Perhaps you’ve heard some version of the saying: You can’t manage what you can’t measure.
We need clearly defined measures to gauge the steps toward improvement and objective criteria to determine if we have achieved true progress.
In health care we’ve seen how gathering measurements can advance care. Take hospital- acquired infections. By using defined metrics to track and publicly report outcomes, we’ve found that aggressive interventions can indeed reduce infection rates. The numbers translate into lives saved. And as we move away from fee-for-service to value-based reimbursement, there is growing demand for useful information on quality that patients, payers, providers and policy makers can use in their decision-making.
But can we have too much of a good thing?
When it comes to health care reporting and measurement I fear the answer is yes. We are seeing a backlash from physicians, nurses and health care administrators criticizing the number of reports and measurements that are a part of health care today. Take Theresa Brown, a hospice care nurse who recently described, in The New York Times, how hospital charting, tracking and electronic record keeping are crowding out time for patient communication and care. She described a nurse who asked an injured patient in the emergency room to describe her level of pain on a scale of 1 to 10. The nurse dutifully recorded the number, and then left without offering any pain relief. Record keeping usurped care.
I believe measurement is critical to quality, safety and cost-containment. But we need to inject more sanity into the process. We need to align our measurements and make sure we are measuring the right health care actions and outcomes — the kinds that really matter to patient safety, outcomes and cost containment.
Positive steps are being made, and at the Quality Institute we’re playing an important role. We’re part of New Jersey’s State Innovation Model (SIM) Design Grant from CMS. Our work includes identifying steps New Jersey can take to align measures in the Medicaid program, pilots, contracts and the DSRIP program. We need consistency in the measures across the various programs and we need to ensure that all stakeholders are held to similar measures. We need to remove, or at least reduce, the enormous redundancy in health care measurements.
Along the same lines, CMS, National Quality Forum, and the trade group, America’s Health Insurance Plans, recently announced an agreement to create a series of core quality measure sets. As with the SIM Grant, which is designed in part to rationalize measures used in different programs, the CMS/AHIP agreement seeks to harmonize the core measures across both government and commercial payers.
We want the voices of our members heard as we work to bring common sense to health care measurement. So we will soon begin Quarterly Quality Breakfasts for Quality Institute members to seek their input on:
- CMS core measure sets
- National Quality Forum
- Leapfrog Group’s Hospital Safety Survey and Scores
- SIM grant measure alignment work
- Other local or national event involving quality measures
Not long ago the founders of the Quality Institute fought for public reporting of health quality measures. We won the battle. Now we have to work to make the best use of the victory.