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Despite Push from CMS, Most Hospitals Overlook Patient-Reported Outcomes, Survey Finds

August 2, 2016
by Rajiv Leventhal
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While the government is looking to make patient-reported outcomes, or PROs, more widespread when it comes to determining Medicare reimbursement, most U.S. hospitals are not currently paying much attention to these self-reported health measures, according to a new survey from Health Catalyst.

The Salt Lake City, Utah-based analytics vendor surveyed 100 clinical and administrative executives in health systems of all sizes across the country. Respondents included 35 CEOs; 32 chief medical officers and related clinical roles; and a variety of departmental leadership roles. The data 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 percent) of survey takers who said they “rarely” or “never” use PROs also said they plan to begin using the measures within one to three years.

First incorporated into a new Centers for Medicare and Medicaid Services (CMS) program designed to lower the cost of knee and hip replacements, patient-reported outcomes 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.

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,” said Caleb Stowell, M.D., vice president of standardization and business development for the International Consortium for Health Outcomes Measurement (ICHOM). 

The research–based 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.

“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,” added 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.”

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).

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 percent) and “symptom tracking for cancer care patients” (22 percent) were the other most common areas of PRO use. 

 

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