Our nation's healthcare system is moving inexorably toward greater openness, transparency and accountability. This movement is in part a response to the demands of patients, payers, legislators and regulators, and in part reflects a growing recognition among healthcare providers that promoting these values in the healthcare system is critical to fulfilling their missions. We operate in an environment characterized by rising costs, increasingly limited public resources, a growing uninsured population and intense private efforts to control healthcare costs. There is also a growing awareness of lapses in the quality of health services, reflected, for example, in the broad impact of the Institute of Medicine's 1999 report that as many as 98,000 Americans die annually as a result of preventable medical errors in hospitals.
As never before, healthcare providers are under scrutiny. As never before, we are being asked to justify the prices we charge, explain the medical outcomes we achieve and demonstrate the benefits we bring to the communities we serve. To name but a few examples:
The Centers for Medicare and Medicaid Services last November released quality-of-care information on nearly 17,000 nursing homes as part of its Nursing Home Quality Initiative. This information is available to the public on the CMS Web site, cms.gov.
In January, Kaiser Permanente settled lawsuits brought by consumer groups by agreeing to post on its Web site the clinical guidelines used by its personnel in treating patients. Kaiser also agreed to post information on its physician compensation structure.
In 2002, the CMS initiated an effort to create a national standard for measuring patient satisfaction with hospital care.
The Leapfrog Group, a consortium of private and public healthcare purchasers formed in response to the IOM report, is engaged in a focused campaign to improve hospital safety.
As this list of initiatives indicates, the movement to greater accountability and openness also is fueled and facilitated by the widespread availability of technology that allows ease of access to large amounts of information over the Internet. The democratization of all types of information is well-advanced and expectations for the healthcare system as a "content provider" are growing.
The provider community has not been idle. The American Hospital Association, the Federation of American Hospitals and the Association of American Medical Colleges have joined the CMS and other organizations in a public-private collaboration to develop evidence-based, standardized hospital quality measures. The Catholic Health Association has a continuing commitment to promoting transparency and community accountability. This commitment arises from our concept of healthcare as a service that is both the end and the means of our mission. As we serve, we engage with people in their most vulnerable moments and they rely on us to put their interests first. The relationship is, in essence, a covenant based on trust that requires honesty, openness and reciprocity by both parties.
It is this view of healthcare service as a covenant with patients and communities that led us, more than a decade ago, to publish the Social Accountability Budget: A Process for Reporting Community Service in a Time of Fiscal Restraint. This document provides a set of tools to help healthcare leaders examine and demonstrate institutional commitment to serving the community. It has been used by many institutions, both Catholic and other not-for-profit healthcare providers, to inventory community services provided, identify gaps in those services, and report to their communities on their programs and services.
In 2001, we updated and expanded this document as the Community Benefit Program: A Revised Resource for Social Accountability. This new volume addresses issues such as improving community health, calculating the value of community benefit as well as the cost and evaluating community benefit activities. In 2002, with the help of VHA, Premier and the Alliance of Community Health Plans, CHA issued a companion version for use by other than Catholic institutions. Our experience has been that both healthcare institutions and the communities they serve are enhanced by this kind of self-examination and give-and-take.
The CHA also believes that being accountable includes making basic information about a healthcare institution available to the public. For us that means, among other things, posting on our Web site our annual 990 report filed with the Internal Revenue Service rather than simply fulfilling individual requests for copies, as required by law (See special report, p. 28). We encourage our members to do the same.
Every participant in the healthcare system should be accountable to their communities, but accountability depends on the availability of accurate information presented fairly and intelligibly. Data collection and reporting standards must be reasonable and reflect the realities of delivering healthcare. Performance data must be carefully collected and comparisons should take into account differences among the composition of patient populations served. Comparisons should be based on standardized concepts and terminology to ensure accuracy and full understanding by all users of the data.
We as leaders in that system have an obligation to encourage the development of responsible and reliable programs and methods for demonstrating accountability to the communities we serve so that we can strengthen the bonds of trust that are essential to the well-being of our nation's healthcare system.
The Rev. Michael Place is president and chief executive officer of the Catholic Health Association, St. Louis.