With as little fanfare in its dissolution as it evoked during its ten-year existence, the Hospital Quality Alliance (HQA) in December wrapped up its efforts to advance public reporting for hospital care.  By informing patient and family decisions regarding the quality of their hospital care, the HQA was the nation’s first and foremost organization for developing and reporting “apples-to-apples” quality information. 

Founded in 2002, the HQA’s mission was to implement measures that portray the quality, cost and value of hospital care, and to make meaningful hospital performance information available to the public. HQA was composed of a wide spectrum of dues-paying participants, such as purchasers, providers, insurers, patient-interest representatives, and government agencies. Its membership was committed to the vision of a multi-stakeholder, private/public organization dedicated to developing, reporting and updating information about hospital quality performance. This approach was a particularly good fit for the Society of Critical Care Medicine’s (SCCM) multiprofessional critical care model.

The Society joined HQA in 2008, recognizing a unique opportunity to contribute to the rapidly evolving national discussion around hospital quality measurement and public reporting. Using public hospital data can be a little like turning to TripAdvisor for hotel reviews or to Angie’s List for advice on selecting contractors — anecdotal and akin to the characteristics of Lake Wobegon (all the hospitals have great performance, all the patients are highly satisfied, and all the outcomes are above average). However, in the last five years, the HQA has streamlined the process for reviewing and endorsing structure and outcomes measures for impartial public reporting.  These rigorously chosen data are reported on the U.S. Department of Health and Human Services Hospital Compare, now the nation’s broadest compendium of publicly available, widely accessible, comparable quality measures. Hospital Compare reports on more than 50 performance measures for inpatient and outpatient care, allowing the public and healthcare providers to compare the performance of more than 4,500 hospitals across the nation.

HQA also catalyzed adoption of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), the first standardized survey for measuring patients’ perceptions of their hospital care. This survey is now routinely included in all patient satisfaction instruments used by public and private hospitals; it provides a level of rigor and consistency long sought as a benchmark for improving quality. Additionally, HQA endorsed the nation’s first measures for surgical site infections; hospitals that publically reported these infections saw improved outcomes.

A consistent challenge (and gripe) from providers and healthcare institutions is that measurement and reporting consume a disproportionate amount of resources and often overlap due to the use of redundant measures. Further, public reporting of some measures has never been rigorously shown to drive performance improvement or better patient outcomes. HQA, with its partners at the Centers for Medicare & Medicare Services and The Joint Commission, has consistently prioritized streamlined reporting to reduce the burden, identifying high-impact measures that drive improvement and discontinuing reporting on measures that are insensitive or “topped-out” (close to 100% compliance).

So why is HQA closing up shop unlike virtually any other Washington, D.C.-based organization?

The multi-stakeholder HQA measure review model served as the template for other quality alliances and was incorporated into provisions in the Affordable Care Act. Included as part of that transformative law was the outline for a federally mandated quality improvement focus. Now fully realized as the National Quality Forum’s Measures Application Partnership (MAP), the law requires a multi-stakeholder group to identify quality gaps and then specify, validate and endorse public reporting measures that will be used for accountability, performance review and value-based purchasing.

The MAP has kicked into high gear, and HQA is winding down with a measure of satisfaction in transitioning this important work to the National Quality Forum. SCCM Past-President Mitchell Levy, MD, FCCM, serves as an independent content expert for the MAP, ensuring that a critical care perspective will be considered in the selection and approval of measures.

At the final HQA meeting, Carolyn Clancy, MD, Director of the Agency for Healthcare Research and Quality, reflected on the accomplishments of HQA. She recognized the group’s success in advancing public reporting for hospital care and promoting a national conversation about quality in a serious and informed fashion. She noted that while “much work still remains to be done and quality is still deficient,” the HQA has assured that the patients’ perspective and experience are now truly respected.

The Society has a significant, ongoing role to play in achieving the objectives of high-quality healthcare for all. It is my hope that all SCCM members will participate in our national effort to advance the quality and affordability of care for critically ill and injured patients.

During these last two years, it has also been my privilege to chair the Society’s newest committee: the Quality and Safety Committee.  In the future, I will offer comments on that experience and the work of the committee in advancing quality and safety for our vulnerable, critically ill patients, their families and communities.

Ivor S. DouglasMD, served as an organizational principal to the Hospital Quality Alliance for the Society of Critical Care Medicine. He serves as chair of the Society’s Quality and Safety Committee.  He is Chief of the Division of Pulmonary and Critical Care Medicine and Director of Medical Intensive Care at the Denver Health Medical Center in Colorado. He is associate professor of medicine at the University of Colorado School of Medicine.