72 Percent of Hospitals With Limited or No Patient-Reported Outcomes Tracking Say They Will Implement it Within 1-3 Years
The Centers for Medicare and Medicaid Services (CMS) recently began using a new yardstick to calculate how much providers should be paid: a patient’s own view of their health.
First incorporated into a new CMS program designed to lower the cost of knee and hip replacements, patient-reported outcomes, or PROs, may soon become far more widespread. The self-reported health measures are a key component of the proposed Merit-based Incentive Payment System (MIPS) that would significantly restructure how Medicare pays for virtually every medical service. As a result, providers whose patients report significant improvements in health could be paid more than those whose patients report problems.
Despite the interest in PROs by the nation’s biggest payer, though, fewer than one-fifth of U.S. hospitals say they regularly review the measures to guide medical care, according to a new survey from Health Catalyst (@HealthCatalyst). The online survey of 100 clinical and administrative executives in health systems of all sizes across the country revealed that just 18 percent always use PROs to guide clinical care.
Still, hospitals appear to have seen the writing on the wall. Nearly three-quarters (72%) of survey takers who said they “rarely” or “never” use PROs also said they plan to begin using the measures within 1 to 3 years.
“Patient-reported outcomes are critical to enabling healthcare’s evolution away from focusing on the volume of services delivered to the value created for patients,” said Paul Horstmeier, Senior Vice President of Health Catalyst. “Their use promises seismic changes not only in the way providers are paid, but how they measure success, how patients choose their doctors, and most importantly how clinical outcomes are improved. Yet with few exceptions our nation’s hospitals are unprepared for the shift and need help managing this new priority within the ever-shifting field of time-intensive regulatory requirements.”
The search for PRO standards
A PRO is any measure of a patient’s symptoms and physical, cognitive, social and emotional functioning, as well as their health-related quality of life. Traditionally, health systems and clinicians have focused on measuring adherence to evidence-based medicine guidelines, with outcomes measures limited to such concrete events as death. “But for most of medicine, the question is no longer whether someone will survive, but how their life will be after treatment,” says Caleb Stowell, MD, Vice President of Standardization and Business Development for the International Consortium for Health Outcomes Measurement (ICHOM).
The research–based, nonprofit organization has convened groups of experts on specific conditions, together with patient representatives, to help healthcare organizations worldwide understand and use PROs to improve patient outcomes. ICHOM has already identified standard sets for 20 conditions covering 45 percent of the global disease burden and is currently working with innovative providers and health systems globally to support the adoption of these standard sets.
ICHOM hopes to develop a mechanism for communicating how patients are actually doing. In a blog post, Dr. Stowell cited work being done at Stanford Health Care, which participated in developing, and is measuring outcomes consistent with, the ICHOM Standard Set for Low Back Pain. “As a clinician, when you come in to see the patient you have the [PRO] information immediately available,” said Stanford neurosurgeon Dr. John Ratliff, in a video produced by ICHOM about Stanford’s program. “This benefits the patient by engaging them prior to the consultation. They are already thinking about the outcomes that matter to them, and this cue is being provided at exactly the right time.”
But PROs can do more than just communicate; they can also predict a patient’s health status. Boston-based Partners HealthCare uses PRO data for patients with suspected coronary artery disease to predict their likely benefit from coronary intervention. Such predictive models have helped Partners avoid costly interventions when patients don’t stand to benefit.
And in a study of HIV patients in Alabama, data collected via PROs regarding substance use and depression was found to better predict antiretroviral therapy adherence compared to clinician’s own judgment of patients.
Time and/or money the chief barriers to PRO collection
While many factors contribute to the difficulty of deploying PROs within the healthcare decision making process, respondents to the Health Catalyst survey noted four specific barriers. Thirty-six percent of survey respondents said “time and/or money” was the most significant barrier to using PROs more broadly. The next most common barrier identified by respondents, at 26 percent, was difficulty fitting PROs into clinicians’ daily workflow.
Technology was listed as the most significant barrier to PRO use by only 15 percent of respondents, perhaps reflecting the wide variety of so-called ePRO technologies including mobile and wearable devices that promise to make the collection of PROs far easier.
Coming in third on the barrier list was organizational resistance to change (10 percent), followed by lack of leadership support (4 percent).
Chronic care tracking tops list of PRO uses
Survey respondents who said their organizations use PROs today, even if only occasionally, said they use it primarily to track chronic disease care and progress of surgery patients. Fifty-nine percent selected “chronic care tracking” and 58 percent selected “surgical interventions” when asked to list all of the areas in which they use PROs. Mental health (27%) and “symptom tracking for cancer care patients” (22%) were the other most common areas of PRO use.
Results reflect the opinions of 100 healthcare professionals who responded to an online survey between May and June 2016. Respondents included 35 CEOs; 32 chief medical officers and related clinical roles; and a variety of departmental leadership roles. They work for organizations ranging from some of the nation’s largest urban academic medical centers and integrated delivery networks to small, rural critical access facilities.
About Health Catalyst
Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company that helps healthcare organizations of all sizes perform the clinical, financial, and operational reporting and analysis needed for population health and accountable care. Our proven enterprise data warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more than 70 million patients for organizations ranging from the largest US health system to forward-thinking physician practices.