Report Card Reservations
Those who don’t believe it may have trouble, and sooner than they think. With 70 million beneficiaries, the Centers for Medicare and Medicaid Services (CMS) sets the tone for healthcare quality in the U.S. In fact, Medicare beneficiaries comprise about one-third of those in a typical hospitalist’s practice. Since March 2008, the CMS Web site www.hospitalcompare.hhs.gov/ has reported hospital service data and soon will post cost comparisons.
- eHospital Compare (www.hospital compare.hhs.gov);
- HealthGrades (www.healthgrades.com);
- Leapfrog (www.leapfroggroup.org);
- U.S. News & World Report (https://health.usnews.com/sections/health/best-hospitals); and
- Thomson Reuters (www.100tophospitals.com).
2 Get involved with your hospital medicine group and hospital efforts to contribute to public reports;
3 Brush up on quality improvement tools. Those available at the SHM Web site now include QI resource rooms, a QI primer, a quality track, training sessions, the QI pre-course section from the 2008 annual meeting, a PowerPoint presentation used in the pre-course of the 2007 meeting, and Thomas Valuck, MD’s, tutorial on value-based purchasing;
4. Get trained. Some resources include the Health Research Educational Trust fellowship program, the National Patient Safety Foundation courses, and the Intermountain Institute of Healthcare Improvement Advanced Training Program at https://intermountainhealthcare.org /xp/public/institute/;
5. Educate patients about quality reporting and how to use the information, including tips on evaluating the popular consumer Web sites.
6 Educate the public about a hospitalist’s role in patient care, increasing patients’ understanding of what it means to them.
7 Develop the skill set for performance measurement and reporting. This would include taking the lead on core measure education and compliance, explaining the Hospital Consumer Assessment of Healthcare Providers and Systems survey to your staff, and offering suggestions on how they can use the data to track and improve the process of patient-centered care, and knowing the use of different hospital bundles, such as CLAB infection bundles and value-added purchasing.—AS
“CMS is a payer we have to pay attention to (them),” says Patrick Torcson, MD, chair of SHM’s Performance and Standards Committee. “The CMS performance and quality agenda is specified at the statutory level as part of the Congressional record, and is very political. Therefore, that agenda right now is part scientific, part policy, and part methodology. There is a little something in it for everybody.”
Increasingly, quality measures are gradually, and insidiously, changing healthcare. For instance, Dr. Jha’s study found outcomes data did not greatly influence hospital market share, however, the surgeons with the highest publicly reported mortality rates were much more likely to retire after the release of each report card.2
Obstacles to Utilization
If these data can help us make educated healthcare decisions, why aren’t more people consulting them? To start, current measures aren’t sufficient, says Peter K. Lindenauer, MD, MSc, FACP, a hospitalist and associate professor of medicine at Baystate Medical Center in Springfield, Mass.
“The number of measures and the strength of the evidence that current process measures are based on are still quite limited,” Dr. Lindenauer says. “Moreover, it is unclear how much the structural and process measures that have remained the focus of most public reporting contribute to patient outcomes.” It’s difficult to make statistically meaningful comparisons across hospitals or providers. Those efforts are “hampered by inadequate risk adjustment and tend to be underpowered to detect statistically significant differences.”
