Over the past 25 years, federal policies and national trends have helped to determine which measures will be used in the annual 100 Top Hospitals study.
When the list was first published in 1993, most of the measures focused on financial performance of hospitals. Jean Chenoweth, senior vice president of performance improvement at IBM Watson Health, said that's a reflection of what was happening politically.
"At the time, the focus was on access and on cutting costs, so the scorecard in its initial version is a reflection of those priorities because that is what the leaders were focused on," she said. "We have always tried to focus on the areas that were in the minds of the leaders."
Related chart: Top 100 Hospitals measures through the years
The influence of federal policy on the measures used to determine the 100 Top Hospitals reflects a larger truth about quality measurement in the U.S. Experts argue that most of the measures hospitals use and value are the ones that have been pushed by the CMS as important either through regulations or payment programs. Consequently, how the measures can help patients and improve outcomes are secondary, and sometimes they're even moot points.
Many "of the measures are tied to payment—it's a big influencer because hospitals know that it goes right to their bottom line," said Dr. Amita Rastogi, medical director of Altarum's Center for Value in Health Care.
The emergence of clinical measures didn't really begin until after the Institute of Medicine published its landmark report To Err is Human in 1999. Under enormous pressure to better regulate safety and quality issues at hospitals, the CMS began developing quality and safety measures.
Sorely missing from those conversations were patients, which led to the development of measures that often don't help patients, Rastogi said. "We still don't know which measures are important and actually make an impact," she added.
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