Consequences of Quality Reporting
An important tool for consumer decision making in health care are quality reports on health care facilities. These quality reports contain summary measures that influence patient choices and provide an incentive for quality improvement to facilities (at least along the metrics reported). Some metrics are also used for government payment formulas as part of the Patient Protection and Affordable Care Act. As these metrics have become more commonplace and published more widely, it is important to understand exactly what information is and is not carried within the quality reports, as well as how the act of publication influences the behavior of participants in the health care market. The first paper looks at how score reporting influences patient decision making. Specifically, how reported scores for hospitals impact patient preferences for where to get an organ transplant. The second paper asks the question “how much information is contained in quality scores?” It evaluates the Medicare Value Based Purchasing program, which pays hospitals based on their quality score performance, with a particular focus on how much of the score distributions used for reimbursement are essentially statistical noise. The final paper looks at how facilities adjust their behavior in response to the release of quality score information. It analyzes the responses of nursing homes to a Medicare “star based” rating system.