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Outcomes measurement in the modern era: A hospital imperative

The so-called “father of outcomes management” – Ernest Codman – began developing ways to standardize and track patient results in the early 1900s. Dr. Codman pioneered the outcomes movement, using what he called “End Results Cards” to document demographic, diagnosis, and treatment data on each patient he treated.

Today, his legacy lives on in many ways, as evidenced in results from a recent Deloitte Center for Health Solutions analysis, Understanding Medicare’s 5-star rating hospital program. Modern day health care experts understand the importance of tracking patient outcomes and many have begun to develop systematic ways to monitor how providers – from hospitals to skilled nursing facilities – perform on quality measures. One recent system that the US Centers for Medicare and Medicaid Services (CMS) created in this vein is the Hospital Star Ratings Program. CMS released the first hospital star ratings on July 27, 2016. It developed the program to help consumers make more informed decisions by giving them a way to compare hospitals based on quality ratings. After the initial ratings release, many hospitals sought to better understand how the Star Ratings Program works and determine how they could improve their scores.

An analysis of 64 measures that comprised the initial star ratings release revealed two major findings:

For one, there are many ways to achieve a 5-star rating. CMS designed the program to capture multiple aspects of quality and to offer a number of pathways for hospitals to achieve a 5-star rating. And in an industry that is increasingly focused on patient-centered care, it is generally important to have a flexible system.

Second, our analysis revealed that hospitals that earn a 5-star rating generally have better scores in the heavily weighted categories focused on outcomes (i.e., mortality, patient experience, safety, and readmission). To determine hospital ratings, CMS relies on a complex methodology. The score is calculated using a five-step process, which involves standardizing individual quality measures, grouping them into seven categories, calculating scores for each individual category, and then using a summary score to calculate the final star rating. Some categories, such as outcomes, are considered more important and are weighted more heavily than others. And, hospitals that perform well under the program generally score higher in these categories. For example, among hospitals that met the threshold for reporting the safety of care category (weighted at 22 percent in the model), 64 percent scored “above the national average.” By contrast, just eight percent of 1-star hospitals received the same score.

While CMS designed the system to change over time, the focus on patient outcomes is not likely to change. Moreover, the Star Ratings Program is just one of CMS’ initiatives to improve health care quality; hospitals also may be measured as accountable care organizations – through payment incentive programs – and by other payers using different sets of quality measures.

Though CMS delayed the latest star ratings update until October 2017, hospitals will be reviewing the data over the next several weeks, as CMS gives them an opportunity to correct errors or appeal their rating. As hospitals review the latest star ratings data, they might consider leveraging the following strategies in order to navigate the complex topic that is quality ratings:

  • Adopt a broad quality improvement strategy: Hospitals may be best served by focusing on their own population needs and areas for improvement rather than having the Star Ratings Program drive their agenda. Indeed, the star ratings are just one way that hospitals will be gauged based on their patient outcomes. Many hospitals are also involved in accountable care initiatives that emphasize a different set of measures and patient outcomes. Understanding the overlap may help hospitals focus improvement in areas that are similar across these different initiatives and programs.
  • Invest in technology and analytics tools to support quality improvement goals: An important feature of any quality improvement strategy should be identifying the right tools an organization needs to reach its goals. Technology and analytics platforms to support these initiatives may come in many colors and focus on different areas of operations or patient engagement. As an example, results from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey, which gauges hospital performance in patient experience, are one of the heavily weighted categories integrated into the Star Ratings Program. Digital solutions focused on the patient – such as customer apps, patient portals, personalized digital kits, and self-check-in kiosks – could help hospitals struggling with patient experience improve in that area.

A staunch champion of his system, Dr. Codman believed it was important to track “misadventures” in patient care in order to prevent future treatment failures. He fought that battle throughout his career, even going as far as opening his own hospital for several years to test his theories. More than a century later, the health care system is still testing ways to monitor and make hospitals responsible for their patients’ outcomes. In the end, hospital quality measurement is going to continue, as evidenced by CMS’s continued commitment to improving the Star Ratings Program. Hospitals should consider this as they begin to review the latest star ratings data and develop new strategies to improve on patient outcomes.

PS: Please stay tuned in October as CMS releases the new ratings and check the Health Care Current for our insights on the topic!

Author bio

Claire is a health policy manager for the Deloitte Center for Health Solutions in Washington, DC. In her role, she provides in-depth analysis of regulatory and legislative updates to inform Deloitte’s account teams as well as external clients on key trends in health policy. Before joining Deloitte, Claire worked in the non-profit sector, providing development and outreach experience to organizations in the aging services field from the local to national level. She has a B.S., B.A., and Graduate Certificate in Gerontology from The University of Georgia and a Masters of Public Health in Health Policy from The George Washington University.