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"Quality gaps" still exist among providers, says NCQA

Quality Improvement Monitor, September 29, 2004

The quality of care improved noticeably last year among health plans that publicly report on their performance, although the U.S. healthcare system as a whole remains plagued by deadly "quality gaps" that contribute to 42,000 to 79,000 avoidable deaths every year, according to The State of Health Care Quality, an annual report by the National Committee for Quality Assurance (NCQA), a private watchdog for the managed care industry.

The quality gap refers to the difference between the national average on a given clinical measure and the performance of the top 10% of health plans. The latter is used as a benchmark because it represents a realistic, achievable goal for the entire system.

"It would never be acceptable to say, 'I'm sorry we didn't save your loved one. We knew how, we just didn't do it,' " says Ellen Stovall, president and CEO of the National Coalition for Cancer Survivorship. "But these quality gaps show us that that actually happens thousands of times every year. And every time it happens it represents a failure to put healthcare knowledge into practice. Surely we can do better."

Quality gaps exact a severe financial toll on the nation as well. In addition to the roughly $1.8 billion in direct medical expenses that can be traced to missed opportunities to provide needed care, employers lose another $9.6 billion in the form of reduced productivity among workers for whom these missed opportunities translate into extended illnesses and sick days.

"The findings suggest that the system is deeply polarized, delivering excellent care to some people, and generally poor care to many others," according to the NCQA. The report also states that nearly 66.5 million avoidable sick days and more than $1.8 billion in excess medical costs can be traced to the healthcare system's routine failure to provide needed care.

This year's report also highlights various efforts aimed at improving healthcare, including several physician and hospital pay-for-performance projects, which are seen by many experts as a key part of the solution to the nation's healthcare woes.

"Measuring performance allows us to do three very important things: inform consumer choice, reward quality and identify opportunities for improvement," says Mark McClellan, MD, CMS administrator. "There is enormous potential in these activities to drive improvement and without measurement you can't do any of them. Medicare is 100% committed to pay-for-performance."

-- Wendy Johnson
wjohnson@hcpro.com

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