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| Federal Register | Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements |
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| Performance Managment |
Rating the Raters: The Inconsistent Quality of Health Care Performance Measurement.
Shahian, David M. MD; Normand, Sharon-Lise T. PhD; Friedberg, Mark
W. MD, MPP; Hutter, Matthew M. MD, MPH; Pronovost, Peter J. MD, PhD
THE PROBLEM OF FLAWED METHODOLOGYGiven the analytical complexity of health care outcomes measures and lack of widely accepted and enforceable standards, flawed or inconsistent rating methodologies are neither surprising nor rare.5–12 In some instances, different rating organizations have produced completely divergent ratings for the same hospital during the same rating period, and patients have no way of knowing which are more accurate and relevant to their needs.
Contrary to the aphorism that ‘‘any data are better than no data,’’ bad data or methodology can often be worse than no data, and can produce serious unintended consequences. They misclassify doctors and hospitals, misinform and confuse the public, and squander increasingly scarce resources. Inaccurate report cards can mislead patients into seeking care from providers falsely labeled as above average in performance, or steer patients away from truly excellent providers mistakenly identified as low performing. Providers incorrectly categorized as below average may divert resources to address alleged but nonexistent quality issues, whereas truly low performing providers are lulled into complacency. Based on faulty reports, payers may reward low-performing providers or penalize true high performers. Ultimately, flawed report cards foster cynicism and distrust of all performance measurement.
There are enough healthcare quality measures - Modern Healthcare Modern Healthcare business news, research, data and events
It doesn't matter how much healthcare providers and researchers rail about the inadequacy and inconsistency of the consumer ratings offered by the CMS, the Leapfrog Group, journalism outfits and online startups. They are not only here to stay, they are proliferating.
Last week, Yelp, best known for its consumer reviews of restaurants, teamed up with ProPublica, a not-for-profit investigative journalism group, to rate nursing homes. It's the first of what promises to be a series of partnerships linking hard data to consumer ratings in healthcare.
On Yelp's newest online tool, if an elderly person or family member searches for nursing homes by ZIP code or city, not only can they read individual consumer reviews about their experiences, they also can get instantaneous readouts of the homes' histories of receiving excessive fines or whether they had ever been suspended for poor performance by the CMS. They can even read each home's biannual inspections reports.
That came less than a month after ProPublica stirred outrage among the nation's surgeons by releasing an independent analysis of Medicare-derived data on 16,810 surgeons. The group's online search tool allows consumers to look up how many times each surgeon performed one or more of eight common procedures; how many complications occurred; and where that surgeon's complication rate ranked on a national scale.
Over the next few months, you can expect articles in medical and health policy literature blasting ProPublica's focus on the limited data of individual surgeons without adequate risk adjustment. “It goes against everything we're trying to do in the patient-safety movement,” lamented one surgeon, who focuses on improving the systems within which surgeons operate.
Memo to hospital officials, physicians and other providers: Consumers and patients don't read the scientific and policy literature.
Background/Related:
- Performance Measurement in Healthcare: Part II - State of the Science Findings by Stage of the Performance Measurement Process :: Longwoods.com
- comptenxz.p65 - measuring_the_competence_of_hc_providers_qap_2001.pdf
- Yelp adds healthcare data for hospitals, nursing homes to reviews - LA Times
- Yelp Adds Hospital Nursing Home Reviews
- spendergast: A key AHRQ Health Care Metric - HAC rates down - but not so much lately and with some surprising laggards
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