New Metrics for Health Care Reform

March 21st, 2012 / By Kristine Daynes

There is a big shift occurring in the way we measure the efficiency and effectiveness of health care. The shift is moving beyond process measures toward patient-satisfaction measures, such as CAHPS surveys and outcomes measures, including hospital-acquired conditions and hospital readmissions. These new measures are quickly becoming the foundation of new payment systems.

For example, the CMS hospital readmissions reduction program will penalize excessive hospital readmissions. This provides a huge incentive for hospitals to improve protocols and procedures to lower readmission rates. However, it isn’t just a clinical care issue. It’s a measurement issue, too, as pointed out by the Healthcare Financial Management Association (HFMA) in their letter to CMS. HFMA argues for CMS to provide data on readmissions and to change how they are defined and calculated. (They also made an unsolicited endorsement of 3M classification methodologies. Thanks, HFMA!)

Traditionally our industry has focused on quality process measures such as whether a medicine was delivered or not on time. Process measures are important.  That’s a critical step in an equality hierarchy, but they’re not a measurement of the outcome of interest. If you’re trying to measure infection rates after surgery or a lung puncture or aspiration pneumonia, that’s the outcome.

So we’re moving from process measures to outcome measures, and we’re also moving to a broader set of outcome measures. Traditionally we focused on things like hospital-acquired condition lists, and never events. Now more payers and systems are looking at much broader rates of outcomes (see my previous blog for more on this topic).  It’s a new frontier for a lot of health systems. It requires tools to measure the system’s performance on these different outcomes, and then benchmark the performance against different national norms.

With measurement tools you can see if a system’s rates are higher or lower and by how much over time. It’s just as valuable for best practice as it is for something that may be questionable: “What’s going right with having such a low readmission rate for heart failure at this one system?”  That kind of analysis can only be done with tools and measurements that not only give you breadth, but also comparison, and then finally, the ability to drill down.

Kristine Daynes is Product Marketing Manager, Payer Markets, with 3M Health Information Systems.

Learn more about identifying process and performance issues that lead to avoidable post-admission complications or increase risk of patient readmissions by downloading 3M’s eGuide on Potentially Preventable Events.