Quality Measures—Consumers’ Choice

Not long ago, it was very difficult for individual consumers to access quality and safety data related to health care. Meaningful information about the performance of specific doctors or hospitals was almost impossible to come by, so we were more dependent upon the subjective opinions of others.

While word-of-mouth was a powerful mechanism for passing along anecdotal information, it lacked the sophistication of a rigorous scientific review. In the attempt to shed some light on performance, a number of national ranking lists emerged. These tended to be somewhat more scientific in their approach, using a more formal set of criteria for their analyses. Early versions were still fairly subjective in the way they evaluated providers, though many have evolved toward a more objective assessment model.

The dearth of reliable, objective quality and safety data in the public domain was one factor that helped create a tipping point in the latter part of the 20th century. Other contributing factors included a pair of seminal reports from the Institute of Medicine (IOM).

The first one, “To Err is Human,” was published in 1999. It highlighted the problem of medical failure, estimating that somewhere between 44,000 and 98,000 people per year were dying as the result of medical errors, which placed medical failure somewhere between the fourth and eighth leading cause of death in the United States.

In 2000, the IOM published a second report entitled, “Crossing the Quality Chasm,” in which the IOM took a more in-depth look at the quality and safety problem and made number of recommendations to enhance health care quality and safety. One important recommendation focused on the issue of transparency, stating, “the system should make available to patients and their families information that enables them to make informed decisions when selecting a health plan, hospital, or clinical practice, or when choosing among alternative treatments. This should include information describing the system’s performance on safety, evidence-based practice, and patient satisfaction.” The impact of this report was tremendous, and its recommendations resonated in the hearts and minds of consumers, providers and insurers.

Recognizing the inefficiencies arising from numerous uncoordinated sources of data and disparate reporting methods, the Centers for Medicare and Medicaid Services (CMS) announced the creation of the Hospital Quality Initiative to address the need for objective, easy-to-understand data on hospital performance published in the public domain.

As a result, CMS initiated a voluntary reporting program in which hospitals were asked to report data to CMS without inducement or threat of reprisal. CMS then published this data on its Hospital Compare website www.hospitalcompare.hhs.gov. While many hospitals began reporting on a strictly voluntary basis, a major motivator was introduced in 2003 which practically ensured universal compliance by all hospitals serving Medicare patients.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 provided a strong incentive for eligible hospitals to submit quality data for ten quality measures known as the “starter set.”  The law stipulated that hospitals not submitting performance data for the ten quality measures would receive a reduction in their annual payment update from CMS for FY 2005, 2006 and 2007.

I believe that health care consumers are the big winners in the evolution of hospital quality and safety data reporting, and I applaud the efforts of CMS and others in taking the lead on this important issue.

Because transparency and openness are essential components of the ongoing effort to close the quality and safety gap, and because I believe that consumers deserve to have the objective information they need to make informed judgments, I strongly support this movement. I also encourage my friends, neighbors, and fellow citizens of Iowa to visit the Hospital Compare website and take advantage of this valuable resource.