Summary: Performance transparency is as broken in health care as price transparency is. Here is a compelling perspective in a piece from the New England Journal of Medicine explaining just how many ways performance metrics are broken, and offering a few suggestions on how to fix the situation.
“Just a few decades ago, there was little effort to measure the performance of the health care system — indeed, most aspects of health care quality were considered unmeasurable. The situation started to change as research revealed wide variability in the safety and quality of health care and as measurement was increasingly recognized as an important tool for improving quality. Today, health care providers and payers spend substantial resources collecting, analyzing, and reporting data on providers’ performance. Given the investment and stakes involved, we need to ensure that we get the most improvement possible out of these efforts.
“The current measurement paradigm, however, does not live up to its potential. Many observers fear that a proliferation of measures is leading to measurement fatigue without commensurate results. An analysis of 48 state and regional measure sets found that they included more than 500 different measures, only 20% of which were used by more than one program.
“Similarly, a study of 29 private health plans identified approximately 550 distinct measures, which overlapped little with the measures used by public programs.
“Health care organizations are therefore devoting substantial resources to reporting their performance to regulators and payers; one northeastern health system, for instance, uses 1% of its net patient-service revenue for that purpose.
“Beyond the problem of too many measures, there is concern that programs are not using the right ones. Some metrics capture health outcomes or processes that have major effects on overall health, but others focus on activities that may have minimal effects…” More via Getting More Performance from Performance Measurement
Christine K. Cassel, M.D., Patrick H. Conway, M.D., Suzanne F. Delbanco, Ph.D., Ashish K. Jha, M.D., M.P.H., Robert S. Saunders, Ph.D., and Thomas H. Lee, M.D., Getting More Performance from Performance Measurement — NEJM, December 2014 (free online, though NEJM is usually behind a paywall).
