HHS Should Develop Better Quality Measures, Watchdog Says

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By Michael D. Williamson

Oct. 13 — Federal regulators need to improve their planning of health-care quality measures, a government watchdog recommended Oct. 13.

The Government Accountability Office (GAO), in a report, also urged the Department of Health and Human Services to prioritize the development of so-called electronic quality measures. Electronic quality measures allow providers to report data elements digitally through information collected on electronic health records.

However, electronic quality measures are problematic for providers, Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association (AHA), told Bloomberg BNA Oct. 13.

Recommendations in the GAO report are meant to reduce administrative requirements for providers, who must often spend time collecting and reporting on different quality measures for a variety of public and private payers. The Centers for Medicare & Medicaid Services and private insurers use data collected from quality measure reporting as a way to encourage better patient outcomes and more efficient use of financial resources. However, payers sometimes mandate providers' collection of information on conflicting quality measures, and this misalignment could create administrative burden for providers.

The HHS concurred with the GAO's recommendations, the report said.

Problems With Electronic Quality Measures

A major problem with using electronic quality measures is clinicians record needed data in different fields in the digital form, which makes it difficult for medical record abstractors to obtain and record the information they need to report, Foster said.

Moreover, clinicians often use different wording and/or language to record data needed for reporting on the quality measures, Foster said. The lack of consistent language also makes it difficult for medical record abstractors to get the information they need.

Another problem is that quality measurement developers tried to simplify complex instructions used to collect quality information from paper records and then applied the simplified instructions to electronic quality measures, Foster said. However, the shortcuts on getting data from electronic measures often meant that medical record abstractors sometimes omitted necessary quality information.

Electronic health records will need to be changed to better cull information from them for quality measures, Foster said.

Additional Observations

Overall, the GAO is highlighting a very important issue that the AHA and others have been raising for a while, Foster told Bloomberg BNA. The challenge for hospitals and other providers is the quality measures are too plentiful, not well aligned and on many occasions have same or similar titles, but then ask for data differently, she said.

Quality measures with similar titles but that ask for different data make it confusing for patients, Foster said. This makes it difficult for patients and others to study comparisons among providers.

The report also said hospital personnel are spending an inordinate amount of time collecting data and not on improving performance, Foster said. While there are problems with the current system, Foster said the public sharing of performance is critical and important to efforts to improve quality.

The AHA is a hospital industry group with offices in Washington and is based in Chicago.

Report Specifics

The report said the GAO's interviews with HHS officials and others indicate there are three interrelated factors driving misalignment of health-care quality measures

One factor driving misalignment is dispersed decision making, the report said. Specifically, among public and private payers, each entity independently decides which quality measures it will use and which specifications should apply to those measures.

In addition, variation in data collection and reporting systems may allow payers to choose different measures, modify existing measures or leave details about measure specifications up to providers to accommodate differences in data that providers collect and the systems they use to collect these data, according to the report.

There's also a problem that only a few measures are “leading to meaningful improvements in quality,” although hundreds of quality measures have been developed, the report said.

The Medicare Access and CHIP Reauthorization Act of 2015 includes a provision for the GAO to examine the use of quality measures across HHS programs and private payers, with a focus on reducing burden, the GAO said. The watchdog group sent the report to the Democratic and Republican leaders of the Finance Committee and Health, Education, Labor and Pensions Committee in the Senate and the Energy and Commerce Committee and Ways and Means Committee in the House.

To contact the reporter on this story: Michael D. Williamson in Washington at mwilliamson@bna.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bna.com

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