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The Department of Health and Human Services (HHS) is responsible for a variety of efforts to improve health care quality and the transparency of information for consumers. However, HHS could improve how it measures the quality of care and provides information to consumers.

Quality of health care

The cost and quality of health care services can vary significantly, with high cost not necessarily indicating high quality. To help improve health care services, HHS publicly reports quality measures, and has begun to adjust payments to certain providers accordingly.

For instance:

• Federal health care programs and other health care payers are increasingly examining the quality of the services people receive—and adjusting payments accordingly. However, payers do not always agree on which quality measures to track, making it difficult to improve the quality of care and burdening doctors and other providers with having to report different data to different payers. While HHS is working to better align its health care quality measures across programs and private payers, it needs to set key priorities for these efforts and develop more meaningful measures.
• Medicare’s Hospital Value-Based Purchasing program provides bonuses or penalties to hospitals based on their performance on certain quality and efficiency measures. Despite the program's intention to reward hospitals that provide high-quality care at a lower cost, some hospitals with relatively low quality scores received bonuses because they had high efficiency scores. So that lower quality hospitals do not receive bonuses, Medicare needs to revise the way it calculates performance scores.
• Clinical Data Registries (entities that work with physicians treating Medicare patients to collect clinical information) have demonstrated strengths in their ability to track and interpret trends in physician quality over time. However, HHS needs to establish key requirements for these registries that focus on improving both quality of care and efficiency.
• HHS measures of nursing home quality show mixed results. For instance, the average number of consumer complaints reported per nursing home increased by 21% from 2005-2014. However, the number of serious issues identified per nursing home decreased by 41% over the same period. HHS needs to conduct audits to ensure the reliability of nursing home data so that it will be better positioned to determine whether trends reflect actual changes in quality, data issues, or both.

Nursing Home Consumer Complaints and Serious Deficiencies, 2005-2014

Providing better information

As consumers pay for a growing proportion of their health care, they need better information on costs and quality so that they can make informed decisions. Transparency tools can provide such information.

• CMS operates a range of online transparency tools, including Nursing Home Compare, Dialysis Facility Compare, Home Health Compare, Hospital Compare, and Physician Compare. However, none of these tools contain information on patients' out-of-pocket costs. Consequently, they do not allow consumers to assess the value of health care services or anticipate the cost of services in advance. HHS needs to improve these transparency tools, such as by developing metrics to ensure the tools address consumers’ needs.
• Nursing Home Compare allows people to research and compare nursing homes using a rating system. However, this tool lacks some key information, such as consumer satisfaction scores and the ability to compare nursing homes across states.

Example of Missing Information Affecting a Consumer's Nursing Home Decision

High-Risk Issues

• Medicaid Program
• Medicare Program

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