Safety Net Hospitals Fight Back Against Federal Quality Metrics (Part 1 of 2)

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SNH-thumb3Are the current quality metrics by which hospitals are evaluated fair for all organizations?

According to safety-net hospitals, the answer is a resounding “No!,” reports Joe Cantlupe at HealthLeaders Media. In fact, some safety-net hospitals are preparing to wage an intensive pushback against federal quality metrics, saying the “current quality measurement scores don’t address the basic healthcare needs of urban at-risk patients, and, as a result, funding is redirected elsewhere.”

It’s important to note that quality metrics for safety-net hospitals tend to be lower than the scores for other hospitals, Cantlupe writes, mainly because “the safety-net hospitals provide a significant level of care to low-income, uninsured, and vulnerable populations.”

Given these constraints, most safety-net hospitals can’t meet the prescribed metrics, thus threatening their reimbursements.

Martin Serota, MD, chief medical officer of Los Angeles-based Alta Med Healthcare Services, who is among those healthcare executives fighting the government’s quality metrics, goes so far as to challenge the original intentions behind these standards, saying, “There [are] a lot of reasons for our current quality measures. They were based on several criteria, things that can be measured easily, and measured by claims data and not by truth.”

This is an important point, Cantlupe adds. “While traditional quality measures may be suitable for the commercially insured population, they may not be suitable for patients who need safety-net care.”

In fact, these measures end up distracting the physician from the patients’ actual needs.

Serota brings up colon cancer screenings as an example. These screenings “are legitimate in mainstream hospitals. But healthcare facilities serving impoverished patients have difficulty enrolling patients in such programs because the patients have more pressing concerns, such as chronic illness, or drug and alcohol addictions.”

At AltaMed, physicians made an attempt to comply with colon cancer screenings and ended up 20 percent below target. They even upped their strategies to bring patients in, launching outreach campaigns and devising electronic reminders, Cantlupe writes.  In the end, they were left wondering if it was worth it.

“Although we fully appreciate the value of colon cancer screening (one of us had almost 100 percent compliance rates previously in private practice), we weren’t certain that focused outreach to improve our rates was the best use of staff time,” Serota recently wrote in the Journal of the American Medical Association. “In order for our case managers or referral specialists to dedicate efforts to promote colon cancer screening, they would need to spend less time doing something else.”

And it’s that something else that is Serota and his colleagues’ main gripe: patients have plenty of needs that need to be addressed, but the government never addresses them. We’ll cover that in our next post.

In the meantime, as healthcare executives, do you agree with Serota? Are the federal quality metrics too much of a “catch-all,” to the detriment of certain types of hospitals? How could this be fixed?

-by Pete Fernbaugh

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