In order to develop tools for improved Ohio health system data transparency, HPIO educates state policymakers and the people who influence them by providing concise, comprehensive and easy-to-understand information and analysis on the topic. HPIO is an objective source for unbiased analysis of data, research, and state/federal laws and regulations.
Health care cost and quality data sources
Federal health care cost and quality reporting
Health System Measurement Project
In May 2012, HHS launched the Health System Measurement Project, a web-based tool that allows policymakers, providers, and the public to track the performance of the nation’s health care system and compare national trends to state and regional trends. The Health System Measurement Project contains measures related to access to care, cost and affordability, prevention and health information technology and are drawn primarily from existing publicly- available datasets maintained by the federal government. The measures were selected by the HHS Office of the Assistant Secretary for Planning and Evaluation to align with the HHS Strategic Plan, the National Quality Strategy, and other departmental strategic planning efforts.
The Agency for Healthcare Research and Quality (AHRQ), The Centers for Disease Control and Prevention/National Center for Health Statistics (CDC/NCHS) have partnered to provide a portal in AHRQ’s metadata registry that facilitates the comparison of data elements across state APCDs and the corresponding national standard for each data element. The portal includes a core set of data elements from each state’s All-Payer Claims Database (APCD) and the corresponding data elements in (1) the Accredited Standards Committee (ASC) X12 5010 standard, (2) the ASC X12 Post-Adjudicated Data Reporting Guides (in development), and (3) the National Council for Prescription Drug Programs (NCPDP) Uniform Healthcare Payer Standard Implementation Guide Version 1.0.
Health Indicators Warehouse (HIW)
A user-friendly, web-accessible database launched by HHS in 2011 to:
- Provide a single source for national, state, and community health indicators
- Meet the needs of multiple population health initiatives
- Facilitate the harmonization of indicators across initiatives
- Link indicators with evidence-based interventions
- Serve as the data hub for the HHS Community Health Data Initiative
Health Data Initiative (HDI)
The Health Data Initiative (formerly the Community Health Data Initiative) is a large-scale, public-private effort led by HHS to release data, encourage innovative application development, and catalyze change to improve community health. The site, HealthData.gov, provides access to many datasets and tools that have been gathered from agencies across the Federal government.
Agency for Healthcare Research and Quality (AHRQ)
Consumer Assessment of Healthcare Providers and Systems (CAHPS)
A comprehensive family of standardized surveys that asks consumers and patients to report on and evaluate their experiences with health care.
Health Care Cost and Utilization Project (HCUP)
A family of both national and state-specific longitudinal databases containing all-payer, encounter-level information on inpatient stays, emergency department visits, and ambulatory care in U.S. (1988-present). These databases are created by AHRQ through a Federal-State-Industry partnership. These databases enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to health care programs, and outcomes of treatments at the national, State, and local market levels. This data is available to the public and to researchers for a fee.
Health Resources and Services Administration (HRSA)
The Uniform Data System (UDS)
Contains data reported by grantees of HRSA primary care programs: Community Health Center, Migrant Health Center, Health Care for the Homeless, Public Housing Primary Care. It tracks patient demographics, services provided, staffing, clinical indicators, utilization rates, costs, and revenues. UDS data are reported at the grantee, state, and national levels.
Centers for Medicare and Medicaid Services (CMS)
An online tool for comparing the quality of care that hospitals provide. It also includes data on some Department of Veterans Affairs medical centers. The quality measures are developed by the Hospital Quality Alliance (HQA), a public-private partnership established in 2002. Quarterly reporting is mandatory for all acute care hospitals in order to receive the annual Medicare inflationary payment update.
Nursing Home Compare
An online tool for comparing the quality of care provided by Medicaid or Medicare-certified nursing homes. It rates nursing homes based on health inspection reports, staffing data, and quality measures.
Home Health Compare
An online tool for comparing the quality of care that home health agencies provide. It provides a list of U.S. home health agencies, services provided and quality measures. The information comes from home health agencies that have voluntarily agreed to submit quality information.
Dialysis Facility Compare
An online tool for comparing the quality of care that dialysis facilities provide. It provides a list of U.S. dialysis facilities, services provided, quality measures, and resources.
Dashboards are designed to improve public understanding of Medicare and Medicaid programs by simplifying and making data more accessible.
Medicare Provider Utilization and Payment Data
Contains service volumes and Medicare payment data for inpatient and outpatient hospitals, physicians, Part D prescribers and other suppliers.
Substance Abuse and Mental Health Services Administration (SAMHSA)
The Treatment Episode Data Set (TEDS)
Includes records for some 1.5 million substance abuse treatment admissions annually. Facilities reporting TEDS data are those that receive State alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of substance abuse treatment
CDC’s National Center for Health Statistics
Health Data Interactive (HDI)
Presents tables with national health statistics that can be customized by age, gender, race/ethnicity, and geographic location to explore different trends and patterns.
National Healthcare Safety Network (NHSN)
A secure, internet-based surveillance system that enables healthcare facilities to collect and use data about healthcare-associated infections, adherence to clinical practices known to prevent healthcare-associated infections, the incidence or prevalence of multidrug-resistant organisms within their organizations, and other adverse events. Some states utilize NHSN as a means for healthcare facilities to submit data on healthcare-associated infections (HAIs) mandated through specific state legislation.
Ohio-specific health care cost and quality reporting
Ohio Hospital Compare
This is a legacy website containing hospital performance measures for 2008 through 2012 for the following 12 health conditions:
heart attack, heart failure, heart surgery, stroke, pneumonia, surgical care, infection, infection prevention, patient safety, patient satisfaction, childhood asthma and pregnancy/delivery. Under legislation enacted in 2006, all hospitals in the state of Ohio were required to report (bi-annually) except for hospitals operated by the Ohio Department of Mental Health, long-term care hospitals and veteran’s hospitals. Subsequent legislation eliminated the reporting requirement.
Ohio Hospital Price Disclosure Reports
In compliance with state law, each Ohio hospital provides a price list containing its charges for room and board, emergency department, operating room, delivery, physical therapy as well as the 60 most common inpatient procedures (called diagnosis-related groups) and 50 most common outpatient procedures.
Ohio Public Health Data Warehouse
A web-based, interactive data retrieval system that provides access to summarized health-related and vital statistics data for Ohio. The data is valuable for community assessments and community planning as well as for evaluating health practices.
National, private-sector health care cost and quality reporting
FAIR Health is a national, independent, not-for-profit corporation founded in 2009 to create and maintain a database of charge data for healthcare procedures and to offer consumers web-based tools to estimate out-of-network expenses for specific medical and dental services in their geographic area. Insurers nationwide use FAIR Health benchmarking data to establish usual and customary rates (UCR) for out-of-network reimbursement.
FAIR Health obtains its data (dated 2002 to the present) from private health plans, insurance carriers and third-party administrators. Approximately 60 companies nationwide currently participate in the data contribution program providing data for over 18 billion billed procedures covering over 151 million lives. The data is organized by procedure code, geographic area, and date of service. To maintain privacy, claims in the database do not include information that can identify individuals. As an incentive to contribute data, FAIR Health offers credits that reduce data licensing fees to data contributors.
FAIR Health distributes the data from its database in the form of product modules and custom analytics, which are licensed for a fee to health insurance payers, providers, and other customers. Each data product module contains benchmarks for procedures and services within a particular category (such as Medical/Surgical, Dental, Anesthesia, Outpatient, etc.) FAIR Health data products are updated at least twice a year to incorporate newly-collected data. FAIR Health makes its data available to consumers through free, web-based consumer cost-lookup tools at www.fairhealthconsumer.org.
FAIR Health also has data available for licensure to researchers and policymakers at www.fairhealth.org/research. The Benchmark Modules data provides claims data regionally sortable by procedure, with both current and historical data available. The FAIR Health National Private Insurance Claims Database for Research (FH NPIC), meanwhile, contains additional encounter and patient information. Researchers may use the data to identify and understand patterns, trends and geographic disparities in service utilization and private healthcare spending.
National Quality Forum
The National Quality Forum (NQF) is a nonprofit organization that aims to improve the quality of healthcare by building consensus on national priorities and goals for performance improvement and endorsing national consensus standards for measuring and publicly reporting on performance. NQF’s membership includes a wide variety of healthcare stakeholders, including consumer organizations, public and private purchasers, physicians, nurses, hospitals, accrediting and certifying bodies, supporting industries, and healthcare research and quality improvement organizations. Over the past decade, NQF has endorsed more than 500 standards for tracking health care quality and performance.
NQF Tools of Interest to State and Community Leaders
- NQF-Endorsed Measures. NQF endorses ways to measure health and healthcare, using evidence-based reviews and a formal process that assesses each measure based on importance, scientific validity, reliability, usability, and feasibility.
- National Priorities Partnership (NPP). The NPP is a multi-stakeholder group convened by NQF to provide input to the Department of Health and Human Services (HHS) on national priorities and goals, and to align public- and private-sector efforts around a shared vision of improving health and healthcare.
- Measure Applications Partnership (MAP). The MAP is a multi-stakeholder group convened by NQF to provide input to HHS on selecting measures to be used for public reporting requirements and performance-based payment.
- Quality Positioning System (QPS).NQF’s measure search tool allows users to more easily find NQF-endorsed® measures, explore ways to use those measures, and learn about others’ quality measurement and improvement initiatives.
- Health Information Technology (HIT).NQF is leading a range of HIT activities to lay the foundation to enable the use of NQF-endorsed measures within electronic health records to build the data sources needed for performance measurement, reporting, and quality improvement.
National Committee for Quality Assurance (NCQA)
The National Committee for Quality Assurance is a private, not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has helped to elevate the issue of health care quality to the top of the national agenda. NCQA uses a variety of approaches to assess health care quality (e.g. on- and off-site surveys, audits, satisfaction surveys, and clinical performance measurement), and uses these for a range of accreditation, certification, recognition and performance measurement programs for different types of organizations, medical groups and physicians. In addition, NCQA regularly tracks the quality of care delivered by the nation’s health plans. To earn NCQA’s seal of approval, accredited health plans must comply with a set of more than 60 standards and must report on their performance in more than 40 areas.
The Joint Commission
The Joint Commission evaluates and accredits more than 20,500 health care organizations and programs in the United States. An independent, not-for-profit organization, The Joint Commission is the nation’s oldest and largest standards-setting and accrediting body in health care. It requires hospitals to report quality improvement efforts quarterly, for a variety of treatment areas. The information is made available to the public though Quality Check.
The Leapfrog Hospital Survey is an annual, voluntary public reporting initiative launched in to2001 to assess hospital performance based on four quality and safety practices that are proven to reduce preventable medical mistakes and are endorsed by the National Quality Forum (NQF). Consumers, health plans, and hospitals can use data to identify areas of improvement and to compare hospital performance locally, regionally, and/or nationally.
HealthGrades is a healthcare ratings company that compiles outcomes data from dozens of independent public and private sources and translates it into report card ratings on providers, including physicians, hospitals, nursing homes, and home health agencies. Quality and cost information is available to consumers, hospitals, employers, health plans and others.
Health Care Cost Institute (HCCI)
HCCI is a non-partisan, non-profit organization that provides information about health care utilization and cost through a large health insurance claims database. The database is available primarily to academics conducting research on utilization and cost.
Guroo is a website created by HCCI to provide cost and quality data, free and accessible to the public. Data includes national, state and local cost and quality information for 78 care bundles, a grouping of a health condition and the services typically provided for that condition.
Best Hospitals is a hospital ranking report by U.S. News and World Report. The interactive online report ranks over 5,000 U.S. medical centers in 16 specialty areas. The report includes an Honor Roll for hospitals scoring very high in at least 6 specialties. Common Care, a Best Hospitals tool released in May 2015, provides data on how hospitals perform on select chronic health conditions and common elective surgeries.
Consumer Reports is an editorially-independent not-for-profit organization that reviews and compares consumer products. These reviews are available online and in print for subscribers. The website includes ratings on hospitals and heart bypass surgeons, as well as guides on how to use the ratings and pick a provider. Hospital ratings include scores for safety, avoiding infection, avoiding readmission, avoiding C-sections, and surgery adverse events; surgeons are rated on a 1-to-3 star scale based on complication rates, patient survival, and other measures.
In addition to the tools listed above, many health insurers have their own cost and quality data tools available for their insured.