To be clear, no one is saying process measures aren't important. They have one critical advantage in that they're not affected by severity of illness or economic demographics, so they don't need a complex risk adjustment algorithm. The question is merely, was the thing done or not?
Also, if these process measures tracked, we should see the same hospitals scoring well on HospitalCompare and on the new Joint Commission list. That's not generally the case.
I think hospital executives have another reason to be confused by The Joint Commission's report. The Centers for Medicare & Medicaid Services' is signaling – both with reimbursement policies scheduled to take effect in 2014 and with the release of data on its HospitalCompare website, that it plans to aggressively emphasize outcomes, such as 30-day readmission rates for heart attack, pneumonia and heart failure and 30-day mortality rates those same conditions.
Consumers, employers, payers, and providers alike are in the very early stages of understanding how to measure quality. Patients are just beginning to realize that their decisions can be based on real metrics rather than the beautiful artwork in the hospital lobby or the place where a neighbor volunteers.
The Robert Wood Johnson Foundation now lists 224 reputable state, federal, and consumer group lists that rank hospitals in a variety of ways. If healthcare executives are confused about all of this, imagine how confusing it is to those who have to make a choice of where to seek care, the patient.