Public reporting of health care quality performance

There is some evidence that public reporting of health care quality data improves quality of care^{3, 4, 5}. Effects appear strongest in competitive markets, especially for nursing home facilities⁶ and health insurance plans⁴. However, additional evidence is needed to confirm effects^{1, 3, 7}.

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^{4, 5}. 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 publicly⁴. Public reporting may increase health care equity across racial and ethnic groups and reduce disparities in health outcomes between hospitals⁸.

Some studies suggest public reporting may be linked to physicians choosing not to perform certain procedures for higher risk patients^{9, 10}. One study suggests that LTC providers may readmit residents to the hospital before facility assessments to improve the LTC facility’s performance measures⁴, and another suggests lower quality health plans may choose to discontinue reporting quality information⁷.

Public reporting does not usually affect consumers’ choice of providers or insurance plans^{4, 11, 12}. Publicly reported quality ratings may support informed patient decision making about hospital selection for non-urgent care, such as elective surgery¹³. In some circumstances, performance data can lead more educated consumers to select health plans^{4, 11, 12} and hospitals^{2, 12} with higher quality ratings than they would have otherwise selected.

Some experts suggest that health care reporting systems should develop performance measurement standards based on measures that are transparent and systematically reviewed. In addition, to ensure reliability of the reports and accurate comparisons of the included organizations, insurance plans, or providers, each should provide comprehensive data for all measures collected, which may then be used by consumers for decision making purposes^{14, 15, 16}.

Most existing reporting systems are not sensitive to patients’ health literacy levels¹⁵. Experts suggest that less complex websites increase consumers’ understanding and lead to more informed choices¹⁷. Presenting the site’s purpose in simple terms on the home page and using action words such as “learn,” “compare,” and “choose” can guide users through the site¹⁸. Displaying data clearly and uniformly¹⁸, with summary scores and performance results shown in positive directions (i.e., higher is better) along with brief explanations or context (i.e., extra use of care is not always better), may aid understanding¹⁷. As consumers may assume that higher costs indicate higher quality care, experts suggest pairing information about health care costs with easy-to-interpret data about quality¹⁹ and the results of patient experience surveys²⁰, and then highlighting the high value options¹⁹.

To increase patients’ use of publicly reported health care quality data, experts suggest social media public education campaigns about quality and the value of evidence-based care²⁰. Websites that clearly identify responsible entities¹⁸ and are produced by independent or local stakeholder coalitions could increase consumer trust of report cards²¹.

There are a variety of government agencies and private organizations which report on health care quality performance. The Centers for Medicare & Medicaid Services (CMS) promotes public reporting and publishes reports allowing consumers to compare providers, hospitals, long-term care (LTC) facilities, and Medicare coverage options through Care Compare, a tool combining CMS’s existing eight compare sites²².

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^{2, 23}. AHRQ also provides State Snapshots for every state, which feature state-specific health care quality information outlining strengths, weaknesses, and opportunities for improvement; State Snapshots contain over 250 quality measures and example users include state health officials, hospital associations, health plans, and community organizations²⁴.

The National Committee for Quality Assurance (NCQA) uses measurement, transparency, and accountability in reporting on health care across the country²⁵. NCQA offers report cards on clinicians, health care organizations, and health insurance plans nationwide, with the option for consumers to filter within each category by name, state, accreditations, or care specialty²⁶.

Health insurance plans offered through state exchanges must report quality and cost information²⁷.