Blog » The Paradox of Quality Accountability

The Paradox of Quality Accountability

Created Oct 03 2016, 08:00 PM by Lippincott Solutions
  • Modern Healthcre
  • quality measures
  • Center for Medicare & Medcaid Services
  • patient safety
  • standardizing care
  • CMS

Tuesday, October 4, 2016

The enthusiastic rush in recent years to hold hospitals and providers accountable for the quality of care they provide is resulting, ironically, in poorer quality care, according to a growing segment of healthcare providers fed up with the volume of quality measures they are called on to report.

A publication from the Healthcare Association of New York State tallied the number of quality measures required by private insurers, accountable care organizations, the Centers for Medicare & Medicaid Services, and other groups and came up with a staggering 2,100-plus.

“Measure madness” is how the association describes the current state of affairs.

All the time and energy put into reporting the thousands of quality measures, they say, takes up “precious resources that could be directed toward meaningful efforts to continuously enhance quality and patient safety.”

Indeed, the National Academies of Sciences, Engineering and Medicine last fall said that rushing through clinical reasoning could be behind the high rate of diagnostic errors in the U.S. healthcare system, according to a Modern Healthcare article. They deemed the problem a “persistent blind spot” in attempts to increase patient safety.  


Just how much time must providers spend reporting on quality measures? According to a study in the March issue of Health Affairs, physician practices spend 785 hours reporting quality measures per physician, at a total cost of more than $15.4 billion a year.

Researcher Lawrence Casalino, MD, PhD, chief of the division of health policy and economics at Weill Cornell Medical College, New York City, told Modern Healthcare that $15.4 billion is “a large amount of money being wasted on checking this box and that box. It’s time physicians could spend on not rushing a patient or thinking about a diagnosis more carefully.”

Participants in Dr. Casalino’s study were just as outspoken in their comments, according to Modern Healthcare, with one calling quality reporting a “complete waste of time.” Another stressed the need for consistency. “Otherwise, we are always training on reporting, rather than improving care,” the family practice leader wrote.


Consistency and standardization are exactly what many providers seek. The Healthcare Association of New York State is calling on stakeholders to tone down measurement madness by jointly committing to a specific number of measures that focus on the most vital aspects of care.

"What we have right now is a labyrinth of confusing metrics, specifications and reporting rules that serves no one," said Kathleen Ciccone, DrPH, RN, executive director of the association’s quality institute. “We need to get to a common set of measures that matter for improving patient care."

Robert Wachter, MD, a professor in the school of medicine at the University of California San Francisco, advocated for a similar approach in a New York Times opinion piece back in January. 

“Measurement cannot go away, but it needs to be scaled back and allowed to mature. We need more targeted measures, ones that have been vetted to ensure that they really matter,” he wrote.

“In medicine, for example, measuring the rates of certain hospital-acquired infections has led to a greater emphasis on prevention and has most likely saved lives. On the other hand, measuring whether doctors documented that they provided discharge instructions to heart failure or asthma patients at the end of their hospital stay sounds good, but turns out to be an exercise in futile box-checking, and should be jettisoned.”


While the healthcare field eagerly awaits the emergence of quality reporting standardization, some health systems are taking action on their own. Indiana University Health recently began a multiyear project to scale back and streamline measures clinicians in its multispecialty group must report, according to Modern Healthcare.

By next year, the system aims to boil down the measures specialty providers will have to track to fewer than a dozen. Last year, it cut the number of inpatient measures tracked from 199 to 10, according to the article.

“Someone needs to pay attention,” Jonathan Gottlieb, MD, chief medical executive, told Modern Healthcare. “But we want our doctors and nurses to focus on measures that contribute directly to the welfare of the patient.”

Do you think quality measure reporting results in better—or poorer—quality of care? How does your health system handle it?

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