• Article
  • June 1, 2017

3 Challenges Children's Hospitals Face as They Define and Demonstrate Value

Here's what matters to children’s hospitals in accountability programs and quality measures.


Demands for measuring the quality and value of the care children's hospitals provide are increasing. Payer contracting, consumer interest, public reporting, regulatory and accreditation requirements—all are asking for quality measures.

To help inform children's hospitals and industry leaders in quality and accountability measurement, the Children's Hospital Association (CHA) launched a survey to gain insight into hospitals' exposure to programs of accountability. The survey, with more than 80 responding children's hospitals, provides insight into hospitals' participation in these programs, the types of measures they use, and future trends.

Mitch Harris, director of research and statics in comparative data and analytics at CHA, reviewed key findings from the survey during a May 10 webinar.

Here are three key challenges identified in the survey:

The current landscape is a "jungle"

There are many types of accountability programs, and providers and consumers question the value some of these programs add to the care delivery and improvement process. Harris says the hospitals reported participating in about 1,500 programs in seven different categories: public reporting; value-based purchasing; accreditation; certification, designation or award recognition; centers of excellence; network inclusion, exclusion or tiering; and patient registries. "The challenge is to design or select programs that clearly support the system in bringing about better outcomes," Harris says.  

Also, a number of stakeholders in the quality measurement community say the landscape is chaotic and cumbersome. The key is to take the overgrown "jungle" of programs and key measures and trim it to a more manageable "garden" where there are clear choices for providers, payers and patients, Harris says. The available measures are often imperfect and burdensome to collect, and there are still gaps for children’s hospitals in pediatric measures. 

Measures variation and the disconnect with payers

When asked in the survey about the most important quality measures that children’s hospitals should access to drive quality improvement, safety and infection measures ranked at the top. 

"It's striking that as a community, children's hospitals recommend safety and infection at the top of the list," Harris says. "But when payers are thinking about value, they don’t think about safety and infections, they see this more as part of the basic process of delivering care—it's a baseline of quality that we should be delivering as pediatric providers. Payers don't want to focus on this as part of our measures. They think this is something hospitals should be taking care of, not part of the value equation." 

Significant resources required

Staff time and the resources are required to meet the demand for demonstrating value and tracking and reporting measures:

  • 97 percent of respondents indicated more or much more effort is now in the production and use of measures compared to three years ago
  • 83 percent of respondents say having dedicated resources for measurement activity was a moderate or serious challenge
  • 90 percent of respondents say tracking measure performance in real-time so they are actionable was as a moderate or serious challenge

Despite the resources needed to track the programs and measures, 29 percent of respondents say the measures they tracked were only somewhat, slightly or not at all representative of the quality of care their organization delivered. Harris says this suggests there is work to do to align the measures used. 

What’s next?

"Given all of the varied types of accountability programs and differing levels of participation, is there a way to increase the value or efficiency of hospitals participating in these programs?" Harris asked. "We'll be trying to answer this over the next coming months as we dive into the data further."

More results and content will be developed and disseminated in 2017. An aggregate report is in progress and will be available to all CHA members. Additional analysis on regional variation, specific programs and a detailed list of public reporting measures are identified as future work this year. And don't miss the June 6 webinar on payer-led accountability programs and measures.

With the expected growth of programs and measures, there is an opportunity for providers to build significant relationships with payers and patients in an attempt to drive the future quality measurement environment. "It's our hope the results of the survey will continue to identify the challenges the children’s hospitals are experiencing, but also the best practices that can help us all succeed in this demanding environment," Harris says.  

Learn more about the survey, listen to the webinar recording or contact Sally Turbyville, senior fellow of quality policy and research at CHA, for more information. 

Send questions or comments to magazine@childrenshospitals.org.