Addressing Healthcare Quality Ranking Flaws: 5 Steps for Moving Forward

| URAC Staff
doctor writing on chart

Healthcare ranking systems intended to measure quality of care can garner mixed reviews among providers. While many critics point to flaws in how such systems are structured, organizations like URAC are focusing on approaches to quality measurement that may be more reflective of provider performance. 

 “Ranking systems are heavily weighted toward process measures,” says Marybeth Farquhar, URAC’s Vice President of Quality, Research and Measurement. “Many of the measures that contribute to a ranking are basically indicating that a task has been completed, rather than looking at patient outcomes that resulted from that task.”

Whether it’s the Star Ratings from the Centers for Medicare & Medicaid Services (CMS), the Top Performer Program from the Joint Commission or NCQA’s Health Plan Ratings, ranking systems are and will continue to be an important part of the shift toward value-based payment.

“As we move toward more patient-centered care, patient-reported information is critical in moving toward better patient outcomes,” says Eleni Theodoropoulos, Director of Quality and Measurement for URAC.

Here are five ways that today’s ranking systems can be improved for the patient-centered care of tomorrow.

Have a continuous-improvement mindset. “URAC takes the stance that providers should be in a mode of continuous quality improvement,” says Farquhar. “Our focus is not punitive, it’s educational and collaborative, working with providers to identify the areas or gaps that need improvement. Eliminating the costs associated with poor service delivery requires a focused, sustained effort to improve. Measurement allows us to do that.”

Several of URAC’s accreditation programs currently incorporate quality measures; all of which are aligned with the HHS National Quality Strategy and focus on areas such as coordination of care, patient safety, efficiency and healthcare IT integration. URAC’s goal is to help providers make improvements that are sustainable in the long-term. 

Account for variations in patient population. “Ensuring a ‘level playing field’ is an important characteristic of ranking systems,” says Farquhar. “Adjusting for the effects of patient characteristics that may vary across providers is necessary because stakeholders can easily draw incorrect conclusions if certain factors are not taken into account when reporting rankings.”  Risk adjustment is particularly important for outcome measures because patient outcomes are driven in part by factors such as age, gender, medical history, comorbid illnesses, social and behavioral as well as physiologic factors that should be calculated into the scoring methods used by ranking systems.

Measure outcomes, not processes. Outcome measures quantify something important in their own right, such as the death rate for myocardial infarction.  While there are other factors such as lifestyle and socio-economic status that influence outcome measures, they are valid measures of quality if health services are directly linked to patient outcomes.  Process measures, while sensitive to changes in care quality are easily interpreted and are relevant only if they are linked to outcomes. 

Focus on patient experience, not satisfaction. “The patient perspective is an important aspect in assessing care quality,” says Farquhar.   Patient surveys, whether they measure patient’s experience or satisfaction with care, demonstrate that providers are interested in quality and in doing things better.  Standardized surveys, such as those measuring patient experience, produce data that allow objective and meaningful comparisons of providers on topics that are important to patients.  And because there is a standardized way to implement the survey, they are more actionable than satisfaction surveys. 

Improve timeliness. When ranking providers and reporting on quality, data collection can become a challenge.  Ranking systems that report cost and quality to consumers should use data that is accurate as well as timely.  “Many ranking systems use data that are a year old and sometimes much older,” says Theodoropoulos. “Things can change very quickly in healthcare, so these rankings may not be a current, accurate reflection of provider organizations that have implemented improvements.”


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