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Using AHRQ Quality Indicators for Hospital-level Reporting and Payment

Slide Presentation by Andy Webber


On October 27, 2004, Andy Webber made a presentation in a Web Conference entitled Using AHRQ Quality Indicators for Hospital-level Reporting and Payment.

This is the text version of his slide presentation. Select to access the PowerPoint® slides (114 KB).


The Cost of Poor Quality

National Business Coalition on Health
Andy Webber
President and CEO

Slide 1

National Business Coalition on Health

  • National, non-profit membership organization:
    • 80 employer-based health coalitions.
    • 7,000 employer members, 25 million covered.
  • Vision: Establish value-based health care markets in every community.
  • Mission: Provide superior membership service and build the capacity of members to advance value-based purchasing.

Slide 2

The Costs of Poor Quality

This slide contains a pie chart depicting the costs of poor care versus the costs of appropriate health care. The cost of poor care is 30%. The cost of appropriate health care is 70%

Beneath this pie chart is the text: "Causes of poor care: Misuse, underuse, overuse, waste - Juan Institute and MBCH 2003

Slide 3

Value Based Purchasing: A Path Forward

  • Performance measurement.
  • Public reporting and recognition.
  • Market share migration.
  • Differential reimbursement.

Accelerating the pace to the Ultimate Goal: Quality and Health Status Improvement

Slide 4

IOM Strategy for Reinventing the Health Care System

This slide depicts a flow chart of the Care System. The top box shows the Care System. Below it are four boxes connected by arrows that shows: Supportive payment and regulatory environment; Organizations that facilitate the work of patient-centered teams; High performing patient-centered teams; and Outcomes: Safe, Effective, Efficient, Personalized, Timely, Equitable. Below these four boxes is one, large box with the text: Redesign Imperatives: Six Challenges: Reengineered care processes, Effective use of information technologies, Knowledge and skills management, Development of effective teams, Coordination of care across patient-conditions, services, sites of care over time, and Making change possible.

Slide 5

Performance Measurement in Action: NBCH Member Profile

This slide uses a table to show the performance measurement in action. The first Measure Use is Hospitals with a 47% quality improvement activities score, a 28% public reporting score, and an 11% financial incentives score.

The second Measure Use is Health Plans with a 47% quality improvement activities score, a 42% public reporting score, and an 8% financial incentives score.

The third Measure Use is Individual Practitioners with a 13% quality improvement activities score, a 0% public reporting score, and a 3% financial incentives score.

Slide 6

QualityCounts Hospital Report: An Alliance Initiative

  • Produced and disseminated report on 24 hospitals in S. Central Wisconsin.
  • Rated hospitals on complications and deaths.
  • Used risk adjusted administrative data.
  • Promoted public awareness of Report.

Slide 7

Data Display in QualityCounts Hospital Report:

This slide shows an example of a report. The report has a legend at the top and a graph below.

The legend reads: "What the symbols mean."
A grey shaded circle with a plus sign means few mistakes, complications and deaths than expected.
A white circle means average number of mistakes, complications and deaths.
A black circle means more mistakes, complications, and deaths than expected.

The graph shows the types of mistakes for 4 different regional hospitals in the areas of surgery, non-surgery, hip/knee replacement, cardiac, and maternity.

Hospital A
Surgery shows a grey shaded circle with a plus sign
Non-surgery shows a grey shaded circle with a plus sign
Hip/knee shows a grey shaded circle with a plus sign
Cardiac shows a grey shaded circle with a plus sign
Maternity shows a white circle

Hospital B
Surgery shows a grey shaded circle with a plus sign
Non-surgery shows a grey shaded circle with a plus sign
Hip/knee shows a grey shaded circle with a plus sign
Cardiac shows a white circle
Maternity shows a white circle

Hospital C
Surgery shows a grey shaded circle with a plus sign
Non-surgery shows a grey shaded circle with a plus sign
Hip/knee shows a grey shaded circle with a plus sign
Cardiac shows a white circle
Maternity shows a black circle

Hospital D
Surgery shows a grey shaded circle with a plus sign
Non-surgery shows a black circle
Hip/knee shows a grey shaded circle with a plus sign
Cardiac shows a black circle
Maternity shows an asterisk

Slide 8

Impact of Report on Hospitals: Experimental Design

This slide depicts a flow chart of the experimental design used for the Impact Report on Hospitals.

The first section shows 115 Eligible Hospitals in Wisconsin. Of the 115 hospitals 24 were in the Alliance service area (Hospitals in Public Report). The remaining 91 hospitals were in the Non-Alliance service area. After a random assignment, 46 hospitals fell into the no report category and 45 fell into the private report category. There is a footnote regarding the private report hospitals at the bottom of the slide.

*Three hospitals were lost to closure and two hospitals were ineligible due to overlapping administrative structures.

Slide 9

Percent of hospitals with significant Improvements of Declines in OB Performance in the Post-Report Period:

This slide depicts a bar graph showing the percents of hospitals with significant improvements and significant decline. The y-axis shows the percent ranging from 0% to 40%. The x-axis shows Public Report, Private Report, No Report.

The Public Report section shows 35% significant improvement and a 5% significant decline.
The Private Report section shows 23% significant improvement and 14% significant decline.
The No Report section shows 13% significant improvement and 13% significant decline.

Slide 10

Percentage of hospitals who had poor scores at baseline and who improved their scores in the post-report period

This slide depicts a bar graph showing the percentage of hospitals with poor scores at baseline who improved their scores in the post-report period. The y-axis shows the percent ranging from 0% to 100%. The x-axis shows the Public Report, Private Report and No Report.

The Public Report (n=8) is 88%
The Private Report (n=15) is 33%
The No Report (n=12) is 42%

Slide 11

Needed Features for Quality Measures

This slide shows a chart of the features needed for quality measures and whether or not AHRQ's Quality Indicators include these measures. The first feature is Expert Validation. The second feature is Rely on available data. The third feature is Risk adjusted. The fourth feature is Widely used, with comparative data available. All of the features are included in the AHRQ QI's.

Slide 12

Overall Emphases

  • Don't let perfect be enemy of good.
  • Purchasers should be lead drivers of value-based purchasing.
  • Public reporting of standardized healthcare measures essential to progress.
  • AHRQ to be congratulated for its leadership.
  • Challenge now to move from consensus on the value of the AHRQ Quality Indicators to rapid implementation and use.

Current as of March 2005


Internet Citation:

Using AHRQ Quality Indicators for Hospital-level Reporting and Payment. Text version of a slide presentation at a Web conference. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/buyright/webbertxt.htm


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