Value-Based Care

The Volume and Cost of Quality Metric Reporting

JAMA Network

A Johns Hopkins-led study in JAMA reached a conclusion that many health systems are already all-too-familiar with: reporting on quality metrics is a costly endeavor. 

The time- and activity-based costing study estimated that Johns Hopkins Hospital spent over $5M on quality reporting activities in 2018 alone, independent of any quality-improvement efforts.

Researchers identified a total 162 unique metrics:

  • 96 were claims-based (59%) 
  • 107 were outcome metrics (66%) 
  • 101 were related to patient safety (62%) 

Preparing and reporting data for these metrics required over 100,000 staff hours, with an estimated personnel cost of $5,038,218 plus an additional $602,730 in vendor costs.

  • Claims-based metrics ($38k per metric per year) required the most resources despite being generated from “collected anyway” administrative data, which the researchers believe is likely tied to the challenge of validating ICD codes and whether comorbidities were present on admission. 

Although the $5M cost of quality reporting is a small fraction of Johns Hopkins Hospital’s $2.4B in annual expenses, extrapolating those findings to 4,100 acute care hospitals in the US suggests that we’re currently spending billions on quality reporting every year.

That conclusion raises questions that are outside the scope of this study but extremely important for understanding the true value of quality reporting.

  • Do the benefits of quality reporting outweigh the burden it places on clinicians?
  • Would the time and effort required for quality reporting be better spent on patient care?
  • Do quality metrics accurately reflect a hospital’s overall quality of care?

The Takeaway

Non-clinical administrative costs are a giant slice of the healthcare spending pie, and quality measurements unintentionally contribute due to increasing spending on chart review and coding optimization. Quantifying the burden of quality reporting is a key step to understanding its overall cost-effectiveness, and although this study doesn’t tackle that issue directly, it lays the foundation for those who are.

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