Ideally, everyone in the U.S. who needs care would be able to find it and feel confident that they’re in good hands. In reality, though, it can be difficult to predict the quality of care you’ll receive when you meet with a provider.
That’s why health care quality measures are designed to provide consistency in health care. Ultimately, they aim to raise the standard of care for patients across the country. These comprehensive measures come primarily via the government, since the Centers for Medicare and Medicaid Services (CMS) funds more health care than any other payer. Measuring the caliber of care can help guide patients, payers and providers to better ways of rewarding quality over quantity.
As health care moves further from a fee-for-service system of payment and transitions to a value-based care model, these measures are bound to shift over time. However, to get the whole health care system on the same page and delivering the same level of quality, it’s important that everyone involved starts from the same place.
Who Measures Quality, and What Do They Measure?
The National Quality Forum is an independent organization that uses expert panels to develop and make recommendations about quality measures in the U.S. The group, which receives funding from both private and governmental organizations, works to strengthen patient protections and improve the quality of health care. However, it doesn’t report data to the public.
CMS evaluates quality of care by considering factors that indicate whether a hospital is providing care that centers on the patient’s well-being and treats them effectively and safely. They actively monitor factors such as how many patients contracted an infection after they were admitted to the hospital. They may also assess how many patients were diagnosed with high blood pressure versus patients whose high blood pressure was treated, or they could count the number of patients whose diabetes is under control and routinely tested.
Specialty care brings new variables to the mix. For example, pediatricians’ scores may fluctuate based partly on how many children in their practice receive the recommended vaccinations, and measuring obstetrician quality includes reporting how many cesarean section deliveries they perform, since this number should be a relatively small portion of all the deliveries they attend.
Health care quality measures can also vary depending on who is surveying and tabulating the results. Though CMS reporting is mandatory, other organizations, such as the Leapfrog Group, conduct voluntary surveys of hospitals and their patients. They generally also use data from CMS to assign hospital safety scores.
Quality measures used by CMS are based on proven benchmarks or standards in the practice of medicine. For instance, physicians providing high-quality care will typically align their services with recommendations from bodies of experts who set the standards for care.
Do Regional Trends in Health Affect Quality Measures?
Although health care expenditures vary regionally, short-lived health trends like the flu do not affect quality measures. Instead, quality measures look at providers and facilities’ direct actions, such as the fact that a specific doctor only gives flu shots to 15% of patients age 65 and older, or that a certain hospital has a high number of readmissions. It’s possible to measure progress because medicine already has established benchmarks in medicine. In other words, modern medicine already knows how to head off a flu epidemic, and that is with vaccinations. Similarly, looking at test results tells doctors how “well” patients should be when they leave the hospital.
Why are these factors the focus, then, rather than regional ones? Although there are some regional disease trends, the measures of quality of care are consistent across all states. Health care quality measures indicate whether hospitals or ambulatory centers are following recommended treatment guidelines, which ensures that hospitals across the country — not just across a region — can provide the same high level of care.
Consider the stroke belt, an 11-state region of the U.S. covering much of the South that has higher rates of stroke than the rest of the country. Standards for quality are the same as in states with lower rates of stroke: The higher rate of stroke is not a consequence of the health care in those states, but rather a consequence of increased smoking, obesity and high blood pressure. Physicians aren’t penalized simply for practicing in these areas — only if they aren’t delivering appropriate care to these patients. Quality measures are in place to ensure that patients in the stroke belt receive the same standard of care as patients in other parts of the country. In essence, there is simply no need to adjust standards of quality, since they should be the same for every patient, regardless of location.
Will Quality Measures Adjust Over Time?
When patients have access to consistently high-quality care, their health tends to improve. On a larger scale, searching out ways to deliver quality care spells better health for the country as a whole — but it’s worth noting that “quality” as a concept is far from static.
The medical community is always on the verge of the next breakthrough in health science. What initially seemed like a good first-line treatment may eventually become the second- or even third-line treatment in the future, and as treatments change so will popular opinions about what it means for care to be of high quality. But for now, consistent quality means getting everyone to the starting line so that all patients can expect the best chance for their health.
Measuring quality is a delicate process, but in the end the metrics chosen are meant to truly indicate whether hospitals and physicians are following standard protocols. Standard medical practices — washing hands regularly, not offering elective C-sections, asking patients to get their vaccinations, protecting vulnerable patients in the hospital from what their visitors might bring in — do not change much over time. These measures do not remove the “art” from the practice of medicine. Instead, they ensure that the physicians and their staff are following the basic rules that benefit every patient and improve the system that so many rely on to stay in good health.