How Hospitals Can Improve Their Public Quality Metrics: A Decision-Theoretic Model

Danny Hughes
About This Project

Danny Hughes professional headshot in front of classroom chalkboardBy Gita Smith

The Centers for Medicare & Medicaid Services (CMS) publicly report hospital performance quality, which is linked to payments hospitals receive for services. The performance rating a hospital receives can be colored by the actions of a single physician. One specific decision a doctor makes – whether to prescribe just a brain CT scan or a brain-plus-sinus CT on the same day to a patient with a head ailment – can figure into patient satisfaction and a hospital’s quality reputation. In most cases, same-day brain and sinus CT scans are unnecessary and result in higher costs and increased radiation exposure.

Danny R. Hughes, PhD, Director of the Health Economics and Analytics Lab at Georgia Tech, examined three possible approaches a hospital might take to influence physicians’ medical imaging decisions. Along with co-authors Yongjia Song of Clemson University and Christian Wernz at University of Virginia, Hughes’ study considered how training, nudging, and incentives may work differently for physicians with different skill levels. (Physicians possibly unsure of their own diagnostic abilities could be more prone to order two scans of the head instead of one.) Which avenue should a hospital use?

Training programs to improve physician’s diagnostic abilities are particularly attractive to hospitals with larger patients-per-physician ratios. However, training costs can outpace the benefits for hospitals with highly ambitious performance goals. Nudging was found to be most attractive for hospitals with higher patient volumes and a large staff of physicians. However, a hospital’s desired quality performance goal may not be achievable by nudging alone. Nudges are gentle reminders or indirect suggestions to influence decision-making. This could mean reminding doctors of radiation’s harm through grand round presentations, posters or research findings sent to them.

Then what about financial incentives? Not only would this be expensive, but if seen as going to less-skilled doctors, it could be considered a violation of a merit-based system, making this program unacceptable in practice. Hughes used a decision-theoretic model to shed light on physicians’ imaging decision process, accounting for medical and behavioral factors like uncertainty in clinical assessment and a physician’s diagnostic ability. This research adds to hospital policy makers’ knowledge by providing them with valuable insights into multi-level effects of their decisions. This research also provides cost-minimizing strategies to hospitals for incentivization and training plus some mathematical parallels between nudging and incentivization.

How Hospitals Can Improve Their Public Quality Metrics: A Decision-Theoretic Model was published in Health Care Management Science in May 2021.

Read more featured research from the School of Economics, like "How Socioeconomic Factors Affect the Use of Medical Imaging During the Covid Pandemic," also by Professor Danny Hughes.