Measuring medical care

How do your medical clinic and hospital stack up with the quality of care they provide? A new statewide report, issued Thursday by the Minnesota Department of Health, lays out the details on performance measures for everything from heart attacks to diabetes, cancer screening and sore throats.

A fair amount of this data is already publicly available on sites such as Minnesota Community Measurement. But this is the first time it’s been gathered in one place and standardized for hospitals and clinics across the state. State officials see the report as the first step toward value-based health care in Minnesota – that is, rewarding quality rather than simply paying for procedures. The report also is meant to lay the foundation for provider peer grouping, allowing people to compare on the basis of both quality and cost and presumably make more informed decisions about where to seek health care services.

The report is a lunker. In fact, its sheer heft is somewhat of a drawback, when you consider the whole point is to make quality data more available and transparent for the average Minnesotan. The entire document is 800-plus pages long. It contains 43 quality measures for hospital care and 13 for physician clinics.

I’d rate its user-friendliness in the category of “daunting.” Kandiyohi County, for instance, is grouped into a geographic area that includes nearly 40 counties in southwestern, southeastern and south central Minnesota. The section is 242 pages long and I had to scroll through dozens of alphabetical listings until I found the data for Willmar. I notice the website designer remedied some of this today by breaking the report into smaller sections for easier reading, but it’s still quite cumbersome.

Once you get past these initial barriers, though, the findings are revealing. What leaps out is the degree to which hospitals and physician clinics in Minnesota vary on performance measures. Some do well across the board on most of the measures. But many are inconsistent, with good marks on some measures and not-so-good marks on others.

The million-dollar question: Will the report actually be used by consumers, and will it be used in a meaningful way? The answer isn’t entirely clear.

Although some people will have the hardihood to analyze all the numbers and choose their hospital or medical clinic on the basis of its quality performance scores, many consumers can’t or won’t. It’s not just that they don’t want to wade through all those statistics; it’s also about the other considerations that often go into people’s health care choices.

Some of it comes down to simple practicalities. I rarely see any discussion on how value-based consumer choice might apply to residents of greater Minnesota. Is it realistic to think someone living in a rural community can effectively comparison-shop when the next nearest clinic or hospital might be 30 miles (or more) away?

Nor do quality scores take into account the human element, which also matters to patients – whether the medical clinic has convenient hours and a user-friendly system for making appointments, for instance, or whether the patient feels he or she can have a trusting relationship with the doctor.

None of this means quality shouldn’t matter. Absolutely it does matter when consumers know they can consistently receive quality care that gives them good value for their money. But quality scores don’t tell the entire story and they’re not the only piece of information consumers should use in judging whether to go to a particular clinic or hospital.

The real value of this report, I suspect, will lie in the information it provides for hospitals and medical clinics to measure themselves against their peers and identify where they could be doing better. If this happens, ultimately all consumers will be better off, no matter where they happen to live or which provider they choose.

Photo: Wikimedia Commons

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