Impact of Public Reporting on Unreported Quality of Care

Abstract

Objective. The impact of quality improvement incentives on nontargeted care is unknown and some have expressed concern that such incentives may be harmful to nontargeted areas of care. Our objective is to examine the effect of publicly reporting quality information on unreported quality of care. Data Sources/Study Setting. The nursing home Minimum Data Set from 1999 to 2005 on all postacute care admissions. Study Design. We studied 13,683 skilled nursing facilities and examined how unreported aspects of clinical care changed in response to changes in reported care after public reporting was initiated by the Centers for Medicare and Medicaid Services on their website, Nursing Home Compare, in 2002. Principal Findings. We find that overall both unreported and reported care improved following the launch of public reporting. Improvements in unreported care were particularly large among facilities with high scores or that significantly improved on reported measures, whereas low‐scoring facilities experienced no change or worsening of their unreported quality of care. Conclusions. Public reporting in the setting of postacute care had mixed effects on areas without public reporting, improving in high‐ranking facilities, but worsening in low‐ranking facilities. While the benefits of public reporting may extend beyond areas that are being directly measured, these initiatives may also widen the gap between high‐ and low‐quality facilities.

Top-Down and Bottom-Up Approaches to Health Care Quality: The Impacts of Regulation and Report Cards

“…They found that potentially avoidable rehospitalizations were not affected, for the most part, by the publication of the report card, and in those instances in which rehospitalizations did increase, the change was small (109). When they examined other outcomes masked in the report card, they found that facilities with high quality on reported outcomes also performed well on masked outcomes but that low-scoring facilities either did not change or performed worse on masked outcomes (108). This finding suggests that perhaps the low-quality facilities may be facing resource constraints that translate into teaching-to-the-test behavior, a strategy that facilities that are better off financially are not forced to adopt.…”

“…Fifteen studies (6,19,21,24,38,50,55,68,85,88,96,(107)(108)(109)112) found that public reporting led to better performance and patient outcomes, whereas five (15, 42, 54, 95, 103) did not. Thus most studies found positive effects.…”

“…Hamilton et al (47) studied Kaiser pediatric psychiatry clinics and found that the organizational reporting of access and service indicators limited implementation of evidence-based practices. Werner et al (108,109) examined the impact of Nursing Home Compare on postacute nursing home residents during the 1999-2005 period. They found that potentially avoidable rehospitalizations were not affected, for the most part, by the publication of the report card, and in those instances in which rehospitalizations did increase, the change was small (109).…”

Policy instruments to promote good quality long-term care services

“…They found that the care home providers with better star ratings, where the star rating derived from inspection activity, were not necessarily always those with better quality of life outcomes for service users. In addition, although Werner et al (2009) found that unreported aspects of clinical quality improved in US nursing homes, the improvements were less than those for reported aspects, indicating that providers do focus on what is measured to some extent. The mix of indicators is also important to reduce the risk that providers will indulge in cream-skimming, as observed on an albeit limited basis by Mukamel et al (2009).…”

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

“…Studies have found that nursing homes with high concentrations of Medicaid patients were more like to have quality of care problems due to very limited resources compared to nursing homes with low concentrations of Medicaid patients [39,[188][189]. In addition, public reporting may increase the divide between providers that are more or less able to improve quality [190]. The public reporting of quality may steer prospective residents away from poor quality nursing homes as report cards increase the likelihood that patients select higher-quality providers.…”