Researchers push release of cost data that undergirds care decisions

Understanding the cost of measures is critical in transitioning to value-based care, says Mark Schuster, MD.

As the healthcare industry transitions to value-based care, quality measurement has become ubiquitous. However, little is known in healthcare about the exact costs of collecting and analyzing this kind of data, as well as interpreting results for particular measures.

That’s the contention of Mark Schuster, MD, chief of general pediatrics and vice chair for health policy in the Department of Medicine at Boston Children’s Hospital. While collecting, processing, analyzing and reporting quality data is costly, healthcare organizations are not including costs in decisions about which measures to use, he says.

Writing in a viewpoint article published online late last week in the journal JAMA, Schuster and two co-authors make the case that “measures are everywhere,” but the “cost of specific measures has received limited attention” and “is not formally considered when evaluating and selecting measures, in no small part because that cost is usually unknown.”

Also See: How to improve reporting of quality measures

However, as the industry moves from fee-for-service to value-based payment, Schuster makes the case that without understanding the costs of specific measures, healthcare organizations cannot fully assess their value.

“Our hospital—and other hospitals—when negotiating with insurance companies about what measures might be used in risk-bearing contracts, does not have that information available,” he says. “There are many important factors that go into selecting quality measures, and one of them needs to be cost.”

Nonetheless, Schuster and his colleagues point out in their opinion piece that the National Quality Forum—which vets many measures used by healthcare organizations—does not require those who develop measures to report cost data. In addition, they reference the fact that limited information is available about whether and how the Centers for Medicare and Medicaid Services factors the cost of measures into hospital value-based purchasing.

The authors note that the Office of Management and Budget does estimate costs for measurement initiatives. However, they say these estimates focus on the annual burden of entire measurement and reporting programs—such as the Physician Quality Reporting System—rather than the burden of individual measures or the burden for individual institutions.

“When selecting measures, hospitals and clinicians have even less access to cost information than these larger institutions,” states the article.

At the same time, Schuster adds that “our purpose is not to suggest that cost is the most important factor—it’s just a factor, but it’s one that has been missing from most of the discussion.”

To address this shortfall, he and his colleagues call for the development of standards for the units, timeframe and other variables needed for consistent cost comparisons across multiple measures.

“Organizations endorsing measures should include cost estimates in measure descriptions,” states the article. “To start, these organizations could set a deadline after which measure submissions must incorporate cost information. They might create a pilot program to devise and test standard specifications for cost information and to develop methodologies for collecting cost data and estimating costs. Even general estimates could inform measure selection, and the science of cost estimation would likely improve rapidly if measuring cost became a routine component of measure development.”

Schuster emphasizes that “we’re not suggesting that National Quality Forum instantly declare that everyone submit their measures with the cost—there needs to be a period of figuring out how to measure costs and how to have standardization of cost measurement across measures.”

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