Economist Charles Goodhart

Value-Based Care

The Volume and Cost of Quality Metric Reporting

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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The Wire

• Making Care Primary: CMS announced a new Making Care Primary model (MCP) aimed at transitioning more PCPs to value-based arrangements, helping primary care practices form partnerships with specialists, and leveraging community-based connections to address patients’ health-related social needs. Less than half of primary care practices currently participate in CMS’ ACO models, and MCP is the next step of the Biden administration’s plans to bring all Medicare and most Medicaid beneficiaries into some form of VBC contracting by 2030. MCP is a 10-year model set to debut in July 2024, with testing already underway in eight states.  

• Employers Dissatisfied With Behavioral Health: Health plan purchasers are generally dissatisfied with their access to quality behavioral health care, according to a new National Alliance survey of 221 employers. Nearly every respondent (99%) deemed timely access to behavioral health providers important, but only 31% were satisfied with their plans’ in-network options. On top of that, nearly a third weren’t content with their plan’s identification and handling of network access gaps, and only 33% were satisfied with engagement and reporting of behavioral health outcomes.

• LeanTaas Launches iQueue Autopilot: LeanTaaS continues to make moves to become the “air traffic control center” for health systems, rolling out a new iQueue Autopilot generative AI solution to provide hospitals with a conversational interface for its core operating room, infusion center, and inpatient flow products. The example use cases make iQueue Autopilot sound like a serious multi-tool. Users can ask it for recommendations on capacity optimization management (e.g. real time staffing suggestions), configure it to proactively alert them of potential issues (e.g. scheduling conflicts), or ask it to detect any ongoing deviations from standard processes.

• care.ai + Samsung: care.ai is partnering with Samsung to integrate its Smart Care Facility Platform into the tech giant’s displays across health systems and nursing homes to enable instantaneous virtual visits. care.ai’s Smart Care Facility Platform uses ambient sensors spread throughout care facilities to monitor patients and their caregivers, informing real-time clinical and operational insights around areas such as fall prevention, protocol monitoring, and workforce optimization. For a deeper dive on care.ai, check out our funding coverage from December.

• Lagging Wearable Adoption: A JAMA Network Open study highlighted lagging wearable adoption among people with cardiovascular disease. A 2019-2020 survey of 9,303 US adults found that just 18% of people with CVD use a wearable device (vs. 29% of the general population), with older age, less education, and lower income all associated with significantly lower odds of using wearables. Increasing wearable ownership might not be enough to drive use, as 25% of people with CVD who owned a wearable did not use theirs in the previous month.

• Elion EHR Comparison: Health tech marketplace Elion launched a cool EHR vendor comparison product that looks at over 200 EHR features and 10k data points to let you see how different vendors stack up to one another. The tool includes 24 unique EHRs ranging from major platforms like Athenahealth to specialized solutions like Osmind. It’s fun to play around with and explore the wide range of solutions available, especially if you’re in the market for a new EHR.

• Pomelo Care Series A: Virtual maternity care practice Pomelo Care landed $33M in Series A funding to expand its services for fertility, pregnancy, and newborns. Pomelo offers primary and women’s care with around-the-clock virtual access to care teams to help mothers from preconception through the baby’s first year. The company currently serves patients in 44 states and is on pace to cover 2M lives this year through new partnerships with health plans, employers, and academic medical centers.

• The Toll of Rising Drug Costs: A survey of 2k US seniors over the age of 65 revealed that about one in five have stopped taking a medication due to cost, while others forgo basic needs (8.5%) or go into debt (4.8%) to afford their prescriptions. Most patients (89%) are in favor of physicians using real-time tools to show them their expected OOP costs, but about half would be “extremely upset” if the costs then exceeded estimates.

• Akili EndeavorOTC Launch: Following the positive adult trial results that we covered in May, Akili Interactive released an adult version of its video game treatment for ADHD dubbed EndeavorOTC. The game is already available on the Apple App Store for a $10 monthly subscription, no prescription required. Akili was able to launch EndeavorOTC under a lingering pandemic policy that allows “low-risk” digital health tools to be released without full regulatory review, and Akili plans to submit the app for FDA clearance prior to that policy expiring in November.

• Healthcare’s Scariest Disruptors: An article in Becker’s ASC Review based on interviews with six healthcare leaders explored the disruptive medical trends keeping them up at night, finding that AI is widely seen as one of the scariest emerging themes. While AI will improve medicine in many ways, the interviewees urged oversight to prevent unintended consequences. Other than AI, physician burnout, a wave of doctor retirements, and staffing shortages were also topics of concern.

• Sparrow Smartphone Stethoscope: Sparrow BioAcoustics announced the FDA clearance of its unique Stethophone software, which allows medical professionals to capture, analyze, and share cardiovascular and pulmonary sound data – simply by holding an enabled smartphone to a patient’s chest. The Sparrow Stethophone app uses advanced acoustic processing to allow smartphones’ internal microphone to capture a range of cardiac markers (gallops, murmurs, and arrhythmias) and detect “cardiac and pulmonary symptoms, wherever they occur.”

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