Why hasn’t public value reporting led to more patients choosing high value care?

CMS has a number of quality initiatives to measure provider quality.  For instance, there is the Hospital  Inpatient Quality Reporting Program, the Home Health Quality Reporting Requirements, the Skilled Nursing Facility (SNF) Quality Reporting Program, the Inpatient Rehabilitation Facilities (IRF) Quality Reporting Program (QRP), among others.  Have these initiatives led to more patients choosing high value care?  A commentary by Kullgren et al. 2018 argues that the answer is no.  Here is why:

First, many Americans’ choices about where to receive health care services are influenced more by the recommendations of family and friends (Tu and Lauer 2008) or their health plan’s network (Haeder, Weimer, and Mukamel 2015) than information about quality or cost (DiJulio, Firth, and Brodie 2015; Scanlon et al. 2015). Second, even when individuals attempt to use reports of quality or cost, the information in these reports may be primarily intended to influence providers (Mehrotra et al. 2012) and thus may have limited utility for consumers. Third, even when public reports are intended for consumers, the information they contain is often incomplete (Kullgren, Duey, and Werner 2013; Kullgren et al. 2017) and therefore may not be helpful in their decisions. Consequently, there is little evidence that public reporting of performance data has impacted choices of health care consumers in a meaningful way (Ketelaar et al. 2011).

This is not to say that we cannot improve how information is communicated to patients, but to date these quality reporting systems have not been widely used by patients.



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