Study brings CMS website impact into question
New research is once again prompting questions about the usefulness of the government’s Hospital Compare website and its ability to improve hospital quality. A study published in the March issue of Health Affairs found that the CMS’ public reporting website, crafted for use by consumers, has not led to any reductions in 30-day mortality rates for heart attack and pneumonia, and has led to only a slight drop in mortality for heart failure.
First launched in 2005, the CMS established Hospital Compare as a way to inform consumers and direct them to better-performing hospitals and as a tool to push hospitals to do better.
The issue, according to Andrew Ryan, assistant professor of public health at Weill Cornell Medical College, New York, and the study’s lead author, has been Hospital Compare’s reliance on process-of-care measures, such as aspirin on arrival for heart attack patients and smoking cessation counseling for pneumonia patients.
When Hospital Compare first began displaying quality data for acute-care hospitals, there were big gaps in performance on those process measures, Ryan said. But in the years since, compliance has increased significantly.
“Performance on those process measures has really improved over the life of Hospital Compare, but our study says there hasn’t really been any effect on mortality outcomes,” Ryan said. He argues that the website may lead hospitals to focus myopically on process mea- sures at the expense of other priorities.
Concerns about the relevance of the data on Hospital Compare are of particular importance, experts say, because the healthcare reform law mandates that all measures used in the CMS’ upcoming hospital value-based purchasing program must be displayed on the website for at least one year.
Ryan’s study is just the latest to examine whether Hospital Compare’s data actually translates to improved clinical outcomes. A 2010 study published in the Archives of Surgery found that high compliance with perioperative process-of-care measures was not linked to lower mortality rates or lower rates of surgical complications such as infections.
“We found that there was no relationship between the two,” said Lauren Nicholas, a health economist at the University of Michigan’s Institute for Social Research, Ann Arbor, and the study’s lead author. “Just because we can measure something does not make it a useful quality indicator.”
Based on that data, the researchers concluded that the Hospital Compare site was not a useful tool for patients seeking out the best hospitals for high-risk surgery.
“There’s pretty little evidence that Hospital Compare has really motivated any changes in consumer behavior anyway,” Nicholas said. If that were the case, she added, hospitals with lower scores would see their market shares decrease, and that hasn’t happened.
The latest study in Health Affairs came to the same conclusion, Ryan said. Researchers determined that Hospital Compare failed to