White House’s latest quality initiative: Panacea or new ring of red tape?
It might ease reporting burden but miss consumers’ real concerns
If "try and try again" is the key to useful, cost-effective quality measures, then we have another cause for optimism in President Clinton’s recently announced initiative to measure and report health care quality.
Launched on the recommendations of the president’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry, the effort includes both public and private sector components.
The public sector Advisory Council on Health Care Quality will set national clinical aims — for instance, reducing medication errors by a certain percentage within two years. The council also will develop strategies to achieve the national goals. The composition of the advisory council still is on the drawing boards.
The private sector Forum for Health Care Quality Measurement and Reporting will implement comprehensive and standardized health care quality measurements. Its second charge is to ensure widespread availability of quality reports to consumers, providers, purchasers, and others. Serving on the forum will be representatives of private and public health plan purchasers, consumers, and providers.
Work will commence sometime next year, says Richard Sorian of the U.S. Department of Health and Human Services in Washington, DC. Sorian served as deputy director of the commission until it completed its work last March.
The forum’s objectives promise a little something to everyone:
• for providers, lighter reporting burdens by elimination of duplicate and inconsequential reports;
• for consumers and purchasers, a common yardstick to compare health plans, hospitals, long-term care, and physicians.
Experts still aren’t sure, however, whether those objectives will be met. Don Berwick, MD, who is founder of the Institute for Healthcare Improvement (IHI) in Boston, expresses cautious optimism.
A member of the original quality commission, Berwick observes, "We hope the forum’s work will reduce the burden of JCAHO [Joint Commis sion on Accreditation of Healthcare Organiza tions] and NCQA’s [National Committee for Quality Assurance] reporting. In theory it could, but nobody knows how it will play out. It could be politicized, but it has a very real chance of doing some good."
Less hopeful is Patrice Spath, health care quality and resource management consultant with Brown-Spath & Associates of Forest Grove, OR. She foresees problems if private-sector employers were to dominate the forum. "One wonders if their needs and interests are consistent with consumers’," Spath says. "As payers for health care services, employers might have a different idea of how to measure quality.
"There’s a public uproar right now around being able to pick your own doctor," she notes. "But I doubt if payers would place high priority on this because it might raise premiums $100 a month."
There’s resounding agreement about one facet of the forum’s mission — easing providers’ reporting burdens. For example, Berwick says, "Some insurance plans now have as many as 900 data elements they’re reporting to different bodies. And not all the data elements are especially useful."
Sandra Schmoll, MBA, manager of information services with The Alliance, a Denver-based purchaser of health benefits for small businesses, says she’d like the forum to consolidate quality measures to help conserve health care resources. It’s nothing to see insurance companies with whole departments devoted to turning out HEDIS reports for NCQA, she notes. "I would not want to see the forum add to the paperwork in this industry."
Indeed, we probably have 20 different ways to measure immunizations, notes Sorian. "We need to eliminate those and agree on one. That will free up resources to move on to other important measures that we haven’t even touched yet, like measuring care for chronic or disabling conditions." For example, arthritis treatments need attention, he explains.
Does effort presage tighter federal controls?
A partnership like the forum certainly stirs conjecture about advancing governmental presence into private health care. "This seems a portent of more federal control," Schmoll says. "Let’s say a plan does not meet some criteria set by the forum. Will it incur some type of sanction?" she asks. "But we can’t tell until we know how they are going to use the data."
Sorian says the forum’s evolution could parallel that of the NCQA’s HEDIS compliance. Right now, forum participation is voluntary and open to all, even government health care purchasers, he notes. As with NCQA, forum membership will imply agreement that the participating organization will base health service purchasing decisions on the standards to be set by the forum. For openers, he explains, compliance with the forum’s measures and reporting criteria probably will be voluntary.
Will the forum gradually solidify this voluntary compliance into accreditation or certification as NCQA has through its health plan accreditation? How would that improve health care quality for Americans? Only time will tell.
Brian Schilling, NCQA spokesman, explains the accreditors’ move as a sign of their intention to be at the forefront of any effort in this country to rationalize quality measures.
Meanwhile, notes Sorian, AMAP has official representation on the forum. While JCAHO and NCQA do not have official forum representatives, some members of the body have close ties with both organizations, he reports. He reads their participation as a sign of readiness to "give up their less-valuable measures and incorporate more-valuable new ones."
How will the forum’s work help consumers as they decide on insurance plan X, Y, or Z? In theory, Berwick explains, the forum’s objective is to show consumers how health plans measure up to national quality criteria. That information should enable them to choose a health plan on the basis of its quality.
But Spath is pessimistic about the public’s use of quality ratings for much of anything. "I am not sure whether the public will use quality information that tells them they need to drive an extra hundred miles to see a doctor who gets a better rating than their own. Consumers are really clamoring more for access to health care than for quality ratings." (For an eye-opening corroboration of Spath’s comments, see story, at right.)
Sources
For more on health care quality measurement, contact:
• Patrice Spath, Brown-Spath & Associates, P.O. Box 721, Forest Grove, OR 97116. Telephone: (503) 357-9185. E-mail: [email protected]. World Wide Web: http://www.brownspath.com.
• IHI, 135 Francis St., Boston, MA 02215. Telephone: (617) 754-4800. World Wide Web: http://www.ihi.org.
• Sandra Schmoll, The Alliance, 650 S. Cherry St., Suite 300, Denver, CO 80246. Telephone: (303) 333-6767, ext. 141. Fax: (303) 322-3830.
For progress reports on the Forum for Health Care Quality Measurement and Reporting or the Advisory Council on Health Care Quality, or for a free copy of the final report of the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry, contact:
• Consumer Bill of Rights, Box 2429, Columbia, MD 21045-1429. Telephone: (800) 732-8200. World Wide Web: http://www.hcqualitycommission.gov.
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