It’s time for your annual car inspection, and you’re dreading it. Last year, you chose the lowest-cost mechanic you could find. This year, you’re in the market for a new mechanic. Shopping around, you once again put together a short-list of the most affordable auto shops in the area. But will affordability compromise the quality of the service?
Now, apply that logic to the cost of a shoulder surgery. Would you pay less for a shoulder surgery knowing you may need to have it done again in two weeks?
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With price transparency, most patients will lean toward lower cost. But if a shoulder surgery is performed by a provider who has 50% lower quality than other providers in the area, the patient is likely going to wind up back in surgery again in a matter of weeks or be left with an undesirable outcome— making affordability moot. Only in healthcare do we ask health plans and patients to pay an unpredictable amount for an unpredictable outcome.
The White House has placed great focus on pricing transparency that went into effect earlier this year, but very little attention has been given to an essential part of the value equation: quality measure transparency.
If consumers can’t measure the quality of a service, it is impossible to judge value, meaning why would a consumer care about price if they have no idea how to cross-reference cost and quality? If we want to address value, we need to address quality transparency beginning with widespread adoption and utilization of standardized quality measures.
Why we need standard quality measures
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Blackford Middleton An industry expert for over 30 years, Blackford Middleton, MD, MPH, MSc, is Chief Informatics and Innovation Officer at Apervita, the trusted platform for healthcare collaboration for payers, providers and other stakeholders. He is Adjunct Faculty member at the Stanford University Medical Center Clinical Excellence Research Center and currently serves on the Editorial […]
As Lord Kelvin and Peter Drucker have said ‘We cannot improve what we cannot measure,’, and without standardized quality measures, we cannot be confident that every provider is measuring in the same way.
A large government agency’s interpretation of what constitutes a behavioral health practitioner is one example of the level of disparity in quality measurement. By sticking to a loose interpretation of who counts as a “valid practitioner,” this large government was able to include marriage counselors in their behavioral health measurements. On paper, it looked like the agency was seeing more patients for behavioral health checkups than they actually were. This boosted the agency’s quality measurement scores. Health systems that stuck to a stricter definition of who counts as a “valid practitioner” in behavioral health might seem to pale in comparison.
When we measure differently, quality comparisons become false representations of performance, and prevent apples-to-apples comparisons across care settings and providers. If we want to empower patients to make informed decisions about their own health, we need to make quality measures standard and transparent.
Where traditional quality measurement can go wrong
Non-digital, non-standardized quality measurement allows human variation to run rampant. Interpretation becomes part of the job and inherent to the process, as in the case with defining a “valid practitioner.”
Even a simple “AND” vs. “OR” statement can invite misinterpretation amongst coders. A measure that requires a patient to have a diagnosis code (F33.1) AND (F43.23) would have very different results if accidentally coded as (F33.1) OR (F43.23).
With standardized digital quality measurement, there is no room for interpretation or mistakes. Specifications are written in clinical quality language (CQL) and executed without anyone having to rewrite them. This work is already underway at a number of institutions.
The advantages of digital quality measures are inherent
There are some health systems that are more innovative and have embraced digital quality measurement. Others have remained hesitant, largely because it is an investment without an immediate return. However, once digital quality measurement is adopted and implemented, ROI snowballs over time and the advantages become clear. In essence, digital measurement is the cornerstone of the Learning Health Systems, a framework of continuous learning and improvement to drive better outcomes and cost efficiencies.
Having standardized digital quality measurement means easier conversations between payers and providers around performance. Digital measurement allows for guaranteed accuracy of the measure results and empowers providers with intermediate results so that they have granular insights into why a patient is not in the numerator of a measure. Additionally, the ability to see quality measurement in near real-time means providers will be able to improve their performance before submission. Traditional measurement processes could never allow for this.
Another clear advantage of standardized digital quality measurement is the ability to compare on a one-to-one basis, or similar comparison. With digital measures, we can evaluate the quality measures reported by two separate health systems and be confident that one of them is truly performing better than the other.
Applying standards and transparency to quality makes managing value-based contracts and alternative payment models much easier. Today, a health system might be implementing the same measure 10 different times across multiple different departments for multiple different contracts. Health systems that adopt and implement digital quality measures have the advantage of reutilizing the same CQL measures for many different uses.
Where we can go from here
Standardized quality measurement has the power to revolutionize healthcare, but we need to invest and commit as an industry to make it work. There are still roadblocks to progress in the movement toward digital measurements because, unfortunately, there is still money to be made from traditional measurement. Several vendors across the industry have no desire to shift from traditional measurement to digital measurement because, at the end of the day, complicated, traditional measurements can be lucrative.
The Joint Commission — the nation’s oldest and largest standards-setting and accrediting body in healthcare — has made the move to standardized digital quality measures, while National Committee for Quality Assurance (NCQA) has committed to having all their measures in a digital format in the near future. CMS has repeatedly reiterated the importance of standardized digital quality measurement and is mandating a standardized digital format.
It is incumbent upon the industry to take bold steps toward moving past the archaic processes of traditional measurement and accelerate the adoption and implementation of digital measures.
We can start by rallying around CMS’ and NCQA’s strategy to accelerate the shift toward digital quality measurement, and transparency will follow.
Photo: atibodyphoto, Getty Images
An industry expert for over 30 years, Blackford Middleton, MD, MPH, MSc, is Chief Informatics and Innovation Officer at Apervita, the trusted platform for healthcare collaboration for payers, providers and other stakeholders. He is Adjunct Faculty member at the Stanford University Medical Center Clinical Excellence Research Center and currently serves on the Editorial Board of the Journal of Learning Health Systems and the AHRQ ACTS Roadmap Workgroup.
