The California subsidiary of payer PacifiCare Health Systems on Tuesday issued quality ratings of profiles of academic and community hospitals that serve its 2 million enrollees.
Cypress, Calif.-based PacifiCare of California claims to be the first health plan in the nation to publish detailed information on clinical quality and customer service at hospitals. It has been rating medical groups in its coverage network since 1998.
"The objective is to disclose information to consumers so that they can be better informed . . . in selecting providers," explains Sam Ho, M.D., senior vice president and CMO of PacifiCare.
PacifiCare also says it will provide incentives for hospitals to improve performance. "Hospitals that perform better in the quality index and prove themselves to be fiscally efficient will be identified in the report" to encourage competition, Ho says.
The Quality Index Profile of Hospitals rates more than 200 California acute care facilities on 56 criteria, including volume and success rate of surgical procedures, outcomes in key specialties, utilization and patient satisfaction, PacifiCare says. It also gives each hospital a grade of A, B or C based on its standing relative to other hospitals in the survey.
PacifiCare says it obtained the rating information from California and federal healthcare databases, a statewide patient evaluation program and from the Leapfrog Group, the coalition of major corporations that is promoting adoption of patient safety measures.
However, the state's largest physician organization urges caution in interpreting the health plan's report.
"As with any quality program, (ratings) need to be universal across all health plans," says Peter Warren, Los Angeles-based spokesperson for the California Medical Association. "It's absurd for each health plan to have its own standards."
While Warren says it is "good" that a major payer is "talking about quality," he says healthcare providers--physicians and hospitals alike--are wary of rating systems developed without industry consensus.
Referring to the HIPAA transaction rules that take full effect in October, Warren asks, "If claim forms are standardized, isn't it silly for quality reports not to be standardized?"
To this criticism, Ho says, "We do our best to match with current standardized measures, where they exist."
He notes that PacifiCare is a member of the National Quality Forum, which recently published a strategic framework with specific categories of clinical areas that hospitals should measure in their own quality improvement programs.
"We have adapted claims data to the same categories," Ho says. "We've tried to adhere to the spirit and direction of current quality initiatives, but, quite frankly, all of those are still in the planning stage."