Performance Measurement In Healthcare And Education
A recent story in the New York Times reports that, according to an Obama Administration-commissioned panel, the measures being used to evaluate the performance of healthcare providers are unfairly penalizing those that serve larger proportions of disadvantaged patients (thanks to Mike Petrilli for sending me the article). For example, if you’re grading hospitals based on simple, unadjusted re-admittance rates, it might appear as if hospitals serving high poverty populations are doing worse — even if the quality of their service is excellent — since readmissions are more likely for patients who can’t afford medication, or aren’t able to take off from work, or don’t have home support systems.
The panel recommended adjusting the performance measures, which, for instance, are used for Medicare reimbursement, using variables such as patient income and education, as this would provide a more fair accountability system – one that does not penalize healthcare institutions and their personnel for factors that are out of their control.
There are of course very strong, very obvious parallels here to education accountability policy, in which schools are judged in part based on raw proficiency rates that make no attempt to account for differences in the populations of students in different schools. The comparison also reveals an important feature of formal accountability systems in other policy fields.
In both the education and health care contexts, among the more common objections to adjusting performance measures is the idea that doing so — e.g., controlling for student/patient characteristics, such as income — represents “setting different expectations” for institutions (schools/hospitals) based on the people they serve. TheTimes article, for instance, notes that the Obama Administration commissioned the above-mentioned study, but was “not entirely comfortable with [its] recommendations,” since they believe that “performance scores should generally not be adjusted or corrected to reflect differences in the income, race or socioeconomic status of patients.”
On the one hand, this is a very well-intentioned point of view. It is indeed unfair, and even bad policy in any accountability system, to hold institutions to different standards, particularly when those standards vary by characteristics of those served. And it is true that adjusting a measure such as re-admittance rates for patients’ Shanker Blog » Performance Measurement In Healthcare And Education: