Public Reporting of Hospital-Level Cancer Surgical Volumes in California: An Opportunity to Inform Decision Making and Improve Quality

Abstract

There is clear potential for more readily available information about hospital volumes to help patient, providers, and payers choose cancer surgery hospitals. Our successful public reporting of hospital volumes in California represents an important first step toward making publicly available even more provider-specific data regarding cancer care quality, costs, and outcomes, so those data can inform decision-making and encourage quality improvement.

Estimating hospitals’ all-payer volume of cancer surgeries from Fee-for-Service Medicare claims

“…Organizations in California have spearheaded these efforts by sharing methods on how to use administrative or discharge data to report volume, with hopes that other states would follow suit (20). In 2018, the Pennsylvania Health Care Cost Containment Council reported on the number of cancerrelated surgeries performed at Pennsylvania hospitals based on California's report (21)(22)(23). Proponents of reporting cancer volume argue that at the very least patients deserve to have access to hospital volume information to inform decision-making (24).…”

Utilization of Prostate Cancer Quality Metrics for Research and Quality Improvement: A Structured Review

“…Volume is often considered a proxy for health outcomes, and recent literature highlights its importance in oncology, including better health outcomes and survival for prostate cancer in both European 48 and US practice settings. 49,50 The second and third most frequently used measures were process focused: the use of androgen deprivation therapy (ADT)/adjuvant hormonal therapy for high-risk patients, and documentation of clinical T stage. ADT agents have demonstrated benefits achieved for effective palliation 51 as well as survival, 52 while the assessment and documentation of the clinical T stage is fundamental to treatment selection.…”

Association of Hospital Public Quality Reporting With Electronic Health Record Medication Safety Performance

“…Public quality reporting has been theorized to reduce information asymmetries and increase patient welfare while providing low-performing hospitals incentive to improve. 10 , 11 , 12 , 13 However, recent evidence has cast doubt on whether national programs are useful tools in identifying high quality, 14 and while some programs, such as the Joint Commission, do provide a quality floor that all nearly all hospitals must meet, they may not help distinguish higher or lower quality among accredited hospitals, and it is unclear if public reporting is an effective way to encourage improvement. Public quality reporting may also unfairly penalize hospitals that serve low-income and disadvantaged populations, 15 , 16 and result in patient selection to avoid patients who are more seriously ill. 17 While hospitals may improve when they participate in these programs, 18 , 19 pay-for-performance initiatives intended to reward high quality through financial incentives have found mixed results, 20 with the potential for hospitals to game these systems and harm patients.…”

“…One potential policy mechanism to incentivize quality improvement is public reporting of performance. Public quality reporting has been theorized to reduce information asymmetries and increase patient welfare while providing low-performing hospitals incentive to improve . However, recent evidence has cast doubt on whether national programs are useful tools in identifying high quality, and while some programs, such as the Joint Commission, do provide a quality floor that all nearly all hospitals must meet, they may not help distinguish higher or lower quality among accredited hospitals, and it is unclear if public reporting is an effective way to encourage improvement.…”