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Hospitals Closely Watching Quality Initiatives

By Rebecca Adams, CQ HealthBeat Associate Editor

April 27, 2011 -- Federal initiatives to push hospitals to report on the quality of their care—and penalize those who don't measure up—are only useful if the metrics are fair and scientifically sound, evaluate issues vital to patient safety, and consider the differences between patients, a hospital trade representative said at an Alliance for Health Reform briefing.

The Centers for Medicare and Medicaid Services (CMS) increasingly bases hospital payments on whether the institutions report on quality measures and whether those statistics show a given hospital is providing patients with high-quality care. Not only does the 2010 health care law (PL 111-148, PL 111-152) call for additional quality measures, but CMS administrator Donald Berwick also is a strong proponent of evaluating providers' performance quality. By 2017, about 9 percent of Medicare payments to hospitals will be based on reporting and performance of quality metrics.

Hospital executives are concerned, however, that the federal initiatives don't always capture the best information.

Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, said hospital officials have been concerned some data published earlier this month on the Department of Health and Human Services' (HHS) Hospital Compare website doesn't tell the whole story about facilities' performance.

"The tension for hospitals is, shouldn't we wait just a few more months and publish really reliable data?" Foster said. She argued that HHS officials could have waited for more comprehensive data than the Medicare claims data that was published.

One important issue that the data must include is the health of patients, said Foster and another speaker, David Share of Blue Cross Blue Shield of Michigan, because hospitals that treat sicker patients could appear to have lower quality care unless the data are properly adjusted for risks.

In the future, as more federal safety initiatives continue to roll out, some of the differences between patients could become more important. For example, Foster noted that scientists are constantly discovering more information about genetic differences between patients. As more data about how different groups of people respond to medicine becomes available and medicine becomes more personalized, the questions about quality may get more complicated. If the federal government requires hospitals to collect information about the percentage of patients who get a particular medication, and some patients respond well to one type of medication while others respond well to another, the treatment picture will become more complex.

Hospitals also are not always able to control some of the factors that influence whether a patient is readmitted after being discharged, Foster said. Hospitals that care for a large number of low-income patients may see them return to the hospital if they are not able to afford medications or follow treatment protocols that will keep them healthy, she said. "Does that mean that kind of hospital should be penalized?" Foster asked.

The questions about reporting on quality will ramp up in the next couple of years as CMS's efforts accelerate. Regulations involving value-based purchasing, the meaningful use of health information technology, and hospital inpatient quality reporting will affect hospital payments. Two other signature initiatives by the Obama administration—the move toward advanced primary care practices known as medical homes and the integrated care model involving accountable care organizations—also require providers to produce data on quality measures.

Some groups, especially those that pay for coverage of workers, are excited to see the push toward more reporting on patient care.

"The enthusiasm level is just through the roof" among employers and unions who want to get higher-quality care for employees, said Gerry Shea, the assistant to the president of the AFL-CIO. "We have an opportunity to do something here that we've never done before."

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