Neg­a­tive out­come

Study brings CMS web­site im­pact into ques­tion

Modern Healthcare - - THE WEEK IN HEALTHCARE - Mau­reen Mckin­ney

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

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