The Trump administration plans to overhaul the measurements that federal health programs use to assure quality care for patients in the coming year, according to a top Health and Human Services Department official.
An administration “roadmap” will outline how the HHS, the Defense Department, and the Department of Veterans Affairs plan to rework the thousands of quality metrics across the federal government, HHS Deputy Secretary Eric Hargan said in an interview.
Health-care providers must collect and report information on what they’re doing to improve health for their patients, the outcomes of those actions, and how patients feel about their care in order to receive bonus payments from Medicare or private insurers. The quality measures are publicly available for patients to see, but they are often difficult to use.
The administration has made paying for patient outcomes rather than individual procedures a priority, and officials see improving quality care as an important part of that. At the same time, they are responding to complaints from doctors who say the thousands of quality metrics make it difficult to focus on caring for their patients.
Researchers, doctors, and policymakers agree that well-designed quality measures can positively affect patient care. They can allow patients to get more information about doctors and their services so they can choose better quality, less expensive care.
But people in both the government and the private sector say the way quality is measured and reported needs “pretty fundamental reform,” Hargan said. As a result, the departments are tasked with outlining how they would improve quality as part of an executive order aimed at increasing transparency in health care.
Hargan said the blueprint will have three principles that the government and a panel of external participants agreed upon:
- Finding which measures are the most important to keep.
- Making quality information usable to the public and health-care providers.
- Allowing for more involvement from the private sector.
The goal of the roadmap is to establish clear, national priorities for measuring quality, said Shantanu Agrawal, president and CEO of the National Quality Forum, a nonprofit that works on quality measurement and reporting. Agrawal was part of the panel that consulted on the quality roadmap.
The administration will release the roadmap after getting clearance from the departments, communications staffs, and the Office of Management and Budget, Hargan said.
After the proposal comes out, agencies within the HHS, the DOD, and the VA will implement its principles on a more “granular” level, Hargan said.
Lessening the Burden
Doctors have to cope with thousands of quality metrics, in addition to tweaks that insurers and medical providers make to fit their own needs, Hargan said.
Lessening that burden and finding which measures are most useful for improving clinical outcomes are the main priorities that the private sector asked the government to solve, Hargan said.
Some assume that quality measures are only useful for one thing—accountability, Agrawal said. However, patients also want those measures to better understand whom they should seek care from, he said.
Agrawal said the government should take care that narrowing the number of quality measures doesn’t lead to health disparities or underrepresentation of certain populations. For example, if the government chooses to focus on the top five causes of morbidity and mortality, it might miss causes that are more common in communities of color.
Patients and their health-care providers also need to be able to access that quality information, Hargan said. Right now they can, but it’s difficult to do so.
If quality data was more seamlessly collected and shared, more time could be spent by doctors and other health providers on improving care, Agrawal said.
More Private Engagement
There also needs to be more involvement from private companies and health systems in government efforts to assure quality care, Hargan said.
Companies,—like organizations with health quality experts, clinicians, and consumers who work to improve care for Medicare patients—need to be able to provide feedback easily, and the government needs to be able to do the same, he said.
More public-private partnerships would allow for both the government and private sector to learn from each other, Agrawal said. The VA, hospitals, and private insurers have done a lot to improve the quality of care, and partnerships could allow information on those successes to flow more freely, he said.