Hospital quality scorecards, patient severity, and the emerging value shopper

Results of an anticipated second attempt at Medicare fatality ratings in 1987 may prove as misleading as did the first, much-criticized HCFA report, unless the analysts focus more attention on well-defined methodology and accurate analysis, especially in terms of sample size and patient severity issues. Unless all of the information is based on systematic inquiry and statistically defensible results concerning low- or high-quality care, the outcome will fail short of the rhetorical promises made on behalf of comparison shopping and consumer choice. Employers and consumer groups are currently making modest attempts to disseminate information--before any well-defined, accurate methodology to back that information has evolved. Aggressive consumer groups, interested in "price wars" and "quality wars," are raising the battle cry: "Select your hospital and doctor on the facts, not just hopes!" If providers become subject to competition based on high-quality, low-cost criteria, they had better have accurate analysis--"the facts"--behind their claims. Future critics may well argue that circulating incorrect information scorecards has done more harm than providing no information at all. More basic research needs to be undertaken if we are to avoid such mistakes.