Joint Com­mis­sion to shelve hos­pi­tal Top Per­former pro­gram un­til 2017

Modern Healthcare - - NEWS - By Sabriya Rice

A to­tal of 1,043 hos­pi­tals made the Joint Com­mis­sion’s 2015 Top Per­former list, an an­nual award that rec­og­nizes fa­cil­i­ties for high marks on a suite of 49 ac­count­abil­ity mea­sures. That’s about 180 fewer high achiev­ers than last year.

How­ever, it’s telling that in the cur­rent chaotic state of health­care qual­ity mea­sures, the ac­cred­i­ta­tion body also an­nounced dur­ing the release of its an­nual re­port that it will sus­pend the pop­u­lar award for at least one year.

“Due to the evolv­ing na­tional per­for­mance mea­sure en­vi­ron­ment—par­tic­u­larly within the Cen­ters for Medi­care and Med­i­caid Ser­vices,” the pro­gram will be put on hia­tus, CEO Dr. Mark Chas­sin said in the re­port. “In 2017, we will re­turn with a re­freshed pro­gram.” The com­mis­sion has been is­su­ing the awards each fall since 2010.

The science of health­care per­for­mance mea­sure­ment is “all over the place,” safety lead­ers have said. Re­searchers in health pol­icy, qual­ity and safety, and or­ga­ni­za­tions that rep­re­sent hos­pi­tals have urged scru­tiny of the met­rics that rate, rank and fi­nan­cially pe­nal­ize U.S. hos­pi­tals.

“The stakes are get­ting much higher,” said Dr. Peter Pronovost, pro­fes­sor and di­rec­tor of the Arm­strong In­sti­tute for Pa­tient Safety and Qual­ity at Johns Hop­kins Medicine.

For ex­am­ple, as much as 6% of a hos­pi­tal’s base op­er­at­ing pay from Medi­care could be on the line by 2017 through com­bined fed­eral qual­ity in­cen­tive pro­grams. “When you ratchet up the stakes, you’d bet­ter make sure that what you are mea­sur­ing is ac­cu­rate,” Pronovost said.

The Joint Com­mis­sion said it is reeval­u­at­ing the cur­rent land­scape, and part of its goal is to make sure the ac­count­abil­ity mea­sures it uses re­main closely aligned with the CMS’ re­port­ing pro­grams. But it ap­pears that is be­com­ing more chal­leng­ing.

The fed­eral gov­ern­ment has “gone in a dif­fer­ent di­rec­tion” and is in­creas­ingly re­ly­ing on billing data, Chas­sin said in an in­ter­view with Mod­ern Health­care.

Dur­ing a news con­fer­ence, he noted that the Joint Com­mis­sion does not use mea­sures de­rived from hos­pi­tal billing data be­cause they don’t ac­cu­rately iden­tify com­pli­ca­tions, and they don’t pro­vide insight on the sever­ity of pa­tients’ con­di­tions. “We don’t be­lieve those are valid mea­sures of qual­ity,” he said.

The re­port noted changes to the CMS’ Hos­pi­tal In­pa­tient Qual­ity Re­port­ing pro­gram, as well as the agency’s re­tire­ment of topped-out mea­sures.

The lat­ter con­cerns Chas­sin. “Tak­ing the spot­light off of very valid mea­sures of qual­ity is not an ap­pro­pri­ate pol­icy po­si­tion,” he said. “When you take the spot­light off, per­for­mance de­te­ri­o­rates. Why would you want to take that risk?”

It’s a very del­i­cate is­sue, said Pronovost, not­ing that it is also ex­pen­sive to col­lect data. He sug­gested ran­domly ro­tat­ing mea­sures in and out of the cy­cle to en­sure ac­count­abil­ity, as well as com­ing up with more ro­bust ways of eval­u­at­ing the ef­fec­tive­ness of met­rics across the board.

The pro­lif­er­a­tion of rat­ings groups and the wildly dif­fer­ent con­clu­sions they have gen­er­ated are an on­go­ing con­cern as trans­parency be­comes more preva­lent in health­care. A rat­ing scheme now can be cre­ated by “any­one with a com­puter,” said Dr. Robert Wachter, in­terim chair­man of the depart­ment of medicine at the Univer­sity of Cal­i­for­nia at San Francisco. “But the re­sult for pa­tients may be ca­coph­ony,” he said. “Some­times less is more.”

The com­mis­sion said an­other rea­son to pause the pro­gram is be­cause the way data are col­lected is chang­ing. The group in­tro­duced a flex­i­ble re­port­ing op­tion for the cur­rent cal­en­dar year so hos­pi­tals could choose which mea­sures they would re­port on based on the pro­ce­dures they per­form.

Crit­ics have said the com­mis­sion’s top per­for­mance award fo­cuses too much on process mea­sures (such as how many heart at­tack pa­tients re­ceived as­pirin), rather than out­come mea­sures (e.g., how many pa­tients died or had com­pli­ca­tions). Data sug­gest that pro­cesses are eas­ier to im­prove than out­comes.

How­ever, Chas­sin coun­tered that out­comes can­not be im­proved if pro­cesses are not changed. Also, he said that while many of the process mea­sures are ev­i­dence-based, some out­come met­rics used by other rat­ings groups are “so fun­da­men­tally flawed” that they can’t judge per­for­mance.

The de­ter­mi­na­tion for this year’s list of rec­og­nized hos­pi­tals is based on 2014 data sub­mit­ted by 3,315 fa­cil­i­ties. The fa­cil­i­ties were eval­u­ated on ac­count­abil­ity mea­sures re­lated to care for pe­di­atric asthma, heart at­tacks, peri­na­tal care, pneu­mo­nia, psy­chi­a­try, stroke, surgery, sub­stance use, tobacco treat­ment and ve­nous throm­boem­bolism.

Nearly one-third of Joint Com­mis­sion-ac­cred­ited hos­pi­tals won the award this year. While 180 fewer made the list com­pared with last fall, Chas­sin said the drop was an­tic­i­pated as more re­quired met­rics were added to the list. A to­tal of 650 hos­pi­tals made the list for the sec­ond con­sec­u­tive year and 117 fa­cil­i­ties have been on the list for five straight years.

While the temp­ta­tion to add more mea­sures and in­tro­duce new rat­ings is great, Wachter en­cour­aged “tak­ing a bit of a breather and try­ing to sep­a­rate out the wheat from the chaff” in the rat­ings maze. Oth­ers who is­sue such lists may want to do the same, he said, to understand whether they are truly adding unique value.

“Tak­ing the spot­light off of very valid mea­sures of qual­ity is not an ap­pro­pri­ate pol­icy po­si­tion.” Dr. Mark Chas­sin CEO, Joint Com­mis­sion

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