Quality and safety are the top priorities of any health system. Patients put their trust in us, often, in the most vulnerable moments in their lives. High-quality, highly reliable, compassionate care isn't optional.
Patients have the right to expect our best care and good value for their healthcare dollars. Recognizing that, hospitals and health systems are embracing the move to value-based care and enhancing affordability. The goal is to provide greater value to patients by improving quality, lowering costs and enhancing the patient experience.
The "catch" is that defining high-quality care, measuring it and communicating about it with integrity and transparency is tough. Darn tough. It starts with a culture of caring in which patient interactions are authentic and decisions are made with the patient as part of the team.
While understanding culture is easy—just walk around, listen and observe—the challenge is in establishing and maintaining a culture in which the focus is unwaveringly on delivering the best possible performance for the complex and varied patients in our hospitals. Good decisions are based on actionable information that takes a standardized approach and yet respects differences in patients' needs and wishes. A culture of caring is also an environment where caregivers feel comfortable and responsible for reporting errors and near misses.
While not everything that counts can be counted, measurement is necessary and holds tremendous potential for improving quality. Measuring too many things, however, is distracting and wasteful. Excessive measurement is costly. According to an American Hospital Association report, the average-sized hospital spends $710,000 per year on its CMS reports. This includes tracking and compiling data for more than a dozen registries, such as meaningful use, core measure abstraction and eCQMs, MIPS and HCAHPS. The cost is compounded by additional reporting required by private payers and rating groups.
Without question, quality and patient safety have improved in the past decade. But the plethora of measures, rankings and rating agencies have done more to confuse the public than demonstrate our achievements and identify opportunities for further work. It's time to agree on standards to continue to improve the value of healthcare.
To be most useful to patients, we believe it is essential that measures be more patient-centered and procedure- or diagnosis-specific, or be related to processes that affect the majority of patients such as medication management and complication rates, as well as the seamless transfer of health information. We also need measures that address areas where many believe there is significant opportunity for improvement, such as end-of-life care. The CMS took a step recently, proposing to eliminate a number of topped-out and duplicative measures as part of its "Meaningful Measures" initiative.
In addition to assessing safety and quality, it is critical that care be affordable. We are keenly aware that even though there have been significant increases in insurance coverage over the past several years, out-of-pocket costs and premium costs weigh heavily on many families around the country. We need measures that will help us eliminate unnecessary services—giving patients all of the care they need, and only the care they need, to help reduce costs.
While we cannot fix the issue alone, hospitals and health systems must be leaders in finding solutions, collaborating with stakeholders and advocating for policies that promote value. The AHA launched the Value Initiative to drive the national dialogue on improved affordability, working with consumers and insurers, employers, elected officials and others to increase the value of healthcare services offered throughout the country. The initiative also provides hospitals with the education and resources they need to continue redesigning the delivery system, implementing new payment models, improving quality and outcomes, and reducing costs.
We are on a remarkable journey. Hospitals have done significant work to improve quality and reduce costs over the past decade, but we need to do much more. Together, let us serve as a driver of change for the entire field, and may we never lose sight of why.
