Health Care Quality
Despite high health care spending, there are still problems with the quality of the nation’s health care services.
The Department of Health and Human Services (HHS) is responsible for a variety of efforts to improve health care quality and the transparency of information for consumers.
Measuring the quality of care across providers
The cost and quality of health care services can vary significantly, with high cost not necessarily indicating high quality. To help improve health care services, HHS publicly reports quality measures, and has begun to adjust payments to certain providers based on the results.
- Federal health care programs and other health care payers are increasingly examining the quality of the services people receive—and adjusting payments accordingly. However, payers do not always agree on which quality measures to track, making it difficult to improve the quality of care and burdening doctors and other providers with having to report different data to different payers. While HHS is working to better align its health care quality measures across programs and private payers, it needs to set key priorities for these efforts and develop more meaningful measures.
- Medicare’s Hospital Value-Based Purchasing program provides bonuses or penalties to hospitals based on their performance on certain quality and efficiency measures. Despite the program's intention to reward hospitals that provide high-quality care at a lower cost, some hospitals with relatively low quality scores received bonuses because they had high efficiency scores. So that lower quality hospitals do not receive bonuses, Medicare needs to revise the way it calculates performance scores.
- Clinical Data Registries (entities that work with physicians treating Medicare patients to collect clinical information) have demonstrated strengths in their ability to track and interpret trends in physician quality over time. However, HHS needs to establish key requirements for these registries that focus on improving both quality of care and efficiency.
- HHS measures of nursing home quality show mixed results. For instance, the average number of consumer complaints reported per nursing home increased by 21 percent from 2005-2014. However, the number of serious issues identified per nursing home decreased by 41 percent over the same period. HHS needs to conduct audits to ensure the reliability of nursing home data so that it will be better positioned to determine whether trends reflect actual changes in quality, data issues, or both.
Nursing Home Consumer Complaints and Serious Deficiencies, 2005-2014
Improving the transparency of information for consumers
As consumers pay for a growing proportion of their health care, they have an increased need for cost and quality information so they can plan and make informed decisions. Transparency tools can provide such information.
- CMS operates a range of online transparency tools, including Nursing Home Compare, Dialysis Facility Compare, Home Health Compare, Hospital Compare, and Physician Compare. However, none of these tools contain information on patients' out-of-pocket costs. Consequently, they do not allow consumers to assess the value of health care services or anticipate the cost of services in advance. HHS needs to improve these transparency tools, such as by developing metrics to ensure the tools address consumers’ needs.
- Nursing Home Compare allows people to research and compare nursing homes using a rating system. However, this tool lacks some key information, such as consumer satisfaction scores and the ability to compare nursing homes across states.
Example of Missing Information Affecting a Consumer's Nursing Home Decision
GAO-17-551: Published: Jun 30, 2017. Publicly Released: Jun 30, 2017.
Through the Hospital Value-based Purchasing program, hospitals that participate in Medicare receive bonuses or penalties, depending on their performance on a set of quality and efficiency measures. Despite the program's intention to reward hospitals that provide high-quality care at a lower cost, we found that some hospitals with low quality scores received bonuses because they had relatively hig...
GAO-17-61: Published: Nov 18, 2016. Publicly Released: Dec 6, 2016.
Millions of Americans are cared for in nursing homes each year, and that number is expected to increase as baby boomers age. So how do you choose a nursing home? Nursing Home Compare is an online tool that allows people to research and compare nursing homes using a rating system. We found that most people think the site is helpful, but it's not perfect. For example, it lacks some key information...
GAO-17-5: Published: Oct 13, 2016. Publicly Released: Oct 13, 2016.
Hurdles to measuring and rewarding quality health care Medicare and other health care payers are increasingly examining the quality of the services people receive—and adjusting payments accordingly. But payers don’t agree on which quality measures to track, making it difficult to improve the quality of care and burdening doctors and other providers with reporting different data to different p...
GAO-16-33: Published: Oct 30, 2015. Publicly Released: Nov 30, 2015.
In recent years, trends in four key sets of data that give insight into nursing home quality show mixed results, and data issues complicate the ability to assess quality trends. Nationally, one of the four data sets—consumer complaints—suggests that consumers' concerns over quality have increased, while the other three data sets—deficiencies, staffing levels, and clinical quality measures—...
GAO-16-9: Published: Oct 1, 2015. Publicly Released: Oct 1, 2015.
The bonuses and penalties received by most of the approximately 3,000 hospitals eligible for the Hospital Value-based Purchasing (HVBP) program amounted to less than 0.5 percent of applicable Medicare payments each year. GAO found that safety net hospitals, which provide a significant amount of care to the poor, consistently had lower median payment adjustments—that is, smaller bonuses or larger...
GAO-15-11: Published: Oct 20, 2014. Publicly Released: Nov 18, 2014.
Results obtained from two selected private consumer transparency tools GAO reviewed—websites with health cost or quality information comparing different health care providers—show that some providers are paid thousands of dollars more than others for the same service in the same geographic area, regardless of the quality of such services. For example, the cost for maternity care at selected ac...
GAO-14-75: Published: Dec 16, 2013. Publicly Released: Dec 16, 2013.
Clinical data registries (CDR) have demonstrated a particular strength in assessing physician performance through their capacity to track and interpret trends in health care quality over time. Studies examining results reported by several long-established CDRs demonstrate the utility of CDR data sets for analyzing trends in both outcomes and treatments. CDR efforts to improve outcomes typically in...