Johns Hopkins Researchers Quantify Cost of Hospital Quality Metrics

June 8, 2023
Preparing and reporting data for these metrics at Johns Hopkins Hospital required an estimated personnel cost of more than $5 million plus more than $600,000 in vendor fees

Healthcare provider organizations continue to try to quantify the cost and impact of reporting on what they perceive as too many quality measures. For instance, earlier this year Healthcare Innovation reported that the UNC Health Alliance, the University of North Carolina's clinically integrated network, found that they were responding to 158 different measures across 14 value-based care contracts. Now researchers at Johns Hopkins Medicine have published a paper in JAMA identifying 162 metrics the health system is required to report on in the inpatient setting.

“The Volume and Cost of Quality Metric Reporting” published June 6, 2023, in JAMA, sought to evaluate externally reported inpatient quality metrics for adult patients and estimate the cost of data collection and reporting, independent of quality-improvement efforts.

The study used a retrospective time-driven activity-based costing study at the Johns Hopkins Hospital in Baltimore, with hospital personnel involved in quality metric reporting processes interviewed between January 1, 2019, and June 30, 2019, about quality reporting activities in the 2018 calendar year.

Of the 162 metrics identified, 96 (59.3 percent) were claims-based, 107 (66 percent) were outcome metrics, and 101 (62.3 percent) were related to patient safety. Preparing and reporting data for these metrics required an estimated 108,478 person-hours, with an estimated personnel cost of $5,038,218.28 (2022 USD) plus an additional $602,730.66 in vendor fees. Claims-based and chart-abstracted metrics used the most resources per metric, while electronic metrics consumed far less, the authors noted.

The authors note that “significant resources are expended exclusively for quality reporting, and some methods of quality assessment are far more expensive than others. Claims-based metrics were unexpectedly found to be the most resource intensive of all metric types. Policy makers should consider reducing the number of metrics and shifting to electronic metrics, when possible, to optimize resources spent in the overall pursuit of higher quality.”

Survey on infection control measures

In another recent study published in JAMA Network Open, some infection control experts question the effectiveness of surveillance and reporting on infection measures in terms of protecting public health. That is the finding of a new survey led by researchers at the University of Maryland School of Medicine (UNSOM).

The UMSOM researchers analyzed results from survey respondents from 43 U.S. hospitals that are part of the Healthcare Epidemiology Research Network, a consortium focusing on research in infection control and antibiotic misuse. The respondents reported that many metrics, such as surgical site infections and antibiotic-resistant (MRSA) bloodstream infections, were important measures of infection control that should be reported to the federal government. The vast majority of respondents, however, said that two metrics -- related to sepsis management and ventilator-associated infections -- were not useful measures of infection control efforts.

“These infection control metrics are intended to reflect the quality of care at each institution, but some of the metrics don’t take into account the complex care provided by academic institutions as compared to community hospitals,” said study lead author Gregory Schrank, M.D., assistant professor of medicine at UMSOM, in a statement. “Some have infections that can’t be prevented, while other metrics we are required to report aren’t indicative of an infection and don’t lead to an improvement in the quality of care that patients receive. Our survey found that tracking these metrics can detract from other important infection prevention work.”

Even more surprising, 84 percent of respondents said they believed hospitals and staff “intentionally manipulate” hospital-associated infection rates publicly reported on the government’s Centers for Medicare & Medicaid Services (CMS) Hospital Care Compare website. The federal government sets reimbursement rates for Medicare and Medicaid patients based on these metrics. The data are also used in hospital rankings published by US News & World Report and others.  Survey respondents stated that they feel pressure to find ways to avoid reporting cases.  

“We found that survey respondents did not believe the metrics reported on these websites were well understood by the public,” said study co-author Daniel Morgan, M.D., professor of epidemiology & public health at UMSOM, in a statement. “They also did not think reimbursements should be tied to these metrics, given all the caveats to collecting and reporting them.”

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