Quality Reports
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What to Consider
MeritCare works with dozens of insurers, government entities and industry associations – and each organization has a unique role within the health care industry. Some provide insurance to thousands of MeritCare patients. Several regulate, fund and monitor health care organizations. Others were formed by health care providers who work together to advance the health care field.
Many of these organizations also review and assess health care quality. The quality reports they publish are becoming more widely available to patients, including many reports available on the Internet. Because they analyze different aspects of health care, it's helpful to understand how each organization prioritizes, measures and analyzes the information in their reports.
Groups who report quality data use a variety of methods to gather the quality reporting information they publish. Often, they purchase data from the MedPAR file, or from various other vendors who collect information from hospitals around the country. Insurance companies review claims data and also conduct reviews of patient charts annually. The reviews typically focus on some of the most common patient health issues. Reviews of the data are broken down based on the insurer's definitions of types of procedures performed by the health care professional at a facility.
In these early stages of trying to make a complex health care system easier to understand, our industry faces many challenges. As you review the information presented here or on other web sites, keep the following points in mind:
- There are many additional factors to consider when reviewing the quality of a health care system. Other things you can use to help you include recommendations from your friends and family, looking at the number of procedures performed, assessing the experience and expertise of doctors and other caregivers and looking at overall quality outcomes such as mortality rates and board certification.
- Like MeritCare, many hospitals need to improve their documentation and measurement systems. In addition to providing the high level of care needed by patients, we will be focusing more on documentation. You will see an improvement of the measures over time as these systems are put in place.
Quality Report Cards
Quality "report cards" help patients review a health care organization's overall performance and assess their success in specific care areas. Many reports measure how often a specific treatment option is followed, such as giving aspirin to a heart attack patient when they arrive at the hospital. "Report cards" may also evaluate measures including discharge instructions and follow-up care.
Although quality reports can be very helpful, they can also be confusing. Here are some tips to remember when reviewing health care quality reports:
- Many reports are used within the health care industry and consumers are not the main audience. They are often filled with unfamiliar health care terminology and technical descriptions. If you do not understand a report or measure, contact the organization that compiled it.
- Health care professionals compile their measures differently. Each organization has a unique system for gathering and reporting data. And, even though an organization performs the procedure being measured, they may be unable to report certain data. Contact the health care organization if you have questions about their measurements.
- There is not a comprehensive, agreed-upon list of measures that indicate the true quality of care.
- Quality measures and reports are expanding. The health care industry is working to make quality reports more uniform, timely and easier to understand.
- Outside organizations use different types of information from health care organizations. Organizations such as payers and insurers utilize information gained from their insurance claims data from health care organizations. Their reports are often based on specific age groups, conditions or procedures. Because of their specific nature, these reports usually do not reflect all of the information for a health care organization.
- Some organizations who provide quality information are not in the health care industry, yet they developed a business by reporting health care quality. Often, these organizations create reports that are based on patients' billing data and then charge health care organizations to use their results. Sometimes, they charge patients to view the results.
Tips for Viewing Specific Measures
- Organizations may not specifically measure all the quality indicators that are published by others or they have other priorities for improvement.
- Indicators are measured by documentation. In many hospitals, the systems needed to document all types of indicators may need to be improved.