain orthopedic surgeries. If hospitals don't look for a DTV and don't find one, they will still get paid, note the researchers. But other hospitals that look for DVTs and find them won't get paid.

To even out outcome measurements, the researchers recommend standardizing the methods for surveillance among all hospitals. A cost-benefit analysis also should be used to decide which specific measures should be mandated.

"Without a standard way for looking for these complications, the numbers people are looking at--and making major decisions based on--may be worthless," Haut says.

For more:
- read the John Hopkins Medicine press release
- here's the JAMA study