Expanding the Frontier of Outcomes Measurement for Public Reporting

Abstract

The decade from 2000 onward was notable for many changes in health care, but among the most significant was the Centers for Medicare and Medicaid Services' (CMS) effort to develop a large public reporting program. Hospital performance profiling at the national level had not figured prominently since 1986, when the Health Care Financing Administration (HCFA, now CMS) publicly reported hospital-specific mortality rates for numerous medical and surgical diagnoses. CMS began its 21st Century efforts by measuring and reporting processes of high-quality care for acute myocardial infarction, heart failure, pneumonia, and general surgery, such as prescription of aspirin at discharge for patients hospitalized for acute myocardial infarction and timely delivery of antibiotics for patients admitted for pneumonia. Article see p 60 In July 2007, CMS began publicly reporting outcomes for the first time: hospital-specific risk-standardized mortality rates for patients hospitalized for acute myocardial infarction or heart failure. A year later, risk-standardized mortality rates were reported for patients hospitalized for pneumonia as well. Then, in July 2009, CMS added hospital-specific risk-standardized readmission rates for patients hospitalized for these same three conditions. Since that time, CMS has continued to develop outcome measures for additional conditions, and the recently enacted Patient Protection and Affordable Care Act (PPACA) contains several requirements for CMS to expand outcome measurement and public reporting, including the development of additional measures of hospital quality as well as measures of primary care and preventive care quality. Public reporting is considered one of many critical strategies among efforts to improve health care quality because it leverages 3 key change pathways.1,2 First, public reporting can promote informed choices by patients as well as informed referrals by providers, and hospitals are expected to focus on improving quality to increase hospital market share. Second, public reporting can affect the public image or …