Impact of Public Reporting on Unreported Quality of Care

Authors

  • Rachel M. Werner,

    1. 1230 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104,
    2. Center for Health Equity Research and Promotion, Philadelphia VAMC, Division of General Internal Medicine, University of Pennsylvania School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania,
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    • Address correspondence to Rachel M. Werner, M.D., Ph.D., 1230 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; e-mail: rwerner@mail.med.upenn.edu. Dr. Werner is with the Center for Health Equity Research and Promotion, Philadelphia VAMC, Division of General Internal Medicine, University of Pennsylvania School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania. R. Tamara Konetzka, Ph.D., is with the Department of Health Studies, University of Chicago, Chicago, IL. Gregory B. Kruse, M.Sc., M.P.H., is with the Department of Health Care Systems, The Wharton School, University of Pennsylvania, Locust Walk, Philadelphia, PA.

  • R. Tamara Konetzka,

    1. Department of Health Studies, University of Chicago, Chicago, IL
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  • Gregory B. Kruse

    1. Department of Health Care Systems, The Wharton School, University of Pennsylvania, Locust Walk, Philadelphia, PA
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Abstract

Objective. The impact of quality improvement incentives on nontargeted care is unknown and some have expressed concern that such incentives may be harmful to nontargeted areas of care. Our objective is to examine the effect of publicly reporting quality information on unreported quality of care.

Data Sources/Study Setting. The nursing home Minimum Data Set from 1999 to 2005 on all postacute care admissions.

Study Design. We studied 13,683 skilled nursing facilities and examined how unreported aspects of clinical care changed in response to changes in reported care after public reporting was initiated by the Centers for Medicare and Medicaid Services on their website, Nursing Home Compare, in 2002.

Principal Findings. We find that overall both unreported and reported care improved following the launch of public reporting. Improvements in unreported care were particularly large among facilities with high scores or that significantly improved on reported measures, whereas low-scoring facilities experienced no change or worsening of their unreported quality of care.

Conclusions. Public reporting in the setting of postacute care had mixed effects on areas without public reporting, improving in high-ranking facilities, but worsening in low-ranking facilities. While the benefits of public reporting may extend beyond areas that are being directly measured, these initiatives may also widen the gap between high- and low-quality facilities.

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