Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Public reporting of quality information is a potentially powerful tool to improve health care quality. Moving quality information into the public domain may improve quality of care by giving consumers the information necessary to choose a high-quality provider. Additionally, health care providers may respond to this information by improving the quality of care they provide, raising the overall quality level of care. While public reporting has the potential to improve quality of care in areas that are being measured and reported, one potential limitation is the impossibility of measuring all important aspects of care. By necessity, measures of clinical care are limited to what is measurable, and what is measurable is not always what is most important. The impact of quality improvement initiatives on unreported care is unknown, and some policy makers and clinicians have expressed concern that there may be unintended and negative consequences to public reporting, including causing providers to focus their attention on measured aspects of care while neglecting unmeasured but important areas of care.

Our objective is to examine the effect of publicly reporting quality information on unreported quality of care. We do this in the setting of Nursing Home Compare, a public reporting initiative launched by the Centers for Medicare and Medicaid Services (CMS) in 2002 to address quality deficits in nursing homes. Using clinical measures of quality, Nursing Home Compare publicly rates Medicare- and Medicaid- certified nursing homes in the United States on the care they provide for short-stay and chronic-care residents. In this setting, we examine how unreported aspects of post-acute care changed in response to public reporting of some aspects of post-acute care using the Minimum Data Set from 1999 to 2005 on all post-acute care admissions to 13,683 skilled nursing facilities nationwide. We find that that in most cases unreported care improves with public reporting and improvements in reported quality of care. Although there are statistically significant improvements in unreported quality of care, the magnitude of these improvements is small and clinically insignificant. We conclude that public reporting in the setting of post-acute care does not adversely harm quality in areas without public reporting. While unreported quality increased slightly, these increases were small and, thus, benefits from public reporting are unlikely to extend beyond areas that are being directly measured.