The Rewards and Challenges of Focusing on Care Quality Documentation

The quest to document quality in healthcare faces several obstacles. “Quality of care” is a not a simple notion to define. Different entities in the healthcare system interpret quality in different ways. Purchasers, patients, and providers each have unique viewpoints on the core components that make for a quality experience.

The Importance of Quality Measurement

To grade quality, the level of care must be measured. Providers often dispute how to best measure quality. They worry that quality scores do not allow legitimate and meaningful comparisons between systems or between individual clinics and providers. Until recently, professional judgment was used almost exclusively to assess the quality of care—monitoring of quality was done almost intuitively by individual providers. Today, interest has grown in collecting more objective measures of quality. Creating, recording, and interpreting an unbiased assessment of the quality of medical care can be costly, time-consuming, and laborious. It also takes the provider away from focusing directly on patient care.

Collecting Data about Quality

For years, documenting clinical facts and findings on paper was done in whatever way was most convenient, with little regard for how this data might eventually be collected and analyzed. Even today, the data used to measure quality may be located in multiple places and may occur in different formats (text, paper, digital, pictures, videos, etc.). The same data may exist in different systems, and data capture is often inconsistent. While almost every electronic health records (EHR) system claims to capture data in a way that can be used to measure quality, there has been little movement toward a nationally accepted, standardized agreement as to what needs to be documented. Therefore, much of the data captured may be difficult to aggregate and analyze in a manner that is easily converted into a measure of quality. In addition, differences that result over time from regulatory requirements, advances in scientific knowledge, and demographic differences may not be addressed properly with a static system of data capture.

The “Business Case” for Quality

Convincing providers of the “business case” for quality can be difficult in our current environment. Reimbursement has decreased while overhead costs are increasing, and fee-for-service medicine tends to bestow financial rewards on providers for high volumes, not quality. However, more and more reimbursement will be directly affected by quality measurements in the future. There are several initiatives currently underway at the medical group and provider levels which include a “pay for performance” component aimed at providing financial incentives to improve quality. Quality measures will also increasingly be seen on publicly-accessible “report cards.” While public reporting remains controversial and may not be favored by many providers, it is unlikely to go away since evidence suggests that such reporting may yield positive change by stimulating investment in quality improvement activities when report card scores suggest the need.

Care Experiences Often Reflect Quality

Although the vast majority of patients are not medical experts, studies have shown that their impressions of their experiences with the healthcare system are reflective of the quality of their clinical care. While some providers may deride patient satisfaction information as “subjective,” it has increasingly been accepted as a meaningful assessment of the quality of a healthcare system. Additionally, patients who express dissatisfaction with their experiences switch physicians and health plans more often, delay seeking needed care, and have poorer health outcomes. The measures that are contained in HCAHPS and CG-CAHPS are now commonly accepted and will be used to determine reimbursement and will also be publicly disseminated as a measure of quality of your institution or your clinic. Developing a working understanding of what is being measured (from a new perspective of taking the patient’s viewpoint rather than the provider’s) is a key to improve scores on these quality measurements. Most providers are well meaning and try to do the best for their patients.

Where Organizations Need to Focus to Improve Quality Documentation

Based on our experience, the single most important thing we would recommend to organizations that are trying to improve quality documentation would be to focus specifically on the survey questions that are used to assess quality measures. Once one understands the questions, patients can be approached and communicated with in a way that causes their perception of quality to increase. A large part of this communication is to help them understand what we define as quality. Take, for instance, a provider who is trying to stress respect for a patient’s privacy. While interacting with a patient, the provider might close the door to the examining room door and state “If it’s ok, I’m going to close the door so that we may speak privately because respecting your privacy is a very important consideration at our clinic.” In this way, the provider is both reinforcing respect for privacy and educating the patient on the measures the health care team is taking to respect and support their privacy. Whether or not you agree that quality is being measured properly or that proper systems are in place to make such measurements, quality reporting in healthcare is here to stay. Therefore, it is important to come on board to try to make strides to understand and improve on these quality measures. Cognizance of your scores in comparison to your peers is also essential. Systems who do not focus on quality measures will increasingly come under scrutiny from payers, patients, and employers and risk substantial losses to their bottom lines.

This blog post excerpts an article in the Q3 2016 issue of Provider Advisor. Complete the form below to download the issue.

April 1, 2021