At the end of the chapter, the reader will be able to:
Describe a health care report card.
List three reasons why report cards are used in the health care system.
List three principles of reporting quality in pharmacy as outlined by the Pharmacy Quality Alliance.
Discuss the advantages and disadvantages of reporting quality in pharmacy.
One of the cornerstones of value-driven health care is transparency.1 It has become common to see public reports on the quality of hospitals, long-term care facilities, and health plans. The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) have both created websites to provide easy access to report cards on hospitals and other institutional providers.2,3 The National Committee for Quality Assurance (NCQA) has been reporting on the quality of health plans for over a decade using its HEDIS set of performance measures as well as composite ratings of plans.4 CMS has also begun to report on the quality of prescription drug plans in the Medicare program. This has included “star ratings” of plans based on several dimensions of quality (including drug safety), as well as a website unveiled in November 2009 to provide more detailed information on the quality of each plan.
Within the past few years, a growing number of physician report cards have also become available. While most of these reports are at the clinic or group level, there is a growing demand for information about individual physicians.5,6 In early 2007, the CMS launched a new pilot project to promote the use of information on physician performance to drive improvement in the quality of care.7 This project included a set of measures for public reporting of physician performance and was launched by the AQA (formerly known as the Ambulatory Care Quality Alliance) – a national coalition working with a broad group of stakeholders, including CMS, to select measures for public reporting of physician performance. Six “pilots” were selected for testing locally led, collaborative approaches to performance measurement and reporting. Although AQA had selected more than 24 measures of clinical performance suitable for public reporting, many questions remained about how to coordinate data collection and reporting, as well as how to promote the use of the measures among consumers, payers, and providers.
Known as the “Better Quality Information to Improve Care for Medicare Beneficiaries” (or “BQI”) project, the project's goals were to test data collection strategies and to promote the use of quality improvement information. These projects began to scratch the surface of the challenges and successes of public reporting of performance data. Using a starter set of clinical measures selected by AQA, the pilot sites generated reports for Medicare beneficiaries and providers, while experimenting with reporting at the individual physician, group, and systems levels in order to explore what types of information and what approaches to information sharing are most effective.