Medicare

Medicare's Public Reporting Initiative Fails to Reduce Mortality

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Since 2005, Medicare has run a data collection initiative known as Hospital Compare. The program paid eligible hospitals to self-report a number of predetermined quality measures, which were then tracked and made accessible in a public database. The program also provided some information to patients and medical consumers. But a study in Health Affairs by researchers from Cornell Medical College and the University of Michigan reports that the program has not had much effect on health outcomes. Mortality rates dropped, but only in line with preexisting trends.

"Our analysis indicates that the fact that hospitals had to report quality data under Hospital Compare led to no reductions in mortality beyond existing trends for heart attack and pneumonia and led to a modest reduction in mortality for heart failure," the authors write. "We conclude that Medicare's public reporting initiative for hospitals has had a minimal impact on patient mortality."

All else being equal, there is nothing wrong with increased transparency and data analysis. But I suspect that, at least within Medicare, hopes for this sort of procedural reform have long been calibrated too high. As Congressional Budget Office Director Douglas Elmendorf testified last summer, Medicare's demonstration projects frequently produce disappointing results. "It turns out to be pretty hard to take ideas that seem to work in certain contexts and proliferate that throughout the health care system," he told members of Congress. "The results are discouraging."

Not surprisingly, this is far from the first or only failure of various technocratic tweaks to Medicare and other government health programs.