Changes needed in public healthcare quality reporting

Making healthcare quality reporting more patient-centered should be a natural part of making healthcare itself more patient-centered, say two authors of a recent New England Journal of Medicine article.

“Public reporting must shift from ‘one size somewhat fits all’ to an approach that reports metrics reflecting the varied concerns and preferences of consumers,” write Robert Huckman, a Harvard business professor, and Mark Kelley, MD, CEO of the Henry Ford Medical Group.

Amid a national focus on reining in healthcare spending and increasingly more out-of-pocket payments, patients “will want information that goes beyond current public reporting,” they say.

“By focusing patients on choosing between providers of specific services, current public reporting thus does little to keep the proverbial horse of medical utilization inside the barn. Indeed, it provides a guided path for its escape.”

The current system of quality reporting is focused largely on provider processes and procedural outcomes, not on “information that most patients value,” they write.

For instance, while patients in New York and Pennsylvania can get a sense of cardiac-surgery outcomes for specific providers, “this information does little to help patients decide whether they want or need surgery in the first place.”

Patient-centered quality reporting should be a part of shared decision making — something that “requires substantial investments in provider training, information systems, and process reengineering.”

A large barrier is that many clinicians “have neither the time nor the financial incentives to make such investments, especially in a fee-for-service environment” — although that’s slowly being overcome by today’s investments in training, IT, process reengineering and payment reform.

Indeed, the gradual changes in quality metrics should start paying off just as personalized medicine begins going mainstream.

“We now have a more urgent need for a similarly personalized approach to the health care decisions that patients encounter daily, but there is more involved than just clinical decision making,” Huckman and Kelley write. “The analogue of the genetic code in this case is a combination of the patient's clinical problem, the effectiveness and cost of the remedy, and the resulting social or economic consequences for a patient's family.”