Public reporting of health care quality performance

Public reporting of health care quality data allows consumers, patients, payers, and health care providers to access information about how clinicians, hospitals, clinics, long-term care (LTC) facilities, and insurance plans perform on health care quality measures. Reporting websites, report cards, 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 (Cochrane-Metcalfe 2018*, 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.

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 (Campanella 2016, 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 (Cochrane-Metcalfe 2018*, Campanella 2016, Fung 2008*).

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 health care equity across racial and ethnic groups and reduce disparities in health outcomes between hospitals (Trivedi 2014*).

Some studies suggest public reporting may be linked to physicians choosing not to perform certain procedures for higher risk patients (Narins 2005, Burack 1999*). One study suggests that LTC providers may readmit residents to the hospital before facility assessments to improve the LTC facility’s performance measures (AHRQ-Totten 2012), and another suggests lower quality health plans may choose to discontinue reporting quality information (Fung 2008*).

Public reporting does not usually affect consumers’ choice of providers or insurance plans (Reid 2013, AHRQ-Totten 2012, Faber 2009). Publicly reported quality ratings may support informed patient decision making about hospital selection for non-urgent care, such as elective surgery (Blake 2017a*). 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.

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 (Winters 2016*, Bilimoria 2016*, Shahian 2016*).

Most existing reporting systems are not sensitive to patients’ health literacy levels (Bilimoria 2016*). Experts suggest that less complex websites increase consumers’ understanding and lead to more informed choices (Kurtzman 2016*). 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 site (AF4Q-Public reporting 2012). Displaying data clearly and uniformly (AF4Q-Public reporting 2012), 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 understanding (Kurtzman 2016*). 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 quality (Hibbard 2012a*) and the results of patient experience surveys (Findlay 2016*), and then highlighting the high value options (Hibbard 2012a*).

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 care (Findlay 2016*). 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 (Sinaiko 2012*).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

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 sites (CMS-Care Compare).

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 (AHRQ-Talking quality, James 2012). 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 organizations (AHRQ-State Snapshots).

The National Committee for Quality Assurance (NCQA) uses measurement, transparency, and accountability in reporting on health care across the country (NCQA). 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 specialty (NCQA-Report cards).

Health insurance plans offered through state exchanges must report quality and cost information (CMS-Exchanges).

Implementation Resources

AHRQ-Hibbard 2018 - Hibbard J, Sofaer S. Best practices in public reporting No. 1: How to effectively present health care performance data to consumers. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2018.

AHRQ-State Snapshots - Agency for Healthcare Research and Quality (AHRQ). Data. State Snapshots: State-specific health care quality information.

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

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).

IPRO-WNTB - IPRO: Better healthcare, realized. Why not the best.

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.

Campanella 2016 - Campanella P, Vukovic V, Parente P, et al. The impact of Public Reporting on clinical outcomes: A systematic review and meta-analysis. BMC Health Services Research. 2016;16(1).

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).

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.

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.

Cochrane-Metcalfe 2018* - Metcalfe D, Rios Diaz AJ, Olufajo OA, et al. Impact of public release of performance data on the behaviour of healthcare consumers and providers (Review). Cochrane Database of Systematic Reviews. 2018;(9):CD004538.

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.

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.

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.

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.

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.

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.

Blake 2017a* - Blake RS, Clarke HD. Hospital Compare and hospital choice: Public reporting and hospital choice by hip replacement patients in Texas. Medical Care Research and Review. 2017;76(2):184-207.

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.

Winters 2016* - Winters BD, Bharmal A, Wilson R, et al. Validity of the agency for healthcare research and quality patient safety indicators and the Centers for Medicare and Medicaid hospital-acquired conditions: A systematic review and meta-analysis. Medical Care. 2016;54(12):1112-1114.

Bilimoria 2016* - Bilimoria KY, Barnard C. The new CMS Hospital Quality Star Ratings: The stars are not aligned. JAMA - Journal of the American Medical Association. 2016;316(17):1761-1762.

Shahian 2016* - Shahian DM, Normand SLT, Friedberg MW, Hutter MM, Pronovost PJ. Rating the raters: The inconsistent quality of health care performance measurement. Annals of Surgery. 2016;264(1):36-38.

Kurtzman 2016* - Kurtzman ET, Greene J. Effective presentation of health care performance information for consumer decision making: A systematic review. Patient Education and Counseling. 2016;99(1):36-43.

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

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.

Findlay 2016* - Findlay SD. Consumers’ interest in provider ratings grows, and improved report cards and other steps could accelerate their use. Health Affairs. 2016;35(4):688-696.

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.

Citations - Implementation Examples

* Journal subscription may be required for access.

CMS-Care Compare - Centers for Medicare & Medicaid Services (CMS). Care Compare: Find & compare doctors, hospitals & other providers near you.

AHRQ-Talking quality - Agency for Healthcare Research and Quality (AHRQ). Talking quality: Reporting to consumers on health care quality.

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-State Snapshots - Agency for Healthcare Research and Quality (AHRQ). Data. State Snapshots: State-specific health care quality information.

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

NCQA-Report cards - National Committee for Quality Assurance (NCQA). Report cards: About.

CMS-Exchanges - Centers for Medicare & Medicaid Services (CMS). Programs and initiatives: Initial guidance to states on exchanges.

Date Last Updated