Measuring Healthcare Quality Still Difficult

Milwaukee Journal Sentinel
December 14, 2011

More than four years ago, the Wisconsin Collaborative for Healthcare Quality set out to compare its information on healthcare quality with Medicare claims data. The group was one of six nationwide chosen for the research project.

“We thought it would be extraordinarily easy,” said Amy Topel, who managed the project. “And it didn’t turn on out to be.” The same discovery could await similar groups in coming years.

Last week, the Department of Health and Human Services said it will make its database on Medicare claims available to groups that track healthcare quality and cost. They include the Wisconsin Collaborative for Healthcare Quality and the Wisconsin Health Information Exchange (WHIO).

The collaborative, a coalition of health systems and physician practices, develops measures of healthcare quality. WHIO—a coalition of health systems, the state, major insurers and employer groups, such as the Business Heath Care Group—is using claims data to determine which doctors and hospitals provide the best quality care at the lowest cost. Doctors will be identified in the Medicare claims data, but patient information will remain confidential.

The data eventually could help groups such as WHIO develop more accurate information on the cost and quality of healthcare provided by doctors and hospitals. That information is considered essential if the healthcare system is to become more efficient. But making use of the information could take more time than expected based on the collaborative’s experience in the research project

The first sign of potential complexity was when the claims data arrived—on tapes. The collaborative first needed to figure out how to read them. “I had never seen tapes like this,” said Topel, quality operations manager at Gundersen Lutheran Health System.

Other challenges followed. The goal was to compare information on how physician practices performed on various quality measures—such as whether a patient with diabetes had an eye exam in the past year—with the Medicare claims data. The bill for the eye exam would be in the claims data.

But simply making sense of the data proved difficult. Even the Center for Health System Research & Analysis at the University of Wisconsin, which worked on the project and had experience with Medicare data, struggled. “And they are a data shop,” Topel said.

That said, the claims data eventually should help consumer groups, health insurers and others determine which doctors and hospitals make the best use of healthcare dollars.

Relatively little information exists on the quality or cost of care provided by physicians, though some health insurers have begun rating physician performance. “As long as we’ve been at it—10 years in this state—we still have only scratched the surface in terms of the measures we report,” said Christopher Queram, the collaborative’s chief executive.

Getting access to Medicare claims data has been a longstanding goal of many organizations, Queram said. Patients covered by Medicare may account for 30% to 40% of a doctor’s practice. Yet groups such as the collaborative haven’t had access to the Medicare information. “It’s a big gap,” Queram said.