A total of 1,043 hospitals made the Joint Commission's 2015 Top Performers list, an annual award that recognizes facilities for high marks on a suite of 49 accountability measures. That's about 180 fewer high achievers than last year.
However, it's telling that in the current chaotic state of healthcare quality measures, the accreditation body also said during the release of its annual report that it will suspend the highly popular award for at least one year. (Search the 2015 Top Performers by hospital and state.)
“Due to the evolving national performance measure environment—particularly within the Centers for Medicare & Medicaid Services,” the program will be put on hiatus, CEO Dr. Mark Chassin said in the report's introduction. “In 2017, we will return with a refreshed program.” The commission has been issuing the recognition each fall since 2010.
The science of performance measurement in healthcare is “all over the place,” safety leaders have said. Researchers who specialize in health policy, quality and safety, and organizations that represent hospitals have all urged scrutiny of the metrics that rate, rank and financially penalize U.S. facilities.
“The stakes are getting much higher,” said Dr. Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine.
For example, as much as 6% of a hospital's base operating pay from Medicare could be on the line by 2017 through combined federal quality incentive programs.
“When you ratchet up the stakes, you'd better make sure that what you are measuring is accurate,” Pronovost said.
The Joint Commission said it is re-evaluating the current landscape, and part of the goal is to make sure the measures used remain closely aligned with the CMS' reporting programs. But it appears that is becoming more challenging.
The federal government has “gone in a different direction” and is increasingly relying on billing data, Chassin said in an interview with Modern Healthcare. During a news conference, he noted that the Joint Commission does not use measures derived from hospital billing data because they don't work well to accurately identify complications and they don't provide insight on the severity of patients' conditions. "We don't believe those are valid measures of quality," he said.
The report released Tuesday notes significant changes to the CMS' Hospital Inpatient Quality Reporting program, as well as the CMS retiring topped out measures.
The latter concerned Chassin. “Taking the spotlight off of very valid measures of quality is not an appropriate policy position,” he said. “When you take the spotlight off, performance deteriorates. Why would you want to take that risk?” he said.
It's a very delicate issue, agreed Pronovost, noting that it is also expensive to collect data. He suggests randomly rotating measures in and out of the cycle to ensure accountability and coming up with more robust ways of evaluating the effectiveness of metrics across the board.
The proliferation of ratings groups and the wildly different conclusions that are generated have been ongoing concerns as transparency becomes more prevalent in healthcare. A rating scheme can be created nowadays by “anyone with a computer,” said Dr. Robert Wachter, interim chairman of the department of medicine at the University of California at San Francisco. “But the result for patients may be cacophony,” he said. “Sometimes less is more.”
The Joint Commission says another reason for its pause next year is because the way data is collected is changing. The group introduced a flexible reporting option for the current calendar year so hospitals could choose which measure they would report based on the procedures they perform.