Health Care Quality

Despite high health care spending, there are still problems with the quality of the nation’s health care services. The cost and quality of health care services can vary significantly, with high cost not necessarily indicating high quality. As consumers pay for a growing proportion of their health care, they need better information on costs and quality so that they can make informed decisions.

The Department of Health and Human Services (HHS) is responsible for a number of efforts to enhance health care quality and the transparency of information for consumers. However, there are ways it could improve its efforts.

For instance:

• Federal health care programs and other health care payers are increasingly examining the quality of the services people receive—and adjusting payments accordingly. However, payers do not always agree on which quality measures to track, making it difficult to improve the quality of care and burdening doctors and other providers with having to report different data to different payers. While HHS is working to better align its health care quality measures across programs and private payers, it needs to systematically assess the quality measures it selects relative to its quality measurement strategic objectives.  
• States increasingly contract with Medicaid managed care organizations to provide long-term services and supports for adults and children with different types of disabilities or conditions. These organizations make many of the decisions about the amounts and types of care that these Medicaid beneficiaries receive to assist them with basic needs like bathing or eating. However, 6 selected states had significant problems with care management through these contracts, and HHS oversight of quality and access for these organizations has been limited. HHS needs to assess the nature and prevalence of quality and access problems to Medicaid’s managed long-term care services and supports across states.
• During the COVID-19 pandemic, selected states expanded access to telehealth through Medicaid, allowing people to get needed health care while reducing their COVID-19 exposure risk. However, the Centers for Medicare & Medicaid Services (CMS) has not collected or assessed data about the effects of delivering services via telehealth on the quality of care received by Medicaid beneficiaries.
• CMS’s measures of the quality of Medicare- and Medicaid-certified nursing homes show mixed results. For instance, the average number of consumer complaints reported per nursing home increased by 21% from 2005-2014. However, the number of serious issues identified per nursing home decreased by 41% over the same period. Further, infection prevention and control deficiencies, such as failure to use proper hand hygiene, were the most common deficiencies cited by state surveyors in the years prior to the COVID-19 pandemic. Additionally, from June 2020 through December 2021, COVID-19 outbreaks in nursing homes lasted 4 weeks on average and outbreak duration was strongly associated with community spread.
• CMS has taken some steps to improve tools for consumers to have cost and quality information. For example, CMS’s Care Compare, previously known as Nursing Home Compare, allows people to research and compare nursing homes using a rating system. CMS has worked to improve transparency and provide more information to consumers in Care Compare. For example, after it was difficult for consumers to make informed decisions about nursing homes in Oregon due to incomplete information on incidents of abuse, CMS added a consumer alert. CMS also added an abuse icon for consumers to more easily identify homes cited with these deficiencies after gaps were found in CMS’s oversight of abuse in nursing homes. However, Care Compare still lacks some key information, such as consumer satisfaction scores and the ability to compare nursing homes across states. It also needs to include more information on nursing home staffing, like weekend decreases in nurse staffing levels that could affect care.  The information on Care Compare is also not always updated regularly—some of it is more than 2 years old.

Example of Missing Information Affecting a Consumer's Nursing Home Decision

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