Without reliable measures, quality reports have little effect

NATIONAL REPORTS-As healthcare stakeholders try to steer consumers to the most effective care delivery, they first need to overcome longstanding hurdles, including reliable quality measures, a solid evidence base, and an effective means to help consumers make choices to meet their needs, according to a recent policy paper issued by the American College of Physicians (ACP).

Without reliable measures and accurate reporting, the data is meaningless and often ignored, says J. Fred Ralston Jr., MD, FACP, president of ACP. Too frequently, practices are incorrectly singled out for failing to meet quality measures when the evaluation is based on inaccurate facts, he says. Dr. Ralston cites cases in which practices are charged with failing to order certain services, such as mammograms, when the services actually had been administered or were not within best-practice guidelines.

Despite some pitfalls, ACP supports quality measures to distinguish provider performance that are valid, minimally burdensome, transparent in their development, and open to prior review by physicians in order to weed out inaccuracy. Using solid data in a format that allows for continual process improvement, quality measures can be a useful tool for turning medical advancements into accepted practices, Dr. Ralston says.

More consumers are relying on the Internet to obtain information, but subjective Web-based reporting systems can be grossly inaccurate, says Margaret O'Kane, president of the National Committee for Quality Assurance (NCQA).

"The challenge is to discern the good quality information from the less-reliable quality information. Unfortunately, you kind of need a Ph.D to do that," O'Kane says. "The good news is the wheels are turning rapidly to get much more quality information out there to consumers."

NUDGE CONSUMERS ALONG

With so much information to consider, consumers can become overwhelmed by their choices and default to the cheapest providers, O'Kane says. But quality care is not necessarily more expensive, of course. Poor care-ineffective treatments, redundant tests, repeat imaging or errors resulting in complications-causes prices to skyrocket.

And the same holds true for choosing insurance plans. She hopes the upcoming healthcare exchanges will create "choice tools" to help consumers find a plan that's a good fit.

"You can't really expect consumers to sort through all of the information on their own," she says. "We have to nudge them toward plans that are in their best interest."

She believes that payers and patients will benefit if consumers pick plans that meet their needs and choose providers that offer the best value. Insurers can help cut through the information overload with preferred provider lists based on quality targets.

With more medical boards and insurance providers adopting quality standards, O'Kane says measurement is improving but remains uneven. No one should make assumptions on quality without data, she says.

Dr. Ralston says physicians will strive to improve their practices if they are informed of the standards being measured. However, they also must learn to trust the measures used.

"There are a lot of good things about quality measures and monitoring," he says. "It's been done badly in the past, and that makes it harder to convince people that this time we're going to get it right."

If an evaluation process doesn't seem credible, physicians will stop paying attention to it, which can exacerbate gaps in best practices, he says. For instance, some physicians might continue to use a drug that has fallen out of favor as a first-line treatment without realizing a newer treatment had become a preferred choice.

"We've had a gap in this country between [discovery of] medical advances and when they're put into play in the real world of medicine," Dr. Ralston says. "Quality measurement gives us an opportunity to have a process where new guidelines and new measures can be communicated to those in practice."

Nearly all stakeholders-including NCQA-agree that reducing variation in medical practice can save money.