Greater use of electronic metrics could help reduce spending on quality measurement
Health care policy makers and providers are increasingly looking to value-based payment models as a way of curbing health care costs. But measuring and reporting on the quality metrics used in these models may itself be adding to those costs, a new study finds.
The study’s authors, a multi-disciplinary team of researchers at Johns Hopkins University, arrived at that conclusion after studying the costs of reporting on quality metrics at the Johns Hopkins Hospital, an acute care, academic medical center.
The authors identified 162 unique metrics the hospital reported to outside organizations in 2018, based on the National Quality Forum’s definition of “metric” as a “numeric quantification of healthcare quality for a designated healthcare provider.” About 59% of the metrics were claims-based, 62.3% were related to patient safety, and 66% were outcome metrics. Ninety-seven of the metrics were applicable to hospitals nationwide.
Using time-driven, activity-based costing methods, they estimated that preparing and reporting on data for the metrics took 108,000 person-hours costing $5 million per year—not including about $600,000 in vendor-related contracts. The estimates, they add, are just for the preparation and reporting of quality data, and don’t include time spent on quality improvement activities.
A surprising aspect of their findings, the authors say, was that despite being generated from data already collected for billing, claims-based metrics took more time to report on than chart-abstracted ones. They speculate this may be due to the challenge of accurately representing a patient’s health status in International Classification of Diseases-coded data, and whether the patient had any risk-modifying comorbidities when they were admitted.
“Although the order or volume of comorbidity codes or the ‘present on admission’ indicator may not affect billing, these details can significantly alter performance on risk-adjusted claims-based metrics,” they explain. Consequently, hospitals employ clinical documentation and quality specialists to increase the accuracy and specificity of coding
On the other hand, electronic clinical quality measures—those that are automatically reported from EHR data—were much less resource-intensive. And while not every aspect of health quality could be measured using electronic quality measures, “there may be a role for increasing investment in the design of more effective ones, potentially with direct involvement of EHR vendors,” the researchers say.
The authors note that while the $5.6 million Johns Hopkins spent on quality reporting represents a small fraction of the hospital’s $2.4 billion annual expenditures, “when extrapolated to the more than 4,100 acute care, nongovernment hospitals in the U.S. [the findings] suggest annual nationwide expenditures in the billions of dollars simply for reporting quality data.”
Possible ways to reduce the resources devoted to reporting on quality metrics, they say, are to reduce the number of metrics, and invest in developing electronic metricsthat can accurately portray a patient’s illness and the care they receive without the need for reviewing diagnostic codes or chart reviews.
The study, “The Volume and Cost of Quality Metric Reporting” appears in the June 6, 2023 issue of JAMA.