Report cards: a cautionary tale - hospital advertising - special edition: The State of Health Care in America 1995

Business & Health, Annual, 1995 by Paul Kenkel

For two years, Boone Hospital Center in Columbia, Mo., has published a 12-page report card containing information about the facility's: charges and outcomes information. "We had great difficulty finding comparative clinical information with which to compare ourselves," says Mary Becker, Boone's director of marketing communications and community relations. Where's no national data bank that has comparative outcomes. Even for mortality, data are very difficult to come by."

Proponents of report cards admit they are in the "Model-T phase" of measuring quality. Shortcomings include the inability to describe outcomes, a crucial piece of the health care puzzle that remains elusive. Nor can the data in the reports be adjusted by severity of illness calculations, such as age, sex, income, occupation, and other demographic factors.

Nonetheless, if purchasers base their future decisions on report cards, more providers' revenues will be based on how well they have conformed to a standard set of measurments demanded by their customers. That That means consumers may comparison shop for health care some day much as they comparison shop for autos today.

In December, the Joint Commision on Accreditation of Healthcare Organizations, in Chicago, published its first set of report cards assessing the performance of 1,500 hospitals and other health care institutions. The reporting standards address clinical and management functions that have significant impact on patient outcomes, says Dennis O'Leary, M.D., the commission's president.

The Joint Commission's efforts have come under fire from the American Hospital Association and the American Medical Association. Both complain that the standards are burdensome and will be misleading to the public. The Joint Commission, however, has no plans to abandon its report card program. Public disclosure is a major "customer service initiative," O'Leary says.

But, if the data being collected are incomplete or inaccurate, report cards may cause more problems than they cure. In September, a General Accounting Office report to Congress warned that if report card development wasn't approached with care, "individual consumers, corporate purchasers, health plans, and individual providers might be misled by inaccurate information." If the report cards prove to be incorrect, public confidence will be destroyed. John E. Wennberg, M.D., director of the Center for Evaluative Clinical Sciences at Dartmouth College, Hanover, N.H., downplays report cards as merely the latest buzzword for quality, providing only a summary statement of performance by a provider in a fixed period. Antonio Legorreta, M.D., medical director of U.S. Quality Algorithms, a subsidiary of US Healthcare, an HMO, in Blue Bell, Pa. that publishes report cards, is also skeptical. If report cards do not use benchmarks based on accurate data, hospitals and HMOs will be "just shouting in the dark," says Legorreta.