Performance Measurement & Public Reporting: Consumer Perspective and Principles To schedule a presentation of “Performance Measurement & Public Reporting” for your organization staff and/or collaborators, contact the National Partnership at

Presentation Overview The Case for Improving Health Care Quality The Role of Performance Measurement in Improving Care The Role of Public Reporting in Improving Care The Consumer Perspective on Performance Measurement and Public Reporting

Health Care Quality An estimated 190,000 people a year die from medical errors. Adults have a 55% chance of getting the right care at the right time. Children only have a 46% chance! There are more than 1.7 million hospital-acquired infections yearly. Improving health care quality could save $630 billion annually! Quality health care is: Safe: it does not injure patients. Effective: it is based on sound science. Patient-centered: it is respectful of patients’ preferences, needs and values. Timely: it avoids potentially harmful delays. Efficient: it does not waste resources. Equitable: it does not vary because of race, gender, language, ethnicity, income or location.

What are Performance Measures? A way to evaluate the care provided by hospitals and physicians based on accepted national guidelines.

What Do Performance Measures Evaluate? Processes of care Outcomes of care Access to care Patient experiences with care Organizational structure and systems of care Use of services

What Can Performance Measures Tell Us? Overuse Underuse Misuse What Gets Measured Improves!

Public Reporting You can learn more about the safety record of a car than the safety record of a hospital.

Why Report Health Care Data Publicly? What Gets Measured Improves! And What Gets Reported Publicly Improves Even More!!

Consumer Advocates Can Impact Public Reporting Consumers can advocate for performance information that is reported publicly and that is easily accessible and understood by the public.

Raise Consumer Awareness Consumer Advocates Can: Provide consumers and constituents with a framework for evaluating quality. Explain what constitutes excellent, good, and fair performance. Encourage measures that are understandable and actionable. Explain the concept of risk adjustment.

Increase Consumer & Patient Motivation Consumer Advocates Can: Tell consumers and constituents that their choices have consequences. Personalize the issue of quality through stories. Explain that a bad decision carries risk. Provide meaningful information.

Consumer Principles on Public Reporting

~Public reports should use measures that are meaningful, understandable, and actionable for consumers in various health care settings– physician, physician group, hospital, nursing home, etc. ~Public reports should include measures based on national standards – those that are endorsed by the National Quality Forum (NQF). When NQF-endorsed measures do not exist, the next level of measures that should be used are those endorsed by the National Committee for Quality Assurance, the Joint Commission and HQA, a multi-stakeholder alliance that is committed to providing performance information to the public. ~Measures should be useful to consumers in making choices about their health care providers (i.e. does the provider deliver the right care at the right time with appropriate results?) and their treatments (does a certain treatment or procedure have better results than another treatment or procedure?). Measurement Principles

~Public reports should also include cross cutting measures – or measures that are common to all patient visits with doctors, nurses, and other health care providers. Cross cutting measures (i.e., patients’ experiences with care, pain management, etc.,) have more meaning to a greater number of patients ~When possible, public reports should include measures that evaluate the results of care (outcomes measures) and measures of specialty care, particularly for those specialties where patients have more time to choose a provider – such as orthopedics and obstetrics. ~Measures should be collected in a way that permits sorting and analysis of data by race, ethnicity, and gender to determine where health care disparities may exist and to identify potential interventions. Measurement Principles Cont.

~Public reports should be developed with the input of all stakeholders, be easily accessible to all stakeholders, and be promoted by all stakeholders. ~Consumer advocates – like other stakeholders – should be closely involved in the design of reports and the appropriateness of report design should be verified through consumer testing. ~Public reports should be designed for the cultural context, decision context, and literacy levels of consumers, health care purchasers, and other users. ~Public reports should be available for free in numerous formats including online and in hard copy in various locations. ~Public reports should be promoted by advocacy and community groups as well as health care providers, employers and health plans. ~Public reports should present performance information in a comprehensible way. Reporting Principles

Reporting Principles Cont. ~Public reports should include a summary and ranking by performance. Summarizing and ranking providers by performance reduces the data consumers have to process. When any individual measure or groups of measures are combined, the individual scores and any formulas used to develop the combined or composite scores should be available. ~Public reports should use symbols that are universally understood. ~Public reports should avoid overly technical terminology and be as brief as possible. ~Public reports should provide meaningful, but understandable, detail about what constitutes good, poor, etc. performance. ~Public reports should provide information that allows consumers to identify the best and worst performers. When creating reports that bucket providers into categories (average, better, worse), cut-off points should result in provider differentiations. Cut-off points that result in all the providers clustered in the middle with no outliers renders the report useless.

~Public reports should be transparent and credible and provide appropriate contextual information. ~Public reports should identify the sponsors of the report and the source(s) of the data. ~Public reports should be based on the most recent data available and clearly identify the time period for the data. ~Public reports should be fair and accurate in their characterization of health care providers. ~Providers vary in terms of how sick their patients are. To the extent possible, the differences in patient populations should be taken into consideration when calculating measures to allow for fair comparisons across providers. Taking these steps or “risk- adjusting” ensures that providers are not penalized for caring for sicker patients. ~If reports include specific targets for performance, the justification and explanation for setting these targets should be disclosed. Reporting Principles Cont.