Report Card on Quality
This is from a report by the National Committee for Quality Assurance (NCQA):
The Good:
- A 12 percentage point jump in the provision of beta-blocker drugs to Medicare patients who had a heart attack within the previous 6 months.
- Near universal high-quality care for Americans with asthma.
- Substantial gains in helping Medicaid beneficiaries stop smoking.
The Bad:
- Only 46.4% of people taking anti-depressant drugs are monitored by their physicians;
- Only 34.1% of children prescribed medications for attention deficit hyperactivity disorder (ADHD) are seeing a doctor for follow-up care;
- Only half of patients previously hospitalized for mental illness see a physician for a follow-up visit;
- Only 45.3% of people are receiving colon cancer screening at the appropriate age; and
- Only 42.6% of patients with alcohol or drug dependency are entering into treatment.
The Ugly (vulnerable populations):
- Among Medicare Advantage plans, only 5 of 36 measures (14%) showed a statistically significant improvement;
- In Medicaid, 18 of 50 measures (36%) showed a statistically significant gain, and most of these improvements were small.
The problem I have with the NCQA is that they tend to measure inputs, not outputs. How do we really know if all of the things they recommend improve patient outcomes.
I agree with Joe. They have always had that bias.
On balance, I would say this is a somewhat negative report.
Of course the National Committee for Quality Assurance tends to measure inputs rather than outcomes. Medicare pays by task (i.e. inputs) rather than outcomes so it only makes sense that NCQA would attempt to measure quality that way.
My favorite part is the press release, wherein the NCQA calls for the federal government to legislate mandatory reporting to the NCQA. Everyone wants a government-granted monopoly these days!
Speaking of which: Note that only Medicare Advantage plans submit HEDIS reports. Traditional Medicare does not. The government loves to demand measurement and accountability for others, just not its own operations.