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

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SNH-thumb2In our last post, we looked at the complaints that safety-net hospitals have about the federal government’s universally applied quality metrics.

In an article for HealthLeaders Media, Joe Cantlupe revealed  the quality metrics that are natural fits for commercially insured patients aren’t as easily applied to safety-net patients, most of whom have chronic needs outside of the metrics’ scope.

Martin Serota, MD, chief medical officer of Los Angeles-based Alta Med Healthcare Services, one of the safety-net executives challenging the government’s quality metrics, zeroed in on colon cancer screenings as a prime example of this.

In Serota’s opinion, the biggest problem with the screenings and similar measures is they’re not patient-centered; they’re metrics-centered. In other words, it’s not what his patients’ actual needs are; it’s about the quality report.

He then posed a list of items that are more important to his hospital’s patients, like immunization. Or food. Or even shelter.

If this is what AltaMed’s patients really need, he wonders, isn’t it better to direct resources in that direction than to invest them in colon cancer screenings simply to satisfy a federal metric? Furthermore, what will actually improve his patient population in the long run: a screening or perhaps addiction counseling?

This is why Serota and his colleagues want fairer quality metrics that take into account the safety-net hospitals. Instead of labeling too many emergency room and hospital visits a failure and penalizing the hospital for that failure, he said, reward the “hospitals serving at-risk patients…for providing ‘intangible services,’ such as preventative care, social support, and educational resources.”

Furthermore, reimburse hospitals for supplying “’enabling services,’ such as transportation, social and counseling programs, including an obesity prevention focus.”

Speaking of obesity, Serota points out, “one quality measure the government doesn’t address is obesity. Having reduced obesity is not a quality measure, and that’s the biggest health issue facing our country. Yet there’s no quality measure around it.”

Serota recently wrote in the Journal of the American Medical Association, “By changing its focus, the government would help ‘better align quality improvement with what brings value to patients…Without such a shift, quality measurement—and the ensuring improvement efforts—may continue to shift resources away from where they are most needed. This is something we surely cannot afford.’”

As healthcare executives, what are your thoughts on revising quality metrics to better fit the needs of certain patient populations? How would such revisions affect your organization? Are there other, more patient-centric areas in which you could be directing your resources if not for federal standards?

-by Pete Fernbaugh

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