Posted in Perspective

The ongoing debate around quality reporting

Chris Nerney
Chris Nerney, Contributing Writer |
The ongoing debate around quality reporting

One of the most contentious topics among healthcare providers is quality reporting. Advocates say quality reporting inevitably leads to higher levels of care, while critics say it robs them of time that would be better spent seeing patients.
As Healthcare Finance News Associate Editor Jeff Lagasse notes, that debate played out recently in the Point/Counterpoint feature in the Annals of Family Medicine.
In a piece titled “How Quality Reporting Made Me a Better Doctor,” Dr. David R. Scrase, who practices internal medicine and geriatrics at the University of New Mexico Medical School in Albuquerque, made the case that “quality reporting certainly can lead to better outcomes for patients.” However, he added, “it does not always accomplish that goal.”
“As Medicare and other payers move to pay practitioners based on ‘quality scores’ and ‘quality outcomes,’ understanding how to make quality reporting more effective ought to be a critical priority for health care practitioners and health systems,” he writes. “The fact that we are increasingly being paid according to these systems, but are still debating their effectiveness, is a call to action.”
Scrase recommends a six-step model for improving quality of patient care:
1.     Agree on the standard of care
2.     Collect and provide initial reporting of the data
3.     Argue about the data
4.     Improve the data
5.     Provide actionable data
6.     Improve care and outcomes
“It is my thesis that only by using the 6 steps described above can quality reporting lead to better patient outcomes,” Scrase concludes.
Dr. David L. Hahn, meanwhile, contends that the current approach to accountability in healthcare – in which quality measures are blended with “pay-for-performance” (P4P) – results in “use of disease-oriented instead of patient-oriented measures, and arbitrary benchmarks lacking actionable information.”
“Pay-for-performance incentives to maximize performance instead of incentivizing informed patient preferences can put clinicians in the position of having to choose between providing excellent individualized patient care, or being paid equitably,” writes Hahn, who works in the Department of Family Medicine and Community Health at the University of Wisconsin School of Medicine and Public Health.
“Linking compensation with achieving arbitrary benchmarks conflicts with practicing shared decision making wherein the quality measure is the adequacy of the shared–decision-making encounter, not the prevalence of the eventual outcome chosen by the patient,” Hahn says. “These perverse incentives made me a worse doctor as indicated by failing to meet the benchmarks.”
Hahn adds that quality measures should 1) provide actionable information, and 2) “align with good clinical practices and promote patient-centered care, especially shared decision making.”
“Measures should not be used to arbitrarily and spuriously reward or punish clinicians,” he concludes.