Healthcare quality may be set to take a quantum leap forward in the coming years, with important benefits for patients and for those providers that focus on outcomes and reducing medical errors.
The Centers for Medicare and Medicaid Services, employer groups and even many providers are behind this change, which can be derailed only by one simple word: voluntary.
As we report in this week's cover story, the CMS and Premier are rolling out a three-year demonstration project to use enhanced reimbursement to reward hospitals that take better care of patients. Hospitals are evaluated on a number of high-volume clinical areas such as heart attack, heart failure and stroke, and rankings will be made public. If the program is a success it may go national, though we can expect push-back from hospital groups through Congress.
Already, private payers and employers are taking advantage of whatever quality information they can get their hands on. If the CMS program works, expect private payers to jump on board, reimbursing at a higher rate or maybe choosing not to do business with hospitals that fail to measure up.
As we have been reporting in another ongoing story, the CMS also is developing a standardized survey that will look at eight dimensions of patient-centered care that reflect the entire hospital experience. Hospitals in Arizona, Maryland and New York are taking part in a pilot study of the survey, which eventually will be national and mandatory, a condition of Medicare participation.
And, as we also have been reporting, the voluntary Patients' Evaluation of Performance in California survey is getting a higher rate of response, with half of the state's hospitals reporting their numbers. In the program, patients rate their care on their entire hospital experience and scores are made public to help consumers and to encourage underperforming hospitals to improve.
But there is that word, voluntary. If we have learned anything about healthcare quality, it is that voluntary reporting is ineffective and misleading. Study after study has shown that unless a program is mandatory, hospitals that don't fare well one year are unlikely to participate the next. Hospitals in competitive markets where someone else doesn't report don't want to risk a low ranking even if they are doing a better job of taking care of patients. After all, nobody can prove the nonreporting competitor isn't doing better.
A number of states have passed laws mandating reporting on quality and/or patient satisfaction, the result being that hospitals not atop the rankings scramble to discover why and correct their mistakes. Hospitals are acutely aware of their place on state, regional and national rankings.
The major hospital associations, which have fought mandatory reporting at every turn, have a voluntary reporting program that looks at 10 quality indicators. The program has just officially rolled out, but it has been in the works since at least last year. Makes you wonder why 80% of hospitals haven't jumped on board the main industry response to all this external pressure for quality data.
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Please join us again in congratulating our entire 26-member editorial staff, this time for winning four editorial awards from the American Society of Business Publication Editors. Modern Healthcare received three awards in the Midwest regional ASBPE competition: a Gold Award for news section (Week in Healthcare, June 24, 2002); a Gold Award for front cover of a special supplement (Sept. 30, 2002, "100 Top Hospitals" supplement); and a Silver Award for signed editorials ("Understanding too well," Jan. 21, 2002, and "Out with a whimper," July 29, 2002). We also received a Silver Award in the national ASBPE competition for the same editorials. Just four more reasons why senior healthcare executives read Modern Healthcare.