Sept. 24, 2002
Low Quality HMOs Hide Performance Data from Public, Says Journal of the American Medical Association Study
Harvard/Public Citizen Study Finds Voluntary HMO Quality Monitoring System Failing
As many as one half of all HMOs that participate in the nation’s principal quality monitoring system stopped publicly disclosing their quality scores from one year to the next, according to a study to be published in tomorrow’s Journal of the American Medical Association. The study, conducted by researchers at Harvard Medical School and Public Citizen’s Health Research Group, found that poor quality HMOs were at least 3 times more likely than the best plans to drop out of public disclosure of their scores. “Many HMOs are manipulating the system. They’re undermining quality assessment and misleading the public into believing that HMO quality is better than it is,” said Dr. Danny McCormick, a study author and instructor of medicine at Harvard Medical School.
The study analyzed data from the National Committee for Quality Assurance’s (NCQA) HEDIS (Health Plan Employer Data Set) program, the most influential HMO quality-monitoring program. Each year, HMOs voluntarily submit data on their performance on a defined set of quality indicators such as the percentage of women receiving a mammogram or children receiving immunizations. The NCQA then publishes HEDIS scores of participating HMOs. The authors examined whether HMOs’ HEDIS scores in 1997 and 1998 predicted the likelihood of HMOs withdrawing from public disclosure of scores one year later.
“The selective withdrawal by lower scoring plans means that average published scores could improve even if actual quality were stable or even deteriorating,” said Dr. David Himmelstein, a study co-author and associate professor of medicine at Harvard Medical School. “This means that the true quality of HMO care in the U.S. is currently unknowable.”
The study also found large differences in quality among HMOs disclosing data. For example, in 1997, patients enrolled in plans in the bottom one-third were only half as likely to receive life saving beta-blocker drugs after suffering a heart attack as patients enrolled in the top one-third of HMOs (42% compared with 83%). “This underscores why patients need information on the quality of their HMO if they are to make informed choices,” said Dr. McCormick.
“No other industry with so much impact on the public’s safety is so free of public oversight,” said Dr. Steffie Woolhandler, another co-author and associate professor of medicine at Harvard Medical School. “Airlines and car manufacturers are required to disclose data on the safety of their products. The HMO industry is showing that it too needs public oversight. Voluntary participation does not seem to work.”
Click here to view a full list of the 228 HMOs that withdrew from public disclosure of quality scores in 1998 and 1999.