The problem, say hospitals and some analysts, is that rating hospital quality is not so straightforward. How a hospital delivers care is multifactorial and complex, they argue, so trying to cram that into a single score is misleading and can end up like rating a restaurant on its parking.
The measures most often used today to assess care quality are process measures. Actual outcomes, of course, are harder to measure than whether a certain action has been taken—checking the feet of a patient with diabetes, for example. But many experts don’t think process measures get at the heart of quality.
After 25 years, the Healthcare Effectiveness Data and Information Set (HEDIS) is still criticized for focusing on process and taking up doctors’ time. But it has been incorporated into physicians’ workflow and may yet be instrumental in bringing about value-based care.
Requiring some patients with chronic conditions to try and fail multiple medications leads to complications and drives up costs, say many physicians. Insurers answer that the trial-and-error approach can be an important way to rein in costs.
The challenges include not overburdening physicians and fitting into an increasingly complex, multilayered informatics ecosystem. Artificial intelligence is a work in progress, but early adopters of gamification could get ahead of their competition.