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NCQA Report Finds Health Care System's "Quality Gaps" Cause 57,000 Deaths Annually

WASHINGTON— September 18, 2003 -- A new report shows that the nation’s health care system is riddled with "quality gaps" that prevent millions of Americans from receiving "best practice" care. These gaps, the result of factors such as poor use of technology and irrational payment systems, lead to more than 57,000 avoidable deaths each year. NCQA’s annual State of Health Care Quality report also documents the enormous financial toll of commonplace failures to deliver appropriate care—nearly 41 million sick days and more than $11 billion in lost productivity could be avoided annually if well known "best practices" were more widely adopted. The observed "quality gaps" were not equally prevalent throughout the system—among health plans that measure and report on their performance, clinical quality was higher and showed strong gains.

"It’s not a question of knowing how to treat heart disease, diabetes or mental illness," said NCQA President Margaret E. O’Kane. "We know how. We’re just not doing it. We’re literally dying, waiting for the practice of medicine to catch up with medical knowledge. More than 57,000 people will die this year because there is a huge gap between what we know and what we do."

"Quality Gaps" Exact Severe Human, Financial Tolls
These deaths come not as a result of error, but of omission—for a variety of reasons, many Americans do not receive care that medical science has shown to be effective in controlling existing conditions, such as high blood pressure and diabetes, and in preventing others, such as smoking-related heart disease.

The quality gaps lead to enormous variations in the rates at which certain important therapies or services are delivered. For example, nationwide only about 40 percent of the 31 million Americans with diagnosed high blood pressure have their blood pressure adequately controlled. An increase to 68 percent (the level already achieved by the nation’s top health plans) would save an estimated 28,000 lives next year.

The loss of life is compounded by the financial costs the nation pays for these unnecessary gaps in care. Hospitalizations due to avoidable second heart attacks cost the American economy more than $1.6 billion a year.

The economy also suffers millions of lost days of productive labor each year. Collectively, the system’s failure to treat just five health care conditions—asthma, depression, diabetes, heart disease and high blood pressure—with the best available care is responsible for nearly 41 million sick days. This translates to the equivalent productivity of more than 173,000 workers, and annual costs to American companies of more than $11.5 billion.

One of the reasons for the failure to apply best practice care is that current payment systems actually discourage it. Physicians and hospitals are compensated based on the amount of care they provide, thus discouraging the use of new treatments and therapies that may send patients home sooner. Even serious medical errors may be financially rewarded if, as is often true, they justify additional charges.

"We’re throwing up roadblocks to quality, when we should be giving out rewards," said David F. Durenberger, former United States Senator (R-Minn.) and Chairman and CEO of the National Institute of Health Policy (NIHP). "We have to start asking, ‘What are we buying?’"

"The health care system faces an important challenge to link improvement strategies, such as supportive practice environments, incentives for change, and systems design with the best of biomedical science," said Carolyn M. Clancy, M.D., Director, Agency for Healthcare Research and Quality. "Meeting this challenge will ensure that we are harnessing the power of technology to improve health care quality."

The gap between best practice care and the care that many patients receive is a serious business concern as well. "This report underscores that employers and consumers are not getting the quality of health care we’re paying for," said Peter V. Lee, J.D., President and Chief Executive Officer, Pacific Business Group on Health. "The path to saving lives and money lies not in finger-pointing, but in finding out who’s doing it right, and sharing that information with those who want to do it better."

In One Sector, Care Improves
The report found that among health plans that publicly reported their performance data, clinical care improved in most areas. This was true for health plans serving the commercial, Medicare and Medicaid sectors. In particular, organizations continued to make significant progress in areas related to chronic conditions, such as coronary heart disease. For example, heart attack patients are having their cholesterol levels controlled more effectively overall. In the commercial population, screening (79.4 percent) and control (61.4 percent) rates registered increases of 2.3 and 2.1 percentage points, respectively. This marks the fourth year in a row the positive trend has been observed and speaks to the power of public accountability to drive improvement.

For the third consecutive year, health plans serving Medicaid and Medicare beneficiaries demonstrated impressive gains in cholesterol management. In 2002, Medicaid rates for cholesterol screening increased 7.2 percentage points to 57.8 percent, while control rates rose from 34.5 percent in 2001 to 36.7 percent. Medicare organizations kept pace with their commercial counterparts with a screening rate increase of 2.2 percentage points (to 77.7 percent), and outperformed the commercial average for cholesterol control with a rate of 62.3 percent, up nearly 4 points from 2001.

"Transparency" Drives Quality
The number of commercial organizations that reported their data publicly held steady in 2002, with only a handful of unaccredited organizations choosing not to report their results publicly. Among those plans, performance was markedly lower, particularly in measures related to the immunization of children and adolescents. For all adolescent immunization measures, the differences between publicly reporting and non-publicly reporting plans were in double digits, with the gap for the measles/mumps/rubella immunization exceeding 28 percentage points. For childhood immunizations, the gaps were generally in the mid-to-high teens.

To illustrate the importance of transparency, the report includes national listings of the Top 10 commercial health plans for clinical performance and member satisfaction. For the second consecutive year, Appleton, Wis.-based Touchpoint Health Plan was the nation’s strongest overall performer in terms of quality of care. The report also features regional Top 5 listings of the best-performing commercial health plans.

Mental Health, Cervical Cancer, Chlamydia Merit Increased Concern
Despite the gains in other areas of chronic care, the health care system continues to struggle with the treatment of mental illness. Follow-up treatment of patients hospitalized for these conditions showed little improvement in 2002. In the commercial population, slightly more than half (52.7 percent) of patients admitted for mental illness received follow-up care within 7 days of their release. Medicaid and Medicare rates have yet to pass 40 percent.

In addition, some preventive measures are showing signs of having reached plateaus. The commercial cervical cancer screening rate increased by just half of a percentage point (to 80.5 percent) in 2002, and Medicaid rates continue to hover around the 60 percent mark.

Screenings are also critical for detecting and treating chlamydia, the nation’s most commonly reported sexually transmitted disease, because most women infected with the disease have no discernible symptoms. The Medicaid system performed relatively well in this area, with 41 percent of sexually active women ages 16–26, who are most at risk for the disease, receiving chlamydia screenings. However, in the commercial population, fewer than 30 percent received a screening.

The State of Health Care Quality: 2003 is available at NCQA’s Web site. An expanded version of the report, including more detailed analyses, graphs and complete citations, will be added to the Web site later this fall. A printed version of the expanded report (including appendices and other information not available online) can be purchased by calling (888) 275-7585.

The data reported in the State of Health Care Quality report are drawn from NCQA’s Quality Compass® 2003. This database of plan-specific HEDIS data is available on CD-ROM or as an electronic data file in Microsoft® Excel or SAS® formats. Quality Compass can be ordered online through NCQA’s Web site or by calling (888) 275-7585.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS®, the tool the nation’s health plans use to measure and report on their performance. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.

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Source: NCQA

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