Why healthcare quality measures don't go deep enough

As the healthcare industry debates which quality measures are the most meaningful, one expert says the problem with current benchmarks is that they focus on what is easy to assess rather than what matters most to patients.

"The quality programs grew out of two realizations: Healthcare is unsafe and outcomes are poor," Scott Wallace, a visiting professor at Dartmouth's Geisel School of Medicine, told the Wall Street Journal. "But there is no single measure of a doctor's or hospital's quality that will fix those problems. Instead, we're measuring processes."

For example, he said, the federal government's Hospital Compare site features 123 metrics, 102 of which measure processes. The burden of keeping track of these measures now outweighs the benefits, according to Wallace.

Instead, Wallace said, quality measures must emphasize functional outcomes, such as whether a patient can walk or climb steps after a knee replacement procedure. Reporting such measures would be more complex than simply assigning letter grades to providers, Wallace concedes, but "there's no reason it cannot be done in the manner that consumer reviews exist for myriad products and services."

Other industry groups have also suggested adjustments to quality metrics. For example, the American Hospital Association has long called for risk-adjusted quality measures to account for socioeconomic factors such as income, homelessness, education and Medicaid status, FierceHealthcare previously reported.

While outcomes are the "true north of healthcare," the industry must acknowledge the imperfections of outcomes measurement, such as its need to measure vast numbers of patients to produce reliable data, Margaret O'Kane, founder and president of the National Committee for Quality Assurance, told the WSJ. As such, she said, quality measures must focus on the use of evidence-based practices to prevent complications.

Quality measures are under increased scrutiny in the wake of a recent study that found wide gaps among hospital rating services' measures of hospital quality. This is further proof that such ratings should be guidelines for care quality, rather than the backbone of strict protocol, and especially should not be used to determine payments, retired orthopedic surgeon Thomas Guastavino told the WSJ. At this year's Congress of the American College of Healthcare Executives, National Quality Forum President and CEO Christine Cassel, M.D., noted that most people assess healthcare providers through online review sites such as Yelp, indicating a gap between mainstream measures and what actually matters to patients, FierceHealthcare previously reported.

To learn more:
- read the WSJ article

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