nach oben

Clinical Orthopaedics and Related Research®

Erschienen in:

01.04.2012 | Symposium: Value Based Healthcare

Public Reporting of Cost and Quality Information in Orthopaedics

verfasst von: Youssra Marjoua, MD, MPP, Craig A. Butler, MD, MBA, Kevin J. Bozic, MD, MBA

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 4/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

Public reporting of patient health outcomes offers the potential to incentivize quality improvement by fostering increased accountability among providers. Voluntary reporting of risk-adjusted outcomes in cardiac surgery, for example, is viewed as a “watershed event” in healthcare accountability. However, public reporting of outcomes, cost, and quality information in orthopaedic surgery remains limited by comparison, attributable in part to the lack of standard assessment methods and metrics, provider fear of inadequate adjustment of health outcomes for patient characteristics (risk adjustment), and historically weak market demand for this type of information.

Questions/purposes

We review the origins of public reporting of outcomes in surgical care, identify existing initiatives specific to orthopaedics, outline the challenges and opportunities, and propose recommendations for public reporting of orthopaedic outcomes.

Methods

We performed a comprehensive review of the literature through a bibliographic search of MEDLINE and Google Scholar databases from January 1990 to December 2010 to identify articles related to public reporting of surgical outcomes.

Results

Orthopaedic-specific quality reporting efforts include the early FDA adverse event reporting MedWatch program and the involvement of surgeons in the Physician Quality Reporting Initiative. Issues that require more work include balancing different stakeholder perspectives on quality reporting measures and methods, defining accountability and attribution for outcomes, and appropriately risk-adjusting outcomes.

Conclusions

Given the current limitations associated with public reporting of quality and cost in orthopaedic surgery, valuable contributions can be made in developing specialty-specific evidence-based performance measures. We believe through leadership and involvement in policy formulation and development, orthopaedic surgeons are best equipped to accurately and comprehensively inform the quality reporting process and its application to improve the delivery and outcomes of orthopaedic care.

Adams JL, Mehrotra A, Thomas JW, McGlynn EA. Physician cost profiling—reliability and risk of misclassification. N Engl J Med. 2010;362:1014–1021.PubMedCrossRef

AMA. Principles for Pay for Performance Programs. 2005. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/368/principles4pay62705.pdf. Accessed November 2010.

AQA. Principles for Public Reports on Health Care. 2006. Available at: http://www.aqaalliance.org/files/ProviderPrinciplesMay06.doc. Accessed November 2010.

Berwick DM, Wald DL. Hospital leaders’ opinions of the HCFA mortality data. JAMA. 1990;263:247–249.PubMedCrossRef

Birkmeyer JD, Gust C, Baser O, Dimick JB, Sutherland JM, Skinner JS. Medicare payments for common inpatient procedures: implications for episode-based payment bundling. Health Serv Res. 2010;45:1783–1795.PubMedCrossRef

Bozic KJ, Chiu V. Quality measurement and public reporting in total joint arthroplasty. J Arthroplasty. 2008;23:146–149.PubMedCrossRef

Bozic KJ, Chiu VW, Takemoto SK, Greenbaum JN, Smith TM, Jerabek SA, Berry DJ. The validity of using administrative claims data in total joint arthroplasty outcomes research. J Arthroplasty. 2010;25:58–61.PubMedCrossRef

Bozic KJ, Smith AR, Mauerhan DR. Pay-for-performance in orthopedics: implications for clinical practice. J Arthroplasty. 2007;22:8–12.PubMedCrossRef

BQI. Enhancing Physician Quality Performance Measurement and Reporting Through Data Aggregation. The Better Quality Information (BQI) to Improve Care for Medicare Beneficiaries Project. Easton, MD: Delmarva Foundation for Medical Care; 2008.

10.

Christianson JB, Volmar KM, Alexander J, Scanlon DP. A report card on provider report cards: current status of the health care transparency movement. J Gen Intern Med. 2010;25:1235–1241.PubMedCrossRef

11.

CMS. Fiscal Year 2009 Quality Measure Reporting for 2010 Payment Update. December 2010. Available at: https://www.cms.gov/HospitalQualityInits/downloads/HospitalRHQDAPU200808.pdf. Accessed May 2010.

12.

CMS. Hospital Quality Initiatives Overview. Available at: http://www.cms.gov/HospitalQualityInits/01_Overview.asp#TopOfPage. Accessed December 20, 2010.

13.

CMS. 2011 Physician Compare Web Site Background Brief—Section 10331 of PPAC. 2010. Available at: http://www.usqualitymeasures.org/shared/content/Phy%20Com%20Web%20Site_background_paper%20rchell10%2012%202010_LK_ap10%2013in%20508.pdf. Accessed December 20, 2010.

14.

Colmers. Public Reporting and Transparency, Commission on a High Performance Health System. 2007. Available at: http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/Feb/Public-Reporting-and-Transparency.aspx. Accessed November 28, 2010.

15.

Dranove D, Kessler D, McClellan M, Satterthwaite M. Is more information better? The effects of ‘report cards’ on health care providers. J Polit Econ. 2003;111:555–588.CrossRef

16.

Draper DA, Liebhaber A, Ginsburg PB. High-performance Health Plan Networks: Early Experiences: Center for Health System Change. Issue Brief 111. Washington, DC: Center for Studying Health System Change; 2007.

17.

Ferris TG, Torchiana DF. Public Release of Clinical Outcomes Data. Online CABG Report Cards. Available at: www.NEJM.org. Accessed November 28, 2010.

18.

Fleming ST, Hicks LL, Bailey RC. Interpreting the Health Care Financing Administration’s mortality statistics. Med Care. 1995;33:186–201.PubMed

19.

Haas-Wilson D. Arrow and the information market failure in health care: the changing content and sources of health care information. J Health Polit Policy Law. 2001;26:1031–1044.PubMedCrossRef

20.

Hannan EL, Kilburn H Jr, Racz M, Shields E, Chassin MR. Improving the outcomes of coronary artery bypass surgery in New York State. JAMA. 1994;271:761–766.PubMedCrossRef

21.

HCAHPS Hospital Care Quality from the Consumer Perspective. Available at: http://www.hcahpsonline.org/home.aspx. Accessed December 20, 2010.

22.

Healthgrades—Guiding Americans to Their Best Health. Available at: http://www.healthgrades.com/. Accessed December 21, 2010.

23.

IOM. Performance Measurement: Accelerating Improvement. Institute of Medicine Pathways to Quality Health Care Series. Washington, DC: The National Academy of Sciences, the Institute of Medicine; 2005.

24.

James BC, Savitz LA. How Intermountain trimmed health care costs through robust quality improvement efforts. Health Aff (Millwood). 2011 May 19 [Epub ahead of print].

25.

Kaiser Permanente. Delivery System Reform. Action Steps and Pay-for-value Approaches. November 4, 2008. Available at: http://xnet.kp.org/newscenter/media/DeliverySystemReform.pdf. Accessed December 10, 2010.

26.

Khuri SF. Safety, quality, and the National Surgical Quality Improvement Program. Am Surg. 2006;72:994–998; discussion 1021–1030, 1133–1148.PubMed

27.

Lake T, Colby M, Peterson S. Health Plans’ Use of Physician Resource Use and Quality Measures, Final Report. Princeton, NJ: Mathematica Policy Research, Inc; 2007.

28.

Lansky D, Milstein A. Quality measurement in orthopaedics: the purchasers’ view. Clin Orthop Relat Res. 2009;467:2548–2555.PubMedCrossRef

29.

Leapfrog Group. Informing Choices. Rewarding Excellence. Getting Health Care Right. Available at: www.leapfroggroup.org/cp. Accessed December 29, 2010.

30.

Mehrotra A, Adams JL, Thomas JW, McGlynn EA. The effect of different attribution rules on individual physician cost profiles. Ann Intern Med. 2010;152:649–654.PubMed

31.

Mihalko WM, Greenwald AS, Lemons J, Kirkpatrick J. Reporting and notification of adverse events in orthopaedics. J Am Acad Orthop Surg. 2010;18:193–198.PubMed

32.

Milstein A, Lee TH. Comparing physicians on efficiency. N Engl J Med. 2007;357:2649–2652.PubMedCrossRef

33.

NCQA/HEDIS. National Committee for Quality Assurance: Report Cards. 2010. Available at: http://www.ncqa.org/tabid/60/Default.aspx. Accessed December 20, 2010.

34.

Porter M, Teisberg E. Redefining competition in healthcare. Harvard Business Review. 2004:2–14.

35.

Porter ME. What is value in health care? N Engl J Med. 2010;363:2477–2481.PubMedCrossRef

36.

PQRI. Physician Quality Reporting Initiative Measures Codes. 2010. Available at: https://www.cms.gov/PQRI/15_MeasuresCodes.asp. Accessed December 2010.

37.

PQRI. CMS Physician Quality Reporting Initiative Overview 2010. Available at: https://www.cms.gov/pqri/. Accessed December 20, 2010.

38.

RAND. Monograph Report Dying to Know: Public Release of information About Quality of Health Care. 2000. Available at: http://www.rand.org/pubs/monograph_reports/MR1255/index.html. Accessed November 2010.

39.

Reid RO, Friedberg MW, Adams JL, McGlynn EA, Mehrotra A. Associations between physician characteristics and quality of care. Arch Intern Med. 2010;170:1442–1449.PubMedCrossRef

40.

Rubenstein LV, Mittman BS, Yano EM, Mulrow C. From understanding health care provider behavior to improving health care: the QUERI framework for quality improvement. Med Care. 2000;38(Suppl 1):I-129–I-141.

41.

Sandy LG, Rattray MC, Thomas JW. Episode-based physician profiling: a guide to the perplexing. J Gen Intern Med. 2008;23:1521–1524.PubMedCrossRef

42.

Scholle SH, Roski J, Adams JL, Dunn DL, Kerr EA, Dugan DP, Jensen RE. Benchmarking physician performance: reliability of individual and composite measures. Am J Manag Care. 2008;14:833–838.PubMed

43.

Scholle SH, Roski J, Dunn DL, Adams JL, Dugan DP, Pawlson LG, Kerr EA. Availability of data for measuring physician quality performance. Am J Manag Care. 2009;15:67–72.PubMed

44.

Sirovich B, Gallagher PM, Wennberg DE, Fisher ES. Discretionary decision making by primary care physicians and the cost of US health care. Health Aff (Millwood). 2008;27:813–823.CrossRef

45.

Sorbero ME, Damberg CL, Shaw R, Teleki S, Lovejoy S, DeChristofaro A, Dembosky J, Schuster C. Assessment of Pay-for-performance Options for Medicare Physician Services: Final Report. Washington, DC: US Department of Health and Human Services; May 2006.

46.

Wadgaonkar AD, Schneider EC, Bhattacharyya T. Physician tiering by health plans in Massachusetts. J Bone Joint Surg Am. 2010;92:2204–2209.PubMedCrossRef

47.

Werner RM, Asch DA. The unintended consequences of publicly reporting quality information. JAMA. 2005;293:1239–1244.PubMedCrossRef

48.

Wisconsin Collaborative for Healthcare Quality. Available at: http://www.wchq.org/about/documents/Embracing_Accountability. Accessed December 20, 2010.

49.

Wong DA, Herndon JH, Canale ST, Brooks RL, Hunt TR, Epps HR, Fountain SS, Albanese SA, Johanson NA. Medical errors in orthopaedics. Results of an AAOS member survey. J Bone Joint Surg Am. 2009;91:547–557.PubMedCrossRef

50.

Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation (YNHHSC/CORE). Measure Instrument Development and Support. August 20, 2010. Available at: https://www.cms.gov/MMS/Downloads/MMSHipKneePublicComments.pdf. Accessed December 29, 2010.

Titel: Public Reporting of Cost and Quality Information in Orthopaedics
verfasst von: Youssra Marjoua, MD, MPP
Craig A. Butler, MD, MBA
Kevin J. Bozic, MD, MBA
Publikationsdatum: 01.04.2012
Verlag: Springer-Verlag
Erschienen in: Clinical Orthopaedics and Related Research® / Ausgabe 4/2012
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-2077-6

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2012

Is Hip Arthroscopy Cost-effective for Femoroacetabular Impingement?

What are Estimated Reimbursements for Lower Extremity Prostheses Capable of Surgical and Nonsurgical Lengthening?

Value-Based Healthcare and Orthopaedic Surgery: Editorial Comment

The Use of Three Strategies to Improve Quality of Care at a National Level

Drivers of Surgery for the Degenerative Hip, Knee, and Spine: A Systematic Review

Does Total Knee Arthroplasty Change Frontal Plane Knee Biomechanics During Gait?