The federal government's threat last week to create its own hospital-performance reporting system if private-sector initiatives stall became more than political rhetoric as the American Hospital Association fought a popular proposal that would track hospitals' medical errors, Modern Healthcare has learned.
Centers for Medicare and Medicaid Services Administrator Thomas Scully last week told the National Quality Forum, a group charged with establishing the national health quality agenda, to move quickly in setting up a hospital performance reporting system for consumers or he would do it for them.
But earlier, the AHA was part of a small minority that voted against the forum's effort to have hospitals report serious medical errors, or "never events," to state-run databases. The forum's proposal, first unveiled as a draft this spring, includes a list of 27 incidents, such as patient deaths from contaminated drugs and operations on the wrong parts of the body, that hospitals would have to report to the state.
Despite the AHA's no vote, the forum's board of directors approved its "never events" list last week.
While speaking at the forum's annual meeting on Sept. 6, Scully said he was frustrated that a set of standardized hospital quality indicators has not been adopted by the industry, despite ongoing projects by the Joint Commission on Accreditation of Healthcare Organizations, Premier and others. Scully said he didn't see "two degrees of difference" in any of these systems being developed by the various groups.
"Consumers want this information now, and there is no reason not to give it to them," Scully said.
The JCAHO recently delayed implementation of its hospital outcomes measurement system, called Oryx, from January 2002 until July 2002 because of pressure from state hospital association representatives. Premier's database, which tracks indicators such as aspirin use during hospitalization after a heart attack for more than 530 of its member hospitals, is not available to the public.
Scully said HHS Secretary Tommy Thompson wants the forum to select a standardized set of clinical indicators for hospitals "as fast as you possibly can."
"If at some point, if it doesn't get done, I think it is our responsibility as regulators to just pull the trigger and pick one," said Scully, who declined to set a specific time frame for when the CMS would act.
The National Quality Forum is a private, not-for-profit organization established by President Clinton in 1999 to set a national agenda for healthcare quality. Its 150 members include healthcare consumers, purchasers, government officials and provider organizations. Because of its legal standing and structure, the forum's recommendations can be quickly adopted by the government.
But the AHA refused to go along with the forum's first effort at offering a consensus product. The hospital association was one of only four out of more than 120 members to oppose the "never events" report last month.
Other members to vote against the report were the Alliance of Independent Academic Medical Centers, the Virginia Hospital Research and Education Foundation, and Loyola University Health System-Center for Clinical Effectiveness.
By approving the "never events" report, the forum is now able to offer its consensus-approved guidelines to government agencies.
In a letter, AHA Executive Vice President Richard Pollack wrote to the forum's President and Chief Executive Officer Kenneth Kizer, M.D., that the AHA is "concerned with the `accountability' approach" outlined in the "never events" report.
The AHA doesn't see itself as obstructing the forum's efforts, said Anne Berdahl, the association's senior associate director of health policy development.
"This simply was a vote that said this report isn't likely to significantly advance patient safety," Berdahl said.
The forum is developing a set of hospital performance measures that Kizer expects to have ready for use by early 2002.