Hospitals may be a little confused by the Joint Commission’s recent decision to suspend its Top Performer award program after only five years. In an interview with Modern Healthcare, Dr. Mark Chassin, CEO of the Joint Commission (JC), discussed the reasons behind it. The interview revealed some thoughtful and interesting reasons behind the move.
Electronic Quality Measures
The JC evolves and improves to anticipate changes in healthcare delivery systems so that it is always ahead of the game. Electronic quality measurement is a big part of this, and they want to ensure it’s well done. Chassin gives as an example:
“…we are increasing our requirements for hospitals to report perinatal measures, going from hospitals that had at least 1,100 deliveries for the past two years to hospitals that have 300 or more deliveries. That will encompass about 80% of all hospitals with delivery services. But we thought that the Top Performer program could not continue in its current form because of the flexibility that hospitals now have in reporting data on quality, which includes reporting electronically. We don’t have enough experience to be able to compare measures reported that way with the traditional chart abstraction measures.” (Here is the transcript.)
Reflecting True Accountability
The JC outcome measures are based on significantly strict criteria, but it doesn’t always reflect true accountability. Chassin cites the mortality measures that people use as being poorly risk-adjusted for characteristics that affect the risk of mortality for critical patients. He further explains, “The stroke mortality measure that the CMS uses does not adjust for differences between patient populations for the severity of the stroke that caused the hospitalization. When you add severity as a critical component, 58% of hospitals classified as worse than expected are reclassified as average mortality. So, the failure to include severity, which affects the acute myocardial infarction measure, the heart failure measure, the pneumonia measure as well as the stroke measure in the CMS’ database, is an absolutely critical failing.”
Looking at these two major reasons, the suspension seems to be the result of forward-thinking and honest introspection from the JC at the success and failure of its own program.
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