The Era of Big Performance Measurement: Here at Last?

摘要

After a number of false starts, spanning roughly 150 years, there seems little doubt that the era of "big" performance measurement in health care in the United States is here to stay. The vast majority of acute care hospitals now participate in the Joint Commission ORYX~? core measures programs and Hospital Quality Alliance (HQA); the number of measures that providers are being asked to report on is growing on an almost daily basis; and experiments with "pay-for-performance" are taking place with increasing frequency. Although such market-driven efforts have yielded only modest benefits,2 hospital executives increasingly show the same familiarity with concepts such as hospital standardized mortality rates and composite process scores, the lingua franca of the chief quality officer, as they have shown with terms such as days of cash on hand and margin. This long-awaited arrival of sustained interest in performance measurement reflects several related developments: the gradual accumulation of evidence that the quality and safety of health care in the United States are not as good as they should be; an emboldened payor community, led by the Centers for Medicare & Medicaid Services, that has taken on a more active role than was previously imaginable6; and opportunities to share information about health care providers on the Web.