Think of medical outcomes measurement, benchmarking results and performance evaluations of healthcare providers as the bricks and mortar of the quality movement.
Despite the public clamor for clinical and cost data, too many clinicians and managers still question the need for and relevancy of sharing performance information with customers. You know the litany of lame excuses. The public doesn't understand this. The media blow it out of proportion. There aren't enough adjustments to make fair comparisons. Blah, blah, blah. Although the number of naysayers and stonewallers is declining, the healthcare resistance movement is far from dead.
Winning more converts requires evidence that public dissemination of medical outcomes can lead to lower costs and improved quality. That's why the recent release of Pennsylvania's fourth annual Guide to Coronary Artery Bypass Graft Surgery is a welcome and important research tool. Although this year's report is based on 1994-95 data, the state's Health Care Cost Containment Council now has years of comparable statistics, and the results are impressive.
In-hospital mortality following CABG surgeries dropped 27% from 1990 to 1995, while risk factors remained steady, and the volume of procedures skyrocketed 25%. The in-hospital death rate stood at 3.8% in 1995 compared with 5.1% in 1990.
And for the first time, charges for the procedure dipped. The 1995 average cost of $52,465 was 3.9% less than the year-earlier charge. The latest report offered specific data on 43 hospitals and 32 health plans in Pennsylvania.
Newspapers, television news programs and talk radio feast on the heart surgery scorecard that names names and counts numbers. Payers review the data before making decisions on health plans. Providers use report cards to recruit medical staff. Without stretching too far, you can say the information exchange offers a testimonial to competition, capitalism, free market economics and the American way.
But provider performance reports won't reach their potential unless consumers use the information to make choices. A study in the May 27 issue of the Journal of the American Medical Association said only 12% of patients surveyed in Pennsylvania were aware of the state report before undergoing cardiac surgery. Fewer than 1% knew the correct rating of their surgeon or hospital and cited it as a major factor in selecting a provider. Those are sad statistics.
In the end, providers must lead the way in promoting patient education and quality measurement efforts. Without the leadership of healthcare clinicians and management, the drive for accountability will stall.