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June 13, 2007 Public Accountability and Performance Assessment Abounds: National, State, and Hospital ReleasesGiven the heightened focus and attention on quality and pricing transparency, there has been a series of reports released during this week and soon to be released over next few weeks. These reports are coming from a variety of sources and are perceived as credible but most likely confusing to most consumers as the results and rankings for measurements vary for similar types of measurements. It is important to understand some of the methodologies and data bases used in these reports as some reports may carry a title of "2007" but are actually data from 2004 and earlier in light of more current data being publicly available. Hospitals may wish to prepare for any inquiries with more current data available within their organization. Keep in mind that for hospitals using COMPdata, all of the AHRQ Quality and Patient Safety measurements are readily accessible with flexibility to report at measurement or hospital level. Also, the IHA Comparative Performance Initiative with current HQA results is available on COMPdata along with state and national comparisons. Hospital and Other Healthcare Public Releases:
June 21 - Hospital Mortality Rates Methodology These mortality measurements will cover Medicare only patients discharged from July 1, 2005 through June 30, 2006 for all acute care hospitals. The rates include patients that died during the hospital stay as well as 30 days following a hospital stay. Please note that the methodology was endorsed by the National Quality Forum and Hospital Quality Alliance. One of the challenging aspects of the methodology is the difficulty in differentiating palliative care patients that are hospitalized for pain management, end of life care, comfort care, or due to other palliative services available at home or in other healthcare organizations. Expected Report CMS will be having press releases accompanying the reports for the public, as well as displaying the results on the Medicare web site along with methodology background papers. The methodology paper on the mortality rates is about 120 pages and can be found on the Quality Net Exchange web site at: http://www.qualitynet.org/dcs/ContentServer?cid=1163010421830&pagename=QnetPublic%2FPage%2FQnetTier4&c=Page. The report is expected to identify the high performing hospitals, those that fell in the normative range, and those that were below the normative range. Preparing Responses It is helpful to review your own hospital data and be prepared to discuss improvement efforts at your hospital. You may also want to comment on your admission sources for patients, especially if many that fall into the AMI or Heart Failure discharge diagnosis are palliative care patients. It is anticipated that many media will report on these results as they are hospital specific and are some of the first sets of outcome measurements reported in a couple of decades. IHA has already heard from some Chicago media that plan to do stories on the report focusing on Illinois hospitals. June 28 - APIC MRSA Prevalence Study June 13 - Commonwealth Study Illinois ranked overall number 36 among the 50 states plus Washington, D.C., with above average scores in access and equity and average score in quality and healthy lives. The area ranked below average was in the hospital avoidable costs and use which was primarily derived from Medicare administrative data from data sets from 2000 through 2004; some select pediatric data from the Agency for Healthcare Research and Quality (AHRQ); and data from the Behavioral Risk Factor Surveillance System (BRFSS); and 2003 Medicare Re-Admission data. It is important, as with all studies, to review the data sources and time periods. Study Results and Methodology The entire study is publicly available at: http://www.commonwealthfund.org along with all of the methodology and background information. An interactive map with some drill down measurement capabilities is available. The lowest level of analysis is at a state level as the validity and reliability of the results at a hospital specific level have found to be problematic. June 13 - Consumer Guide Rules While the Consumer Guide rules are in their second posting scheduled for adoption, many hospitals are starting to prepare for their adoption. Included in the rules starting January 1, 2008 is the expansion of hospital data reporting to include new elements for all Illinois licensed hospitals, such as Present on Admission code for all inpatient diagnoses; race and ethnicity codes using federal OMB standards (similar to requirements for Joint Commission and Hospital Quality Alliance); 25 diagnoses and 25 procedure codes; E-codes (known as external causes of injury); and several other new codes. In order to prepare hospitals for this reporting, IHA has been conducting training sessions and Webinars for several months and has many more planned through COMPdata. Additionally, Ambulatory Surgical Treatment Centers (ASTC) will also be required to report data on their services. Both hospitals and ASTCs will have their outpatient surgical data released at the same time in the Consumer Guide. Hospital outpatient data will also expand to include observation care and emergency department starting in 2008 with mandatory reporting January 1, 2009. Besides expansion of data is the expected development and release of a Consumer Guide as well as the provision of hospital inpatient data to the public. Next week, IHA will release a detailed memo highlighting all of the changes along with a matrix that details the data reporting requirements and expected public availability of data and the Consumer Guide. IHA will also highlight some upcoming IHA sponsored telephone conference calls on the Consumer Guide developments. Illinois now joins at least 40 other states providing similar data and information to the public on hospital and outpatient services. As many in Illinois will recall, a similar type of function and information had been provided from the late 1980’s to early 2000’s by the Illinois Health Care Cost Containment Council. June 11 - AHRQ Snapshots The information can be found at: http://statesnapshots.ahrq.gov/statesnapshots and one can view state performance on an individual basis or compared to others on specific measurements. The results are also graphically displayed with the use of a meter highlighting performance change. What’s Ahead? Keep in mind that many physicians are also planning on participating in the Physician Quality Reporting Initiative on a voluntary basis starting July 1, 2007. Physicians will have 74 performance measurements to choose to report on to Medicare using CPT-II codes and qualifiers on their claims form. Physicians only need to achieve 80% reporting on at least 3 measurements to receive a 1.5% increase in payment for services reimbursed by Medicare through the last 6 months of calendar year 2007. Similar to hospitals, physicians are starting on a pay for reporting path with the expectation by Medicare that in years to come they too will move to a ‘pay for performance’ approach. The demand for transparency in quality and pricing will only increase over the next few years. Tied to those movements will be the need to expand electronic health records to keep pace with the reporting requirements as well as integration of practice guidelines into the EHR to ensure high levels of compliance with standards of care. IHA will continue to keep you current with all of the public information and impending changes affecting hospitals as well as provide you resources and tools to help navigate through this fast changing environment. | |
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