In the long term, quality measures should elevate recognition of the value of clinical pathology testing
Healthcare quality measures continue to increase, both in numbers and in sophistication. These quality measures offer consumers, insurers, employers, and government health agencies some information about the relative value of clinical services. But the holy grail of quality measures—outcomes data and cost data that adequately reflect patient complexity and environment—is still elusive, say experts.
Dark Daily has long predicted that healthcare quality rating and ranking efforts would boost the fortunes of clinical pathology laboratory testing. Since laboratory tests play an essential role in the diagnosis, treatment, and monitoring of many diseases and health conditions, it stands to reason that physicians would more highly value the knowledge of pathologists and laboratory scientists because it helps them achieve improved outcomes with their patients.
There is agreement among groups that rate hospitals, including Consumer Reports Health Ratings Center, the Agency for Healthcare Research and Quality (AHRQ), and the Leapfrog Group, the quality measurement systems for hospitals, while gaining in sophistication, still can’t accurately measure outcomes.
For example, an article published in the Journal of the American Medical Association (JAMA) in 2002 , specifically looked at the methodology of quality measures published by HealthGrades. HealthGrades has a well-publicized reporting system that incorporates patient outcomes as part of its ratings. Researchers found that the company’s algorithms did well when sorting groups of hospitals, giving higher rankings to those with higher quality and lower mortality risk. But the accuracy of HealthGrade’s methodology was not sufficient to allow an accurate comparison of outcomes at individual hospitals.
One major challenge with a quality measuring system is the complexity of judging severity of disease. Another issue is the inability to predict both a patient’s understanding of his or her disease or the patient’s willingness to comply with recommended care. Since morbidity and mortality are both hugely affected by patient factors outside of the control of hospitals, accurately rating outcomes is difficult.
Moreover, some doctors and hospitals have some ability to accept and treat only those patients that they know will improve their outcomes. Thus, a public institution that must treat any patient who shows up might have worse outcomes than a private hospital, even though the quality of care at the public hospital is equal to or higher than the private institution. Accounting for these differences makes rating hospitals on outcomes difficult.
Medicare first tried reporting outcomes data for hospitals in 1986, but the backlash from hospitals was so fierce that they abandoned those measures in 1993. Beginning in 2005, Medicare, as part of the National Quality Forum (NQF), has published online data through www.hospitalcompare.hhs.gov. This quality rating system uses process measures, rather than outcomes data, to compare hospital quality.
The National Quality Forum is a consortium of 32 groups that represent hospitals, physicians, nurses, insurers, employers and a broad array of health care agencies and foundations. NQF also endorses efforts by other institutions to rate the quality of health services.
Over the past decade, NQF has grappled with an interesting issue. To avoid using direct outcomes measures in a healthcare quality rating system, it has attempted to define process measures that directly affect outcomes as a way of rating quality. The group currently is working on a set of composite measures to reflect both outcomes and cost. These measures, it says, will give consumers and payers useful information about the value of the health services they purchase.
At present, NQF endorses 160 process measures and has 65 outcomes measures in review. Helen Burstin, M.D., NQF’s Senior Vice President for Performance Measures, says the challenge is to find measures that directly reflect quality and value. “We have definitely seen growth,” said Burstin, quoted in the February issue of Modern Healthcare. “We’re really just beginning to scratch the surface.”
Despite concerns over the accuracy and value of hospital rating systems, both private and public payers continue to move toward performance-based pay systems that could radically alter the finances of some hospitals. Tracking the performance measures—and performing well on those measures—will be critically important for hospitals in the coming years.
Clinical laboratory testing plays in supporting improved outcomes. Thus, these efforts by health policy makers and managed care companies to create health quality rating systems have the potential to greatly influence two elements of laboratory medicine. First, providers are likely to pay closer attention to ordering the correct laboratory tests as they consciously take steps to achieve improved outcomes with their patients. Second, pathologists and laboratory scientists may gain higher respect from physicians as their knowledge of laboratory medicine makes important contributions to improving patient outcomes—and raising the quality scores of providers. – K. Branz
How do they measure up? Quality –reporting efforts advance but still uneven, by Melanie Evans, Modern Healthcare, February 15, pp. 30-32.