Health care quality measures are standard, evidence-based metrics designed to assess the performance of health care providers, such as hospitals, in providing care. These measures are intended to (1) inform providers about opportunities for potential improvements in their delivery of care, (2) incentivize providers to consistently provide high quality care, and (3) inform consumers about which providers are most likely to deliver high quality care. There are broad categories of clinical quality measures that address various aspects of quality of care. See table 1 for a description of these broad categories of quality measures. These broad measure categories can be further broken down into more specific groups of related measures. For example, outcome measures can include measures of patient safety, such as the incidence of healthcare-associated infections (HAI) or complications, as well as measures of hospital readmissions and mortality, and results obtained from ambulatory care, such as the proportion of patients with hypertension whose blood pressure is reduced to the normal range. The data used to calculate the results of health care quality measures can come from a number of different sources. Some measures often require detailed clinical information obtained from patient medical records, such as process measures that indicate whether timely and effective care was provided in a specific situation, for example, or whether stroke patients received clot-dissolving medication appropriately. Other measures are designed to use information on patient demographics and diagnoses that can be obtained from more readily accessible sources, such as claims data or other administrative data that have already been collected for other purposes such as billing. In addition, patients can be asked directly, usually through surveys, to report on their experiences receiving care. One key method for disseminating information on health care quality measures to consumers—including which providers are delivering high or low quality care and the costs of care—is through websites that can convey this information to anyone with internet access. HHS is one of the organizations that provide such information to consumers and others. Specifically, HHS’s Centers for Medicare & Medicaid Services (CMS) maintains a series of websites that provide information on health care quality, including a series of websites for hospitals, nursing homes, and certain other providers that participate in the Medicare program. Since 2005, CMS has increased the number of health care quality measures it posts on one of its websites, known as Hospital Compare, that covers more than 4,000 hospitals that participate in the Medicare program. These hospitals supply data to CMS for quality measures of inpatient and outpatient care in return for higher payments on their Medicare claims. Each year HHS goes through a formal process, including receiving input from experts and stakeholders, to review and revise the mix of quality measures that these hospitals report. The Hospital Compare website allows anyone with internet access to select up to three hospitals to compare their performance on each of these measures side-by-side. CMS uses contractors to collect and process the data submitted by individual hospitals, and it posts the results on each of the quality measures on the Hospital Compare website. In implementing a requirement under the Choice Act, VA reports some of the 79 possible health care quality measures reported by non-VA hospitals on HHS’s Hospital Compare website. As of June 2017, VA was reporting 35 measures that it had determined were applicable to its individual medical centers. Of the remaining 44 measures that non-VA hospitals report on Hospital Compare, VA plans on reporting on 12 measures in future years and does not plan to report 32 measures. See table 2 for a summary of VA’s reporting of quality measures on Hospital Compare. The 35 measures VA reported on Hospital Compare as of June 2017 include all of the available patient experience measures (e.g., patient perspectives on how well physicians communicated with them), most of the process measures (e.g., whether stroke patients received appropriate clot-dissolving drugs), and some of the outcome measures (e.g., whether pneumonia patients were readmitted to the hospital within 30 days). (See app. I for more detailed information on the specific measures VA reports on Hospital Compare.) VA officials told us that when they began to report quality measures to Hospital Compare in 2010, the measures they first decided to report included measures that VA was already reporting for other purposes. For example, these included process measures of timely and effective inpatient care that VA reported for Joint Commission hospital accreditation. According to VA officials, choosing quality measures it already reported for other purposes minimized the additional resources needed to report the measures on Hospital Compare. From 2017 through 2019, VA plans on reporting an additional 11 outcome measures on Hospital Compare. These include 6 measures of various HAIs at VAMCs, 4 measures of mortality and readmission rates associated with additional medical conditions and procedures, such as stroke and hip/knee replacement surgery, and 1 measure related to patient safety. Specifically: Regarding the 6 additional HAI measures, VA officials told us that they will report these measures when they can develop a new data collection process that will allow them to meet the requirements for reporting HAI measures in a way that minimizes demands on VA resources. According to VA officials, complying with the existing process for collecting data for and reporting on HAIs would require infection control staff at each VAMC to fill out forms with information on individual patients, whereas VA currently collects its own information on HAIs based on aggregated data assembled by VA Central Office staff. VA officials told us that their new data collection process for reporting HAI measures is intended to meet those Hospital Compare requirements through automating much of the required data entry at the VAMCs. However, VA officials noted that this new reporting process is still in an early stage of development, and they expressed uncertainty about how long it would take to implement the process. Regarding the 4 additional mortality and readmission measures, CMS faces challenges in integrating VA’s clinical information into the Hospital Compare database. According to both VA and CMS officials, VA has had to implement new readmissions and mortality rate measures incrementally due to the limited capacity of one of CMS’s Hospital Compare contractors to develop the programming needed to calculate these measures using VA patient data. Because the readmissions and mortality rate measures require complex programming to implement risk adjustments, based on a number of different diagnoses recorded in patient medical records over time, VA and CMS officials agreed to add only two new measures each year until VA can report all 4 measures. There are another 32 measures non-VA hospitals report on the Hospital Compare website that VA has no plans to report. VA officials determined that these measures are not relevant for VA’s health care system, given its distinctive funding sources, patient population, and health care delivery structure. For example, VA officials stated that they did not plan to report any of the Hospital Compare measures related to costs of care, such as Medicare spending per beneficiary, because those measures are based on Medicare payments and VA does not receive any payments from Medicare. In other cases, VA officials do not plan on reporting measures that relate to health care services that VAMCs rarely, if ever, provide, such as obstetrics and hip and knee replacements. In implementing a requirement under the Choice Act, VA has posted on the Hospital Compare website a link to the notification on the quality measures VA is not reporting. The most recent notice, dated February 2015, broadly explains that VA faces three main challenges that affect the availability of certain measures. According to the notice, these challenges relate to data quality, standard data collection processes, and funding to support the collecting and reporting of quality measures. VA officials told us that they plan on adding to the notification information about the specific measures VA expects to report in the future and when it expects to report them. As of June 2017, VA reported on its own website 110 health care quality measures for its VAMCs. These include measures in many of the same categories that VA reports on Hospital Compare, but they also include several additional categories of quality measures that are not available on Hospital Compare. These additional categories address quality issues VA officials deem relevant for veterans, such as various measures of access to care. For example, the additional measures include measures of how long veterans must wait to obtain care at VAMCs and measures of the quality of care related to ambulatory care, such as colorectal cancer screening rates. See Table 3 for the categories of measures VA reports on its website. Some of the specific measures reported on VA’s website are the same as those reported on Hospital Compare and some are entirely different. For example, most of the patient experience measures reported on VA’s website are the same as those reported on Hospital Compare, while the access to care measures are only reported on VA’s website. In addition, some measures reported on VA’s website are similar to, but not exactly the same as, Hospital Compare measures. For example, among similar measures, the target population may be defined somewhat differently or the result may be calculated differently. (See app. I for more information on the specific measures VA reports on its website.) In implementing a requirement under the Choice Act, VA has also posted a notification of unavailable measures on its website. This is the same February 2015 notice VA provided on the Hospital Compare website. VA publicly reports 110 health care quality measures on two separate webpages on its website—the “Access and Quality” webpage, launched in April 2017, and the “Quality of Care” webpage, which VA has used since 2008. The Access and Quality webpage is intended to be the primary source of information on quality of care at VA for veterans, according to VA officials. VA officials also told us that this webpage was developed to present quality of care information in ways that are easy for veterans and other stakeholders to understand. A link to the primary Access and Quality webpage can be found on the homepage of VA’s website, making it relatively easy to find. VA officials also told us that they retained the older Quality of Care webpage in an effort to be transparent as well as provide historical data on the many quality measures it has tracked. The older Quality of Care webpage is not linked to the homepage of VA’s website.