The Cleveland Health Quality Choice Program, once touted as a national model for hospital report cards, is in jeopardy after a major provider withdrew.
The Cleveland Clinic Health System said it will no longer submit data. Nine of its 10 hospitals participated, representing one-third of program hospitals.
John Clough, M.D., director of health affairs for the Cleveland Clinic, said the data aren't being widely used.
"Our attitude is, we can put this $2 million to better use," Clough said, referring to his system's annual expense for collecting data and paying the not-for-profit firm that assembles the reports.
No time like the present, perhaps. On Friday, Moody's Investors Service reversed its outlook from positive to negative on $630 million of debt held by the clinic, reflecting the system's $13.3 million operating loss for the first nine months of 1998. Moody's attributes the troubles to increased costs related to the system's integration strategies, reduced federal revenues and increased managed-care pressures. The system is rated Aa3.
Patrick Casey, executive director of the Health Action Council of Northeast Ohio, a purchasing coalition of 90 employers, said the clinic's pullout from the quality program "severely damages" the value of the semiannual report cards. The latest is scheduled to be issued in May.
Program President Dwain Harper, D.O., said the coalition of provider and employer organizations that sponsors the program will decide whether to continue it. He disputed the clinic's claim that the data aren't being used, saying they have influenced hospital market share and been a basis for quality improvement.
The program was the first voluntary hospital report card system established by a coalition of physicians, hospitals and employers, Harper said. It was touted as a model for employer and provider cooperation when launched in the early 1990s.
But it has yet to add long-promised data pertaining to costs, the quality of outpatient care and extended outcomes. According to Clough, hospitals feared they would be "crucified" in the press if measures were expanded.
Clough said the study tracks outcomes-mortality and length of stay-that are not useful to most consumers. "It's our impression that the public doesn't use the data and probably doesn't understand the data," Clough said. "It seems to me this was a worthy project that failed."
The data are not used by insurers and employers, who make their own data requests to hospitals, or by hospitals themselves, Clough said. The clinic has established a quality institute to measure its outcomes against national benchmarks.
Clough also questioned why employers don't fund the report cards, if they find them useful. Although employers provided some of the start-up costs, hospitals fund ongoing operations.
"Could we improve the data? Yes, no question," Casey said. "But that depends on the participants being willing to do that, and at the present time it doesn't look like they are."
Harper said coalition members, including hospital and physician associations, agreed to extend outcomes measures last fall. Employers have given more than $100,000 to fund the effort, he said.
Casey said the public is "entitled to some accountability." The council has threatened to pursue legislation to mandate quality reporting. Legislation passed in 1995 requires the Ohio Department of Health to collect and report quality data, said Mary Yost, a spokeswoman for the OHA: The Association for Hospitals and Health Systems. However, there is no time line for implementation, she said.
Employers could drop the Cleveland Clinic from coverage, said Casey, but that would be an extraordinary step because the system commands 40% of inpatient beds in the market.
Local hospital and physician associations said they remain committed to quality measures in some form. "Clearly, we have to make changes," said Sally Domm, spokeswoman for the Center for Health Affairs, which represents Cleveland-area hospitals. `'It's premature to know what those changes are."