The findings in the now two-decades-old report To Err is Human: Building a Safer Health System sparked a call for new, more stringent, quality measures.
The industry had been measuring quality for more than a century, but “it had been a backwater phenomenon until the report happened,” said Dr. Kedar Mate, chief innovation and education officer at the Institute for Healthcare Improvement. “The report upped the ante. It put a new kind of imperative around quality in general and quality measurement especially. The consequence of not understanding quality of care was losing lives.”
Before the Institute of Medicine’s report, quality measurement reporting wasn’t tied to federal reimbursement. Institutions and doctors weren’t penalized for performing poorly.
In the years since the report, much has changed. The CMS now requires hospitals, outpatient settings and nursing homes to track quality in order to receive full Medicare payment. Performance on some measures is publicly displayed on Medicare’s Compare websites. And with the 2010 passage of the Affordable Care Act, the agency now penalizes hospitals for performance on some measures such as readmissions and infections. The Medicare Access and CHIP Reauthorization Act of 2015 authorized a similar fate for physicians.
But those moves have done little to protect patients. In fact, some research suggests one of the more successful metrics, lowering the rate of readmissions, may have led to unintended deaths.
“When you look at the body of measures that are being used today, whether they are Medicare or the private sector, it came from the industry itself. And they weren’t being put up against core criteria,” said Francois de Brantes, senior vice president of business development at consultancy Remedy. “The industry always shoots for the lowest common denominator and you end up with what we have, a (group of measures) that don’t do a good job of actually determining whether or not we are closer to the system the IOM report recommended.”
Of course, it makes sense for quality information to be available for consumers and that payment for services be based in part on the quality of care provided. The problem is that clinicians and quality leaders largely don’t trust the measures and don’t think they help them do their job any better.
“What I’m hearing from our members and what they are hearing from their practicing physicians is that we need to reform the quality measurement regime we are living under right now,” said Dr. Jerry Penso, CEO of AMGA, a trade association that represents 175,000 physicians nationally. “There are too many measures, they are not harmonized, they are not meaningful to the patients or the providers, they are costly and they are burdensome to collect, and it’s contributing to physician burnout.”