Improved quality measurement will reduce variability and drive us toward a lower-cost healthcare system
Quality matters. Better health for everyone should be America’s goal. Yet presently, where one lives and where one receives healthcare services can make a big difference in outcomes.
Everyone—patients, families, physicians and other practitioners, hospitals, healthcare systems and payers—should have access to the same objective information about the quality of healthcare services in their communities. Accessible, transparent and comparative metrics will help move the country forward in addressing the perils of variability, consequently improving quality while lowering costs. According to the Dartmouth Atlas, a more than two-fold variation in Medicare spending per capita in different regions of the country doesn’t necessarily equate with better quality or improved outcomes.
Objective quality-comparison tools, although far from perfect, provide helpful information. The CMS’ Hospital Compare tool and its star-ratings system have been available since 2005. The easy-to-use website facilitates comparisons among hospitals based on nearly five dozen well-defined metrics. Use of this data has dual benefits: assisting patients in choosing healthcare options and accelerating performance improvement because all can share best practices to improve healthcare delivery. While Hospital Compare’s methodology has drawn plenty of criticism, over time the CMS has responded by revising its approach. Such tools have value, even with their limitations.
The CMS’ most recent hospital star ratings are based on seven major measures (mortality, safety, readmission, patient experience, effectiveness of care, timeliness of care and imaging) and 57 subcategories. Fair, transparent, timely and rele- vant scores easily understandable for patients, caregivers and payers—all of those interested in a focus on value rather than volume—are essential as our nation’s healthcare system strives to improve.
Healthcare is the largest industry in America, consuming 17.8% of gross domestic product, $3.2 trillion in 2016 and growing. U.S. healthcare perennially spends the most per capita yet consistently ranks toward the bottom in health outcomes among the 11 most-developed nations. Better performance equates to fewer complications, decreased waste and lower costs. All of these attributes contribute to a healthier America and the ability to transfer resources to other vital endeavors such as education, infrastructure, public safety and environmental protection.
Hospitals and health systems living off their past reputation and perceived greatness, embellished and polished by extensive marketing, no longer represent a rational, effective or even ethical business model. Transparent objective metrics now make some of the most venerable institutions in the nation the most vulnerable.
Shopping for some services in healthcare is desirable given our consumer-centric society. But when people are sick and don’t have the time to check a hospital’s quality scores or prices, they shouldn’t have to worry about whether they might receive better care at the hospital across town.
Even more important, today’s hospitals and health systems should no longer see their core business as a healthcare “repair shop.” We must look outside the four walls of our institutions, and promote wellness and prevention by focusing more on health rather than on care.
Sadly, life expectancy in the U.S. has decreased for the second year in a row, a first since 1963. Healthcare systems are viewed by the communities they serve as stewards of public health, so we should be employing resources for socio-economic problems such as inequities of care, homelessness, hunger, violence, addiction, mental health, and other maladies.
All members of the healthcare community have an obligation to be more responsive to their customers. Sharing best practices among ourselves, just as we are now sharing statistically accurate knowledge, will help everyone achieve better performance and outcomes. Although the process may be uncomfortable initially, in the long run having transparency as a stimulus for improvement will benefit every stakeholder in the industry. We can decrease the percentage of GDP devoted to sickness and hospitalization as we increase wellness and prevention.
Where one receives care matters greatly today. But let’s work to change that. Transparent, objective and trustworthy quality metrics will drive America’s journey to universally excellent care and good health.