During the past 20 years, I have seen the good, bad and ugly of publicly reported data on health care providers. The good is the pressure for improvement that public reporting sometimes creates. The bad is the rancor that results from that pressure. The ugly is the failure of the data to capture the nuances that define real excellence and real caring.
The data are actually much better today than in the 1990s, but they still have a long way to go. We could go to our graves awaiting perfection, though. The time has come for providers to stop complaining about publicly reported data, and to turn transparency into a strategic asset.
For providers to change the game in public reporting, they need to collect more and better data on the issues that matter to patients—and share them. They need to change the basic question that the measures are intended to answer, from “Who is the best?” to “How can we get better than we are today?” As they make this change, the organizations that are most forward-looking will turn their commitments to measurement and accountability into competitive advantages.
Let’s look at some of the characteristics of public reporting that are most problematic from the perspective of providers, and then consider how they might be addressed if providers make the measurement agenda their own.
First, and most important, publicly reported measures do not capture most of the outcomes that really matter to patients. Existing measures tend to rely upon administrative data, so they reflect only services that have been reimbursed under the fee-for-service system. They also concentrate upon providers’ performance of processes that are supported by research studies—i.e., evidence-based medicine.
As a result, existing measures are more about providers and their reliability rather than about patients and how those patients have done. Furthermore, since most providers do a good job of adhering to guidelines, process measures do little to differentiate among them. For many measures, 97% reliability puts you in the middle of the pack.
Another complaint is reminiscent of the old joke about dinner at Catskills resorts— terrible food, and not enough of it. In the case of public reporting, providers say the data are bad, and there is too little of it. In other words, not enough data are collected or reported to capture the real story of a provider’s care.
Valued-based Purchasing measures
focus upon a few narrowly defined patient populations—e.g., patients with acute myocardial infarction, heart failure and pneumonia. And the data for these measures might come only from Medicare or some other subset of payers. Other publicly reported measures may be based upon surveys done on a small sample of patients once a year.
And then there are social media sites where patients can publicly comment on physicians. Who are these patients? We cannot know. Some of the comments are written by disgruntled patients, but how representative are they? Other comments seem to have been written by people hired by the providers to send in glowing praise. With so many unknowns, the data are hard to put in perspective.
All of these problems with publicly reported data are real, but providers should not just throw their arms up in frustration. The answer is to fix the problems. Public reporting is never going to go away, so providers should accept the reality, and make public reporting better.
What does “better” mean? It means collecting useful data and more of it. It means measuring the outcomes that matter to patients—including the suffering that they experience as they navigate the health care system. And it means trying to collect these data on every patient, not just random samples or subsets specified by regulators.
And then providers should take the lead in putting these data in the public arena. They have to do it in a credible way—not cherry-picking the measures on which they look good. My favorite example of this new kind of transparency is the University of Utah’s online publication of every comment from patients who respond to their Press Ganey surveys
—the good, the bad and the ugly. The vast majority of the patient comments are in fact praise for their physicians, but the negative comments are included, too.
With its commitment to measurement and public reporting of patient experience data, the University of Utah has had enormous leaps in its performance during the past few years. And now several health systems around the country are getting ready to follow its lead. My bet is that this trickle will turn into a flood, as providers recognize that they can use transparency as an important strategy to improve their care and hold on to their market share.