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Risk-adjusted patient outcomes don’t vary between hospitals, regardless of how well they scored on the measures of quality-process compliance that are behind Medicare’s Hospital Compare Web site, researchers have found.
“Despite the intentions of the CMS [Centers for Medicare and Medicaid Services] to provide patients with information that will facilitate patient choice of high-quality hospitals, currently available information on the Hospital Compare Web site will not help patients identify hospitals with better outcomes for high-risk surgery,” wrote the authors, from the University of Michigan and the Michigan Surgical Collaborative for Outcomes Research and Evaluation, both in Ann Arbor.
The fault may lie in the Surgical Care Improvement Project (SCIP) measures used to generate the Hospital Compare data, which mainly track very rare complications, such as deep venous thrombosis, and less important events, such as superficial surgical site infections, the authors said.
Released Oct. 18, the Archives of Surgery study looked at data from 2,000 U.S. hospitals on three SCIP outcomes measures: 30-day postoperative mortality, venous thromboembolisms, and surgical site infections (Arch. Surg. 2010;145:999-1004).
CMS mandates reporting of two sets of SCIP data – one on infection and one on venous thromboembolism – for hospitals to receive annual payment increases. Hospitals submit their data quarterly, which are then posted on Hospital Compare. However, it’s not clear whether improved compliance with the SCIP measures actually improves outcomes, especially risk-adjusted mortality, the study authors said.
To examine the question, they looked at patient outcomes after six high-risk surgical procedures: abdominal aortic aneurysm repair, aortic valve repair, coronary artery bypass graft, esophageal resection, mitral valve repair, and pancreatic resection.
Compliance rates with the SCIP measures ranged considerably from 53.7% to 91.4%, but the study found little evidence of a consistent relationship between a hospital’s score and its rates of risk-adjusted mortality, venous thromboembolism, or surgical site infection.
The authors also looked at data on extended lengths of stay, which can result from numerous postoperative complications. They found that patients at the hospitals that most often complied with SCIP were 12% less likely to experience an extended stay relative to middle-compliance hospitals, but there was no difference between the middle- and lowest-compliance hospitals.
The lack of correlation between “process compliance,” such as measured by SCIP numbers, will be important as quality measures have increasing impact on reimbursements for care, said the authors. “If there is a weak link between process compliance and surgical outcomes, CMS public reporting and pay-for-performance efforts will be unlikely to stimulate important improvements or to help patients find the safest hospitals,” they wrote.
They advised the CMS to “devote greater attention to profiling hospitals based on outcomes for improved public reporting and pay-for-performance programs.”
The study’s authors were supported by several federal grants and funds from the Robert Wood Johnson Foundation.
In an “Invited Critique” published with the study, Dr. Charles D. Mabry said that the findings of no relationship between a hospital’s compliance with Surgical Care Improvement Project (SCIP) quality process measures and surgical outcomes, “if true, call into serious question the increased time, labor, and effort currently expended by hospitals and surgeons across the United States to comply with the SCIP program process measures. The findings also could potentially change the field of pay-for-performance and value-based purchasing programs, many of which are based on process compliance measurement.”
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Dr. Mabry cautioned, however, about several potential weaknesses of the study: It was conducted when hospitals were just adopting and beginning to report SCIP processes, before many were proficient at doing so. The fact that the outcomes were from hospital claims data, which are submitted by each hospitals themselves.
“One interesting possible explanation for the results shown in this article is that hospitals that do a poor job at SCIP compliance may also do a similarly poor job of identification and coding of complications and therefore may appear to have the same complication rate as hospitals that show diligence toward both coding and SCIP measures,” wrote Dr. Mabry.
He nevertheless called the new study “an important one that begs the question of whether CMS and the insurance industry should focus on process measures or more on outcomes measures.”
Charles D. Mabry, MD, is with the department of surgery, University of Arkansas for Medical Sciences, Little Rock, and chairs the American College of Surgeons Health Policy Steering Committee. His comments originally were published in the Archives of Surgery (2010;145:1004-5).
In an “Invited Critique” published with the study, Dr. Charles D. Mabry said that the findings of no relationship between a hospital’s compliance with Surgical Care Improvement Project (SCIP) quality process measures and surgical outcomes, “if true, call into serious question the increased time, labor, and effort currently expended by hospitals and surgeons across the United States to comply with the SCIP program process measures. The findings also could potentially change the field of pay-for-performance and value-based purchasing programs, many of which are based on process compliance measurement.”
|
Dr. Mabry cautioned, however, about several potential weaknesses of the study: It was conducted when hospitals were just adopting and beginning to report SCIP processes, before many were proficient at doing so. The fact that the outcomes were from hospital claims data, which are submitted by each hospitals themselves.
“One interesting possible explanation for the results shown in this article is that hospitals that do a poor job at SCIP compliance may also do a similarly poor job of identification and coding of complications and therefore may appear to have the same complication rate as hospitals that show diligence toward both coding and SCIP measures,” wrote Dr. Mabry.
He nevertheless called the new study “an important one that begs the question of whether CMS and the insurance industry should focus on process measures or more on outcomes measures.”
Charles D. Mabry, MD, is with the department of surgery, University of Arkansas for Medical Sciences, Little Rock, and chairs the American College of Surgeons Health Policy Steering Committee. His comments originally were published in the Archives of Surgery (2010;145:1004-5).
In an “Invited Critique” published with the study, Dr. Charles D. Mabry said that the findings of no relationship between a hospital’s compliance with Surgical Care Improvement Project (SCIP) quality process measures and surgical outcomes, “if true, call into serious question the increased time, labor, and effort currently expended by hospitals and surgeons across the United States to comply with the SCIP program process measures. The findings also could potentially change the field of pay-for-performance and value-based purchasing programs, many of which are based on process compliance measurement.”
|
Dr. Mabry cautioned, however, about several potential weaknesses of the study: It was conducted when hospitals were just adopting and beginning to report SCIP processes, before many were proficient at doing so. The fact that the outcomes were from hospital claims data, which are submitted by each hospitals themselves.
“One interesting possible explanation for the results shown in this article is that hospitals that do a poor job at SCIP compliance may also do a similarly poor job of identification and coding of complications and therefore may appear to have the same complication rate as hospitals that show diligence toward both coding and SCIP measures,” wrote Dr. Mabry.
He nevertheless called the new study “an important one that begs the question of whether CMS and the insurance industry should focus on process measures or more on outcomes measures.”
Charles D. Mabry, MD, is with the department of surgery, University of Arkansas for Medical Sciences, Little Rock, and chairs the American College of Surgeons Health Policy Steering Committee. His comments originally were published in the Archives of Surgery (2010;145:1004-5).
Risk-adjusted patient outcomes don’t vary between hospitals, regardless of how well they scored on the measures of quality-process compliance that are behind Medicare’s Hospital Compare Web site, researchers have found.
“Despite the intentions of the CMS [Centers for Medicare and Medicaid Services] to provide patients with information that will facilitate patient choice of high-quality hospitals, currently available information on the Hospital Compare Web site will not help patients identify hospitals with better outcomes for high-risk surgery,” wrote the authors, from the University of Michigan and the Michigan Surgical Collaborative for Outcomes Research and Evaluation, both in Ann Arbor.
The fault may lie in the Surgical Care Improvement Project (SCIP) measures used to generate the Hospital Compare data, which mainly track very rare complications, such as deep venous thrombosis, and less important events, such as superficial surgical site infections, the authors said.
Released Oct. 18, the Archives of Surgery study looked at data from 2,000 U.S. hospitals on three SCIP outcomes measures: 30-day postoperative mortality, venous thromboembolisms, and surgical site infections (Arch. Surg. 2010;145:999-1004).
CMS mandates reporting of two sets of SCIP data – one on infection and one on venous thromboembolism – for hospitals to receive annual payment increases. Hospitals submit their data quarterly, which are then posted on Hospital Compare. However, it’s not clear whether improved compliance with the SCIP measures actually improves outcomes, especially risk-adjusted mortality, the study authors said.
To examine the question, they looked at patient outcomes after six high-risk surgical procedures: abdominal aortic aneurysm repair, aortic valve repair, coronary artery bypass graft, esophageal resection, mitral valve repair, and pancreatic resection.
Compliance rates with the SCIP measures ranged considerably from 53.7% to 91.4%, but the study found little evidence of a consistent relationship between a hospital’s score and its rates of risk-adjusted mortality, venous thromboembolism, or surgical site infection.
The authors also looked at data on extended lengths of stay, which can result from numerous postoperative complications. They found that patients at the hospitals that most often complied with SCIP were 12% less likely to experience an extended stay relative to middle-compliance hospitals, but there was no difference between the middle- and lowest-compliance hospitals.
The lack of correlation between “process compliance,” such as measured by SCIP numbers, will be important as quality measures have increasing impact on reimbursements for care, said the authors. “If there is a weak link between process compliance and surgical outcomes, CMS public reporting and pay-for-performance efforts will be unlikely to stimulate important improvements or to help patients find the safest hospitals,” they wrote.
They advised the CMS to “devote greater attention to profiling hospitals based on outcomes for improved public reporting and pay-for-performance programs.”
The study’s authors were supported by several federal grants and funds from the Robert Wood Johnson Foundation.
Risk-adjusted patient outcomes don’t vary between hospitals, regardless of how well they scored on the measures of quality-process compliance that are behind Medicare’s Hospital Compare Web site, researchers have found.
“Despite the intentions of the CMS [Centers for Medicare and Medicaid Services] to provide patients with information that will facilitate patient choice of high-quality hospitals, currently available information on the Hospital Compare Web site will not help patients identify hospitals with better outcomes for high-risk surgery,” wrote the authors, from the University of Michigan and the Michigan Surgical Collaborative for Outcomes Research and Evaluation, both in Ann Arbor.
The fault may lie in the Surgical Care Improvement Project (SCIP) measures used to generate the Hospital Compare data, which mainly track very rare complications, such as deep venous thrombosis, and less important events, such as superficial surgical site infections, the authors said.
Released Oct. 18, the Archives of Surgery study looked at data from 2,000 U.S. hospitals on three SCIP outcomes measures: 30-day postoperative mortality, venous thromboembolisms, and surgical site infections (Arch. Surg. 2010;145:999-1004).
CMS mandates reporting of two sets of SCIP data – one on infection and one on venous thromboembolism – for hospitals to receive annual payment increases. Hospitals submit their data quarterly, which are then posted on Hospital Compare. However, it’s not clear whether improved compliance with the SCIP measures actually improves outcomes, especially risk-adjusted mortality, the study authors said.
To examine the question, they looked at patient outcomes after six high-risk surgical procedures: abdominal aortic aneurysm repair, aortic valve repair, coronary artery bypass graft, esophageal resection, mitral valve repair, and pancreatic resection.
Compliance rates with the SCIP measures ranged considerably from 53.7% to 91.4%, but the study found little evidence of a consistent relationship between a hospital’s score and its rates of risk-adjusted mortality, venous thromboembolism, or surgical site infection.
The authors also looked at data on extended lengths of stay, which can result from numerous postoperative complications. They found that patients at the hospitals that most often complied with SCIP were 12% less likely to experience an extended stay relative to middle-compliance hospitals, but there was no difference between the middle- and lowest-compliance hospitals.
The lack of correlation between “process compliance,” such as measured by SCIP numbers, will be important as quality measures have increasing impact on reimbursements for care, said the authors. “If there is a weak link between process compliance and surgical outcomes, CMS public reporting and pay-for-performance efforts will be unlikely to stimulate important improvements or to help patients find the safest hospitals,” they wrote.
They advised the CMS to “devote greater attention to profiling hospitals based on outcomes for improved public reporting and pay-for-performance programs.”
The study’s authors were supported by several federal grants and funds from the Robert Wood Johnson Foundation.
FROM ARCHIVES OF SURGERY