Public reporting on processes, outcomes shows clinicians where they can improve
In all the years I have practiced medicine, I have yet to meet the physician who didn’t want to do right by his patients. Even so, in every community across America, doctors and hospitals can and do fall short of providing the care their patients need. Thanks to the growing movement for greater transparency in healthcare, we increasingly know where and who they are. But perhaps even more important, so do they.
To take the measure of the transparency movement, the Robert Wood Johnson Foundation recently set out to find as many free, online public reports on the quality of healthcare as possible. The results can be seen in a new national directory that lists more than 200 local, state and national reports—from the Maine Health Management Coalition’s Get Better Maine “guide to quality healthcare” to the Puget Sound Health Alliance’s Community Checkup.
The reports include information about the process of delivering care (for example, did patients get all the recommended care?), actual outcomes for patients (for example, did patients die or have to return to the hospital?), what patients said in surveys about their experience with physicians or hospitals, cost or some combination of these.
We are calling attention to these efforts in hopes of spurring their use and spawning imitators. We believe measuring and publicly reporting on the quality and cost of care physicians and hospitals provide is crucial to improving the quality and lowering the cost of care nationwide. Thanks to Medicare’s “Hospital Compare” website, you can get reports on the quality of hospital care nationwide. The federal health reform law also directs Medicare to develop a parallel website where people can compare doctors’ quality by 2013.
But until that day arrives, there are far more communities where you can’t get information about the quality of the care doctors deliver than communities where you can. That needs to change, and we shouldn’t rely solely on Medicare.
Issuing public reports on the quality of care isn’t a game of gotcha. It serves three important purposes: First, it allows patients to make informed choices about their care and be better partners with their doctors. Second, it allows healthcare professionals to see where they can improve. Third, it allows payers to
The real challenge is turning the idea of transparency into the reality of quality improvement.
see the value of the care they help pay for.
We’ve all heard the saying that you can’t improve what you don’t measure. It’s just as true that you don’t lose weight by standing on a scale. Measurement is a tool, not a goal or outcome. The real challenge is turning the idea of transparency into the reality of quality improvement on the ground.
In our foundation’s signature quality initiative, called Aligning Forces for Quality, we are working in 16 communities to get the people who get care, give care and pay for care to use these reports. And in clinic after clinic, there have been “a-ha” moments when physicians look at the reports and see that they can do better.
After the Oregon Healthcare Quality Corp., the leader of the AF4Q initiative in Oregon, began reporting on whether women were screened for chlamydia, physicians in the area took note. “Providers just didn’t realize that it was a U.S. Preventive Services Task Force recommendation,” said Dr. Susan Clack of the Pacific Medical Group. “I did two screenings that I would have never done before and both were positive for chlamydia. So it actually did change my practice.”
The reports issued by another founda- tion partner, Minnesota Community Measurement, spurred the Ellsworth Medical Clinic to reach higher. After learning in MNCM’s 2009 report that only 47% of the clinic’s patients received the recommended care for vascular disease, the clinic took action. Clinic staff began checking for missing tests in physicians’ orders, contacting patients about needed visits or screenings and calling them to ensure they were following their treatment plans. In 2010, 68% of patients at the Ellsworth Medical Clinic received optimal vascular care. This made the small, rural practice with two physicians, one physician’s assistant and a few clinical and office staff the state’s top performer out of 433 clinics.
Another partner, the Wisconsin Collaborative for Healthcare Quality, has found compelling evidence that public reporting leads to improved performance. In a recent study funded by the Commonwealth Fund, it found that clinics focused on quality improvement efforts on aspects of care that WCHQ publicly reports on. Moreover, the study found that the clinics that participate in the public reports outperform those who don’t.
We recently asked people working with Aligning Forces to tell us how the transparency movement has changed care in their community. Dr. Peter McGough of the University of Washington summed it up nicely. “What’s incredible is when you gather up a set of measures that the providers will acknowledge are accurate. … They can see how they’re doing relative to the rest of the clinic, one clinic against another, and generally docs are motivated to change if they see they’re not at the top of their game.”
As our new directory shows, the transparency movement is gaining momentum, but it still has a long way to go for physicians everywhere to see where their game is.