Public reporting -- Where do we go from here?

January 12th, 2015

The goals of public reporting have always been noble. Ideally, it would lift the curtain of secrecy on clinical outcomes and let consumers make more informed choices about their healthcare. Many speculated that it would also encourage poor-performing hospitals to clean up their act and provide better care.

But a recent study suggesting that Medicare’s Hospital Compare initiative has had little or no impact on mortality for three important conditions has led some to wonder whether public reporting of healthcare data is really worth the time and expense involved.

The modest impact of Medicare’s public reporting initiative shouldn’t be too surprising. After all, there’s little evidence that general consumers are even aware of Hospital Compare, much less actually using it to help them select a hospital. And if the public’s indifferent, then public reporting loses much of its power to influence hospitals’ behavior and improve outcomes.

Some suggest the general lack of awareness of the data may not be a bad thing. This week, the Columbia Journalism Review questioned whether healthcare journalists should be using it in their coverage of local hospitals, stating “The data, it seems, may not be ready for prime time.” In the Q&A that follows, Kaiser Health News reporter Jordan Rau says, “These metrics…were created for a different purpose. The original aim was to help hospitals look at and track internal problems. They were not set up to compare one hospital with another.”

Indeed, teaching hospitals have complained recently that they unfairly got a black eye when a Medicare evaluation of hospitals indicated that their patients are at higher risk for preventable complications. Many responded by claiming that the measures used didn’t take into account the fact that teaching hospitals often care for sicker patients and perform more complex surgeries.

In any case, public reporting of hospital performance on a host of performance measures isn’t going away, and I don’t really think it should. There’s virtue in transparency, but let’s also be transparent about the fact that these measures aren’t perfect and there’s no perfect way to provide a simple comparison of hospital performance.

And as I’ve stated before, none of this works without a greater level of statistical and health literacy among the consumers public reporting is supposed to benefit.