Report Cards & Reputational Report Cards & Reputational IncentivesIncentives

Moreover, Hospitals have RIs Moreover, Hospitals have RIs to obtain a (+) report cards to obtain a (+) report cards

“ “ Ranked among the top 10 Ranked among the top 10 hospitals in New York hospitals in New York State for cardiac surgery State for cardiac surgery and cardiac catheterization and cardiac catheterization programs” programs”

(CMS discourages hospital (CMS discourages hospital from using its data for from using its data for advertisement; and avoids advertisement; and avoids ranking hospitals) ranking hospitals)

http://images.google.com/imgres?imgurl=http://www.worldclassmedicine.com/images/heart/main_image.jpg&imgrefurl=http://www.worldclassmedicine.com/homepage_heart.cfm%3Fid%3D21&usg=__aaZsK6rltIX6fx3iMcQ29-GaU8Y=&h=249&w=286&sz=15&hl=en&start=8&tbnid=y1zmptwLLVTdpM:&tbnh=100&tbnw=115&prev=/images%3Fq%3Dtop%2Bcardiac%2Bsurgeon%2Bnew%2Byork%2Brated%26gbv%3D2%26hl%3Den%26safe%3Dactive (accessed 11/25/08).

Report Cards & Reputational Report Cards & Reputational IncentivesIncentives

Disruptive Innovation & Disruptive Innovation & Physicians Physicians

Market impact of a (-) Market impact of a (-) report card is more report card is more clear cutclear cut

http://www.hikinghttp://www.hikinguupward.com/OVH/SkyMeadows/images/122907/PC290099.jpgpward.com/OVH/SkyMeadows/images/122907/PC290099.jpg

Report Cards & Reputational Report Cards & Reputational IncentivesIncentives

NYS cardiac surgery NYS cardiac surgery registryregistry– 5% of surgeons with the 5% of surgeons with the

lowest operative mortality lowest operative mortality exited the marketexited the market

– 20% of surgeons with the 20% of surgeons with the highest operative mortality highest operative mortality exited the marketexited the market

2/3 of surgeons admitted 2/3 of surgeons admitted to “cherry picking” patientsto “cherry picking” patients

Ashish K. Jha and Arnold M. Epstein. The predictive accuracy of the New York State coronary artery bypass surgery report-card system. 25 Health Aff 844, 844–55 Ashish K. Jha and Arnold M. Epstein. The predictive accuracy of the New York State coronary artery bypass surgery report-card system. 25 Health Aff 844, 844–55

(2006);(2006);

Report Cards & Reputational Report Cards & Reputational IncentivesIncentives

Objective evidence of Objective evidence of cherry picking: cherry picking: Statistically significant Statistically significant reduction in the reduction in the number of redo-number of redo-CABGs being CABGs being performedperformed

TR McLean, In New York State, do more percutaneous coronary interventions mean fewer or more complex referrals to cardiac surgeons? 6(1) Am Heart Hospital J 30, TR McLean, In New York State, do more percutaneous coronary interventions mean fewer or more complex referrals to cardiac surgeons? 6(1) Am Heart Hospital J 30, 30-36 (2008).30-36 (2008).

Report Cards & Reputational Report Cards & Reputational IncentivesIncentives

Just like hospitals, Physicians Just like hospitals, Physicians make use of (+) report cardsmake use of (+) report cards

““Dr. Ty Goletz is a top-rated Dr. Ty Goletz is a top-rated orthopedic surgeon who has orthopedic surgeon who has received numerous awards and received numerous awards and accolades throughout the United accolades throughout the United States, including being chosen States, including being chosen as one of San Antonio’s Top as one of San Antonio’s Top Doctors, and a Texas Super Doctors, and a Texas Super Doctor by Texas Monthly Doctor by Texas Monthly Magazine.”Magazine.”

http://images.google.com/imgres?imgurl=http://www.drgoletz.com/images/goletz.jpg&imgrefurl=http://www.drgoletz.com/about_goletz.html&usg=__Yggms_l5A8A2rDRBtqgrSiUKZZw=&h=285&w=244&sz=17&hl=en&start=3&tbnid=HyvJGfl4k_29tM:&tbnh=115&tbnw=98&prev=/images%3Fq%3D%2522surgeon%2522%2B%2522top%2Brated%2522%26gbv%3D2%26hl%3Den%26safe%3Dactive (accessed 11/15/08)

Report Cards & Reputational Report Cards & Reputational IncentivesIncentives

All I ever needed to know All I ever needed to know about report cards, I about report cards, I learned in 3learned in 3rdrd grade: grade: They change behavior They change behavior

The Key question is how The Key question is how is the government is the government going to use going to use (capitalize) on this (capitalize) on this information? information?

McLean TR: Will reputational incentives stimulate a reversal of the physician brain drain?. J Health Serv Res Policy 2008; 13:50-52; Werner RM and Asch DA: The Unintended Consequences of Publicly Reporting Quality Information. JAMA 2005; 293:1239-1244

Report Cards & Reputational Report Cards & Reputational IncentivesIncentives

Answer:Answer:– Two new CMS Two new CMS

initiatives:initiatives:

Hospital Quality Initiative Hospital Quality Initiative (HQI)(HQI)

Physician Quality Physician Quality Reporting Initiative Reporting Initiative (PQRI) (PQRI)

Image URL on request

 

Report Cards & Reputational Report Cards & Reputational IncentivesIncentives

Common to both HQI Common to both HQI & PQRI are paradigm & PQRI are paradigm shifts:shifts:

– Accountability shifts Accountability shifts from structure (from structure (e.ge.g. JC . JC accreditation) to accreditation) to outcomes (outcomes (e.ge.g. SSI). SSI)

– Benchmarking for Benchmarking for provider comparisonprovider comparison

Brett Elliott: Pay for Performance and the Hospital Quality Initiative. Del Med Jrl 2005, 77(8):288-96.

Report Cards & Reputational Report Cards & Reputational IncentivesIncentives

HQIHQI– MMA § 501b; Pub L 108-MMA § 501b; Pub L 108-

173 (117 Stat. 2066)173 (117 Stat. 2066)

– But, CMS lacks statutory But, CMS lacks statutory authority to collect provider authority to collect provider specific data.specific data.

– ““Voluntary” performance Voluntary” performance measurement reporting measurement reporting began 2004began 2004

Brett Elliott: Pay for Performance and the Hospital Quality Initiative. Del Med Jrl 2005, 77(8):288-96.