Public reporting of health care quality performance

Public reporting of health care quality data allows consumers, payers, and health care providers to access information about how clinicians, clinics, hospitals, long-term care facilities and insurance plans perform on health care quality measures. “Report cards,” reporting websites, or similar tools can enable patients to compare provider performance on measures of health care quality. These tools can also help providers assess their own practices and consider the performance of other providers (James 2012). Health care quality data is often provided by regional collaboratives, but can also be shared by health insurance plans, state, local, or federal government agencies (RWJF-Quality directory).

Expected Beneficial Outcomes (Rated)

  • Improved quality of care

Other Potential Beneficial Outcomes

  • Improved health outcomes

  • Improved patient decision making

Evidence of Effectiveness

There is some evidence that public reporting of health care quality data improves quality of care (AHRQ-Totten 2012, Hibbard 2005). Effects appear strongest in competitive markets, especially for nursing home facilities (Gabrowski 2011) and health insurance plans (AHRQ-Totten 2012). However, additional evidence is needed to confirm effects (, ).

Public reporting may lead health care insurers or long-term care (LTC) providers to improve performance on measures reported, especially when initial scores are poor (AHRQ-Totten 2012, Hibbard 2005). Public reporting may also lead to better patient outcomes such as reduced mortality among hospital patients, reduced pain and fewer pressure ulcers among LTC patients, and increased vaccination among individuals with health insurance plans that provide data publicly (AHRQ-Totten 2012). Public reporting may increase equity of care across racial and ethnic groups and reduce disparities in health outcomes between hospitals ().

Some studies suggest public reporting may be linked to physicians choosing not to perform certain procedures for higher risk patients (Narins 2005, ). One study suggests that LTC providers may readmit patients to the hospital before they are assessed for reporting measures (AHRQ-Totten 2012), another suggests lower quality health plans may choose to discontinue reporting quality information ().

Public reporting does not usually affect consumers’ choice of providers or insurance plans. In some circumstances, performance data can lead  more educated consumers to select health plans (Reid 2013, AHRQ-Totten 2012, Faber 2009) and hospitals (Faber 2009, James 2012) with higher quality ratings than they would have otherwise selected.

When public reporting is provided via website, experts suggest presenting the site’s purpose in simple terms on the home page and using action words such as “learn,” “compare,” and “choose” to guide users though the site. Experts also suggest displaying data clearly and uniformly and using summary scores (AF4Q-Public reporting 2012). As consumers can assume that higher costs indicate higher quality, experts suggest pairing information about health care costs with easy to interpret data about quality and highlighting the high value options ().

Websites that clearly identify responsible entities (AF4Q-Public reporting 2012) and are produced by independent or local stakeholder coalitions could increase consumer trust of report cards ().

Impact on Disparities

Likely to decrease disparities

Implementation Examples

As of 2012, about half of all states have public reporting programs in place (James 2012). Health insurance plans offered through state exchanges must report quality and cost information. The Centers for Medicare & Medicaid Services (CMS) promote public reporting and publish reports allowing consumers to compare providers, hospitals, and Medicare coverage options through tools such as Nursing Home Compare and the Medicare Plan Finder.

The Agency for Healthcare Research and Quality (AHRQ) reports national and state quality data, helps stakeholders develop quality measures, and disseminates research on public reporting best practices (James 2012). AHRQ’s Chartered Value Exchange (CVE) program supports community collaboratives that report the quality of participating care providers and insurance plans and promote participant quality improvement. More than one third of Americans are served by providers that participate in a CVE collaborative (AHRQ-Totten 2012).

Americans conduct over 500,000 internet searches for hospital quality information monthly (Huesch 2013).

Implementation Resources

RWJF-Quality directory - Robert Wood Johnson Foundation (RWJF). Comparing health care quality: A national directory.

NQF - National Quality Forum (NQF). Good measures improve clinical care.

AF4Q - Aligning Forces for Quality (AF4Q). Improving health & health care in communities across America.

NCQA - National Committee for Quality Assurance (NCQA). Measuring quality. Improving health care.

NPWF-Quality - Americans for Quality Health Care. Performance measuring and public reporting. National Partnership for Women and Families (NPWF).

CWF-WNTB - The Commonwealth Fund (CWF). Why not the best.

AHRQ-CVE - Agency for Healthcare Research and Quality (AHRQ). Chartered value exchange learning network.

AHRQ HCIE-Snowden - Snowden AM. Statewide measurement and reporting system stimulates quality improvement in targeted clinical areas, becomes standard for local and national pay-for-performance programs. Rockville: AHRQ Health Care Innovations Exchange.

Citations - Evidence

* Journal subscription may be required for access.

Fung 2008* - Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG. Systematic review: The evidence that publishing patient care performance data improves quality of care. Annals of Internal Medicine. 2008;148(2):111-23.

James 2012 - James J. Do report cards and other measures of providers’ performance lead to improved care and better choices by consumers. Health Affairs. 2012:1-5.

AHRQ-Totten 2012 - Totten A, Wagner J, Tiwari A. Public reporting as a quality improvement strategy. Agency for Healthcare Research and Quality (AHRQ). 2012 (Evidence Report/Technology Assessment No. 208).

Cochrane-Ketelaar 2011* - Ketelaar N, Faber MJ, Flottorp S, et al. Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations. Cochrane Database of Systematic Reviews. 2011;(11):CD004538.

Faber 2009 - Faber M, Bosch M, Wollersheim H, Leatherman S, Grol R. Public reporting in health care: How do consumers use quality-of-care information. Medical Care, 2009;47(1):1-8.

AF4Q-Public reporting 2012 - Aligning Forces for Quality (AF4Q). Lessons learned: Improving public reporting websites for consumers. 2012.

Sinaiko 2012* - Sinaiko AD, Eastman D, Rosenthal MB. How report cards on physicians, physician groups, and hospitals can have greater impact on consumer choices. Health Affairs. 2012;31(3):602-611.

Gabrowski 2011 - Grabowski DC., Town RJ. Does information matter: Competition, quality, and the impact of nursing home report cards. Health Services Research (HSR). 2011;46(6):1698–1719.

Burack 1999* - Burack JH, Impellizzeri P, Homel P, Cunningham JNJ. Public reporting of surgical mortality: a survey of New York State cardiothoracic surgeons. The Annals of Thoracic Surgery. 1999;68(4):1192-1195.

Hibbard 2005 - Hibbard JH, Stockard J, Tusler M. Hospital performance reports: Impact on quality, market share, and reputation. Health Affairs. 2005;24(4):1150-1160.

Hibbard 2012a* - Hibbard JH, Greene J, Sofaer S, Firminger K, Hirsh J. An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care. Health Affairs. 2012;31(3):560-568.

Narins 2005 - Narins CR, Dozier AM, Ling FS, Zareba W. The influence of public reporting of outcome data on medical decision making by physicians. Archives of Internal Medicine. 2005;165(1):83-87.

Reid 2013 - Reid RO, Deb P, Howell BL, Shrank WH. Association between Medicare Advantage plan star ratings and enrollment. Journal of the American Medical Association. 2013; 309(3):267-274.

Trivedi 2014* - Trivedi AN, Nsa W, Hausmann LRM, et al. Quality and equity of care in US hospitals. The New England Journal of Medicine. 2014;371(24):2298-2308.

Citations - Implementation Examples

* Journal subscription may be required for access.

James 2012 - James J. Do report cards and other measures of providers’ performance lead to improved care and better choices by consumers. Health Affairs. 2012:1-5.

AHRQ-Totten 2012 - Totten A, Wagner J, Tiwari A. Public reporting as a quality improvement strategy. Agency for Healthcare Research and Quality (AHRQ). 2012 (Evidence Report/Technology Assessment No. 208).

Huesch 2013 - Huesch MD, Currid-Halkett E, Doctor JN. Public hospital quality report awareness: Evidence from national and Californian internet searches and social media mentions, 2012. BMJ Open. 2014;4(3):1-9.

Date Last Updated

Oct 22, 2015