Difficulty measuring quality

Kaiser Health News published an interesting article about how some hospitals that are recognized as "five stars" (highest quality) are also some of the very same ones that are penalized for poor performance on patient safety. This seeming paradox appears to stem from the Centers for Medicare & Medicaid Services (CMS) basing its star rating on a variety of metrics, but using a sharper focus on patient readmissions to determine penalties.

While the situation might make sense, it seems that it could be confusing to patients. CMS could adjust its star rating, for example, so that hospitals that are penalized are not eligible for the highest rating.

Tangentially, it appears that many academic medical centers (which many might assume to provide excellent care) are penalized, and one professor noted that measurement relies on self-reporting from the hospital. Some hospitals might be under much higher financial pressure to not be penalized and thus have a strong conflict of interest. It does seem that relying on self-reported numbers is problematic.

More broadly, CMS noted that the penalty for underperforming hospitals is fixed by law. While the intention may have been good, crafting a coherent policy (and corresponding incentives) can be difficult, and it seems that the program might need some refinement to be useful. According to one professor cited in the article, "the program [to reduce patient readmissions] has been a failure."