Our New Reality of Public Reporting: Shame Rather Than Blame?

Abstract

T he number of organizations issuing reports on hospital and physician quality performance has increased markedly over the past decade. Differences in the measures, data sources, and scoring methodologies produce contradictory results that lead to confusion for the public, providers, and governing boards, and impair the public's ability to make well-informed choices about health care providers [1]. This variability continues today and points to concerns about validity and the ultimate reliability of the measures used by these groups.The hospital community and surgeons as a whole support the principle of accountability through public reporting of health care performance data. However, performance data that are inappropriately collected, analyzed, and displayed may add more confusion than clarity to the health care quality question [1]. For data to be understood and for results to be comparable, publicly reported data should adhere to a set of guiding principles. With that goal in mind, the Association of American Medical Colleges (AAMC) convened a panel of experts in 2012 and 2013 to develop a set of guiding principles that can be used to evaluate quality reports. The principles were organized into three broad categories: purpose, transparency, and validity.Under the domain of purpose, the AAMC recognized that public reporting and performance measurement should occur for a variety of reasons, including consumer education, provider quality improvement, and purchaser decision making. Relative to transparency, the AAMC believed that methodologic details should be clearly discerned as they can impact both providers' performance data and the appropriate interpretation of the data. Transparency also requires that all information necessary to understand the data be available to and interpretable by the reader. Limitations in data collection and methodology as well as relevant financial interests should always be disclosed in language that is discernable. Lastly, validity of the data must ensure that the methodology, data collection, scoring, and benchmarks produce an accurate reflection of the characteristic being measured and reflect the care being provided by the hospital or physician. These guiding principles were expanded and proposed by the AAMC to facilitate adherence and to ensure appropriate interpretation of performance as public reporting becomes truly a cottage industry. Federally Facilitated Quality and Patient ProgramsIn the recent and final Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the LongTerm Care Hospital policy for fiscal year 2015, the Centers for Medicare and Medicaid Services (CMS) aimed at promoting high-value and high-quality care using a program that is targeted at a specific set of preventable infections, events, and conditions that occur in the inpatient setting, referred to as hospital-acquired conditions (HAC). Similar to CMS value-based purchasing and readmissions reduction programs, this HAC reduction program has significant implications for academic centers...

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