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From Health Law Daily, November 5, 2013

Confusion found in “grades” for hospital quality standard report card organizations

By Anthony H. Nguyen, JD

Despite promotion as a means to improve the overall quality of care and help people make well-informed decisions about health care, the widespread use of publicly available reports that rate the quality of health care in hospitals results in confusion, according to findings in a Report on Report Cards developed by the Healthcare Association of New York State (HANYS).

In assessing scores for various reporting entities, HANYS found that the confusion was not limited to consumers, as hospitals were impacted trying to assess each report’s methodology to determine whether it merited internal quality improvement efforts. Many report cards did not recognize the complexity of hospital care in generating a single score during evaluation. The HANYS report also called into question the interplay behind scores and profit-making from the organizations that issued report cards, whether it was to generate added subscriptions or to sell business tools to hospitals to improve scores.

Criteria. HANYS developed a set of criteria, namely methodology and data related, to which report cards should adhere, including: (1) transparent methodology; (2) evidence-based measures (3) measure alignment; (4) appropriate data source; (5) most current data; (6) risk-adjusted data; (7) data quality; (8) consistent data; and (9) hospital preview.

HANYS noted its support of the availability of hospital quality and safety information to guide patients in making choices and assist providers in improving care. However, the association recommended that the information should be based on a standard set of reliable and evidence-based measures. Moreover, these measures should be aligned or consistent with nationally-approved measures, such as those endorsed by CMS.

Additionally, the complete methodology employed by the report card organizations should be made available to enable hospitals to replicate results and analyze data. Use of proprietary calculations imposed limitations on hospitals and prevented hospitals from determining whether the data collected was a fair representation of practices.

Likewise, an appropriate data source should be used. HANYS found issue with the report card organizations’ use of administrative data instead of clinical data obtained through medical chart abstraction to generate aspects of the report cards. Use of administrative data could be susceptible to regional variations in coding practices.

Evaluation and assessment. HANYS reported that, in general, government and accrediting organizations were more successful than other report card organizations in meeting HANYS’ criteria for evaluating hospital performance. It noted that the CMS Hospital Compare Web site had made many improvements in its evaluation of hospitals by basing the metrics on current evidence-based clinical guidelines, improving risk adjustment, and achieving greater standardization. However, the reporting services receiving lower scores relied heavily on administrative claims data or unvalidated survey data; gathered comparative data points from different sources and time frames to generate a composite score or ranking; and did not use measures aligned with CMS or other national accrediting organizations.

Overall, The Joint Commission Quality Check, the DOH Hospital-Acquired Infection Report, the DOH Hospital Profile Quality Section, and the CMS Hospital Compare reporters scored the highest in meeting all of HANYS’ criteria for reporting.

MainStory: TopStory NewsStory GeneralNews QualityNews

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