Low-Scoring HMOs Less Likely To Report Subsequent NCQA Quality Results, Study Finds
HMOs that receive poor scores on the National Committee for Quality Assurance's annual "report card" are at least three times more likely to withdraw their scores from public disclosure the following year, potentially misleading the public's perception of HMO quality, according to a new study, the AP/Las Vegas Sun reports (Tanner, AP/Las Vegas Sun, 9/24). For the study, published in today's Journal of the American Medical Association, researchers from Harvard University and Public Citizen's Health Research Group analyzed NCQA's annual "Quality Compass" information for 1997, 1998 and 1999, including Health Plan Employer Data and Information Set quality scores (McCormick et al., JAMA, 9/25). The study found that of the 329 HMOs that publicly disclosed their quality scores in 1997, 161, or 49%, requested that their scores remain confidential the following year. Of the 292 HMOs that allowed public score reporting in 1998, 67, or 23%, asked the NCQA not to publish their scores in 1999. NCQA-accredited HMOs -- those that have passed an on-site evaluation by the committee -- are required to submit information for grading and, since 1999, have been required to allow the information to be publicized. But non-accredited HMOs submit such data on a voluntary basis and may elect to keep the information confidential. Approximately 300 of the nation's 500 HMOs are accredited. The study found that plans with poor scores were "at least three times more likely" to request that their scores remain confidential the following year.
While the NCQA's most recent report card, released earlier this month, indicated that HMOs have made improvements on some quality issues, including patients' access to screenings and other preventive services, approximately 15% of unaccredited plans requested that their data remain private. Dr. Danny McCormick, one of the study's authors and a professor at Harvard Medical School, said that consumers have been given the impression that the report card contains both high and low scores, but "that turns out not to be the case." (AP/Las Vegas Sun, 9/24). "The selective withdrawal by lower scoring plans means that average published scores could improve even if actual quality were stable or even deteriorating. This means that the true quality of HMO care in the United States is currently unknowable," Dr. David Himmelstein, a study co-author and professor at Harvard Medical School, said (Harvard Medical School/Public Citizen release, 9/24). The study concludes that voluntary reporting of HEDIS quality scores is "ineffective," and "[r]eporting and public disclosure of HEDIS and other meaningful quality data by HMOs should be mandatory" (JAMA, 9/25). NPR's "All Things Considered" yesterday reported on the HMO quality reports (Neighmond, "All Things Considered," NPR, 9/24). The full segment is available in RealPlayer online.
Consumers "who depend on health care have a right to know how good that care is," and providers and insurers "have a duty to tell them," Dr. Donald Berwick, president and CEO of the Boston-based Institute for Healthcare Improvement, writes in an accompanying JAMA editorial. According to Berwick, patients' right to confidentiality "conveys no right to secrecy about performance among those who give them care." Berwick writes that public reporting of quality scores must become "the convention, not the exception." To that end, Berwick makes the following suggestions:
- Employers and government purchasers of health care should require health plans to regularly report to the public on their performance.
- CMS should restart a program through which hospitals report mortality rates and other performance measures annually.
- Officials should develop a process by which large medical group practices and clinics can report quality scores.
- The NCQA's Quality Report should be maintained and improved.