The Affordable Care Act changed the way hospitals are paid by introducing a value-based system which links quality of care offered to payment received, alongside the pre-existing fee-for-service model. Doctors and hospitals across the nation are being evaluated on countless quality metrics by rating services, insurance companies, professional groups and government programs.
With results increasingly tied to financial penalties or bonuses it makes sense that industry leaders are concerned with how quality care is being measured, and whether the current benchmarks are focusing on what matters to patients — the sole beneficiaries of hospital care.
According to experts, the current criterion, which fluctuate depending on which quality metric is being examined, fall short because they are focused on processes, not functional outcomes.
"The quality programs grew out of two realizations: Healthcare is unsafe and outcomes are poor," Scott Wallace, a visiting professor at Dartmouth's Geisel School of Medicine, told the Wall Street Journal. "But there is no single measure of a doctor's or hospital's quality that will fix those problems. Instead, we're measuring processes."
Examples of such processes, as taken from the federal government's HealthCare Compare website, include "participation in a systematic database for cardiac surgery" or "tracking clinical results between visits." Wallace suggests that while such benchmarks are important, they don't reflect what a patient values most in their care: "For a patient who got a knee replacement, can she walk and climb steps? For a man having prostate surgery, can we operate without causing incontinence and impotence?"
Wallace admits that reporting such measures would be complex and wouldn't require moving beyond the letter-grade evaluations that currently exist. However such metrics are critical when judging the care a facility is able to provide. A "consumer review" method, as exists for products and services, would be a start, he added.
Patient Approved, a patient feedback service that helps doctors collect and analyze their performance data, is one option for hospitals interested in evaluations that give patients a voice.