Why are we hoarding quality measures?

Aug. 31, 2015 / By Kristine Daynes

It’s hard to get rid of something you use but don’t like, even if it’s no longer practical. Things that are familiar have a lot of staying power. That may be why we can’t seem to shed ourselves of the suffocating layers of quality measures that have accumulated over the years.

There are over 4,600 healthcare quality measures and measure sets in the public repository set up by the National Quality Measures Clearinghouse. Granted, these measures represent all settings and aspects of care delivery and management. The numbers are still staggering:

• 1,102 measures for ambulatory and office-based care
• 780 measures for hospital inpatient care
• 585 measures for hospital outpatient care
• 322 measures applying to managed care plans, with fewer than 10 percent of them addressing outcomes or the value of care

HHS maintains a separate inventory of over 1,250 measures used by its agencies for quality measurement and reporting. Add to the burden all other measures used by reporting organizations and private commercial payers to evaluate the quality of care.

What a mess! No wonder the U.S. compares so poorly to other developed countries for the administrative burden of our health system. We’ve built a rambling, complicated payment structure and stuffed it full of quality measures.

Nobody is asking for more healthcare quality measures. Many people have advocated for different or fewer measures or for new measures to address advances in clinical practice and technology. So, how do we get rid of some of the obsolete, redundant, or less-effective measures as we adopt new ones?

Even more to the point: Why do providers perpetuate redundant or irrelevant measures in their internal quality evaluations when they could choose to use fewer, more relevant measures?

Like I said, things that are familiar have a lot of staying power. Maybe, too, we don’t believe we have the choice to stop using measures internally for our own programs because they are mandated for administrative purposes externally.

We might take some advice from any of a dozen therapists who confront compulsive hoarding on television reality shows. (Yes, I’m really using something from reality TV to address a healthcare issue.) Whenever we can choose our own program metrics, we can commit to pare down to only the necessary few that are fair, actionable and comprehensive—even if they aren’t perfect. Here’s how:

• Get rid of obsolete measures. This applies to a lot of process measures, which served well in an era of paper-based records but pale compared to more sophisticated measures, including risk-adjusted outcomes, which are fairer and better representative.
• Discard duplicate measures—especially those that are specialized to a very limited use—when the same area could be represented by a more uniform, standardized or consolidated measure.
• Don’t overthink. If the value of a measure isn’t immediately obvious, it’s too complicated for general use.
• Avoid too many key performance indicators. Just as too many piles of stuff become clutter, too many categories become a distraction.
• Don’t pursue the perfect set of metrics. Find those that are best or good enough to represent overall care.
• Be brave. There is a risk in letting go of some measures (such as the myriad process measures). But there is so much more to gain in terms of efficiency and effectiveness by focusing on a smaller set of relevant outcomes measures.
• Keep the purpose in mind. Health care is about improving quality of life for people. It should be measured in terms of patients and the outcomes that matter most to them.

I know it isn’t simple to measure health care. There are many factors that affect quality. But that doesn’t mean we need to systematically monitor, report, and design incentives around each factor. Instead we could measure what is most representative of quality care—prevention, disease progression, access, continuity and efficiency of care—and leave more detailed monitoring only to investigate problem areas.

Kristine Daynes is marketing manager for payer and regulatory markets at 3M Health Information Systems.

For more discussion about choosing metrics for value-based care, view this recorded webinar, “How to measure cost and value for care transformation,” originally presented to the Florida Health Plan Association.