CMS' Hospital Compare quality report site did not affect mortality, study indicates

Requiring hospitals to publicly report quality data to the Centers for Medicare and Medicaid Services' (CMS) Hospital Compare website has not led to reductions in mortality beyond existing trends for heart attack and pneumonia, and furthermore, led to a modest reduction in mortality for heart failure, according to a recent study published in Health Affairs.

Back in 2005, CMS began posting quality ratings for more than 3,000 US acute care hospitals on its Hospital Compare site, a public reporting initiative.

For the study, researchers at Weill Cornell Medical College in New York City, analyzed Medicare claims data from 2000 to 2008. The sample consisted of Medicare beneficiaries admitted to US short-stay acute care hospitals with principal diagnoses of 3 publicly reported conditions: heart attack, heart failure, and pneumonia; and 3 non-reported conditions-stroke, gastrointestinal hemorrhage, and hip fracture.

"We found that, to the extent that Hospital Compare had any effect on mortality, it was a result of within-hospital improvement. Our study found that patients have not responded to the program by choosing better hospitals," Ryan said.

Hospital Compare certainly has raised the profile of quality of care as an issue for US hospitals, according to Ryan.

"However, there is limited evidence that it has actually reduced patient mortality for the conditions we examined," he said. "For the period we examined, there was a focus on process measures. Perhaps public reporting on 30-day mortality, which has occurred more recently, will make a larger difference."

"The study is produced at an important time in healthcare policy, with the increasing emphasis on improving quality of healthcare, measuring performance, and finally linking performance to incentives and reimbursement," Dr Mehta told Formulary. "However, one must keep in mind that the study uses Medicare claims data, which may not completely reveal a causal relationship."

The authors of the study focused on the single outcome measure of risk-adjusted 30-day mortality, according to Dr Mehta. "It is difficult to consider that this single measure can comprehensively assess hospital-wide improvements in quality," he explained.

The specific quality measures and claims-based outcomes of the diagnosis-related groups are used to tease out trends in improvement that are not attributable to public reporting, Dr Mehta said. "The authors wanted to understand any spill-over effect of general improvements in care that may not be attributed to public reporting. The authors openly admit the specificity of their study population and state that improvement effects may be different for varying patient populations," Dr Mehta said.

In addition, Dr Mehta said that the study was limited to hospitals that actively report on quality metrics. "Hospitals and health systems have a complex undertaking of serving a wide range of patients in a variety of settings," he explained. "This environment requires an interdisciplinary approach among healthcare professionals actively working in a unified manner for optimal patient care."

Because acute care environments are so multidisciplinary, it is important for hospital decision-makers to clearly understand the methodology and results of the study that drive the author's conclusions, according to Dr Mehta.

PUBLIC REPORTING NEEDED

Hospital administrators should not be discouraged by these findings and should continue to strive for improvement and publicly report quality measures for existing legislation pertaining to incentive payments, he said. "The federal government continues to innovate and use publicly reported measures. It will be useful to raise awareness of the Hospital Compare tool to assess internal levels of achieving sought-after goals," Dr Mehta said. "The purpose of the tool is to compare and assess performance of patient care in hospital settings. Pharmacists are uniquely positioned to influence medication-related quality indicators based on expertise and knowledge of pharmacotherapy and medication use optimization. [Decision-makers] may want to reassess their processes and structure to better target internal goals by including input from the pharmacy department."

Local initiatives for quality improvement should continue to involve pharmacists for their medication use expertise in disease-state management. "The inclusion of pharmacists in clinical decision-making will have great impact on patient outcomes not limited to 30-day mortality," he said. "Pharmacists have an important role in health systems in ensuring that medication use is safe and effective to optimize patient outcomes."