Voluntary, but all aboard
Todd Sloane's June 30 editorial, "No volunteers, please" (p. 19), attempts to make the case that voluntary reporting of hospital performance information can't possibly succeed and that the only answer to the public's need for quality information is more government regulation. That's a premise with which, at least for now, even the government doesn't agree.
The major voluntary effort he criticizes, but never directly names, is the Quality Initiative, a new national movement to build a source of public information on hospital quality and performance. It is an extraordinary approach. Hospitals, the government, accreditors, consumer groups and others are working together to provide information on healthcare quality to the public and to give hospitals tools to enhance the quality of what they do.
The American Hospital Association, the Association of American Medical Colleges and the Federation of American Hospitals, as Sloane correctly points out, are spearheading the initiative. But it is, in fact, a public-private partnership involving government-the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality-along with the National Quality Forum and the Joint Commission on Accreditation of Healthcare Organizations. It has been endorsed publicly by the AARP, the AFL-CIO and consumer organizations, among others. Every one of them, including the government, believes a voluntary national movement toward quality reporting is a better, stronger alternative to more government regulation. Why?
First, all parties have a genuine stake in the initiative's success. This is not one more regulatory burden facing the nation's hospitals. It's a proactive effort to get agreement across the field on something that to date there has been little agreement on: what measures of hospital quality are valid and useful to patients and families and how they should be made public.
Second, because the Quality Initiative is not a creature of the regulatory process, which is often slow and cumbersome, more information can be made available to the public more quickly. Furthermore, it will be based on data about the care of all patients a hospital treats, not just those insured by Medicare. The initiative will be national in scope-a first-and it will not be commercial. No one will profit from it.
The goal is to create an open and available public resource to be expanded over time based on the best available science and data and to provide information that patients and families can use when making choices about medical care. The information first will be pilot-tested on a CMS Web site this fall and will look at how hospitals treat pneumonia and heart conditions. When the information has been tested for clarity and accuracy, it will be moved to a consumer-oriented Web site and will be widely publicized. Soon, information will be added based on surveys of patients about their experiences with hospital care. More clinical indicators will be added using a public process involving all of the public-private partners.
The Quality Initiative was announced in December 2002. Voluntary participation opened on May 5 of this year and since then nearly 25% of hospitals have signed on. And we know that thousands more are doing the internal reviews and consultations with their medical staffs and others that are needed to underpin their participation.
Hospitals have made a long-term, public commitment to the success of this effort. If the Quality Initiative fails, a regulatory approach surely will follow. What's at stake is a new era of public accountability and quality measurement to be achieved not because of a government mandate, but because it's right for patients, families and the public. Modern Healthcare should be applauding this effort.
American Hospital Association
Association of American Medical Colleges
Federation of American Hospitals
Your article, "Triage for the ER" (June 23, p. 65), references a national standard of one bed for every 2,000 emergency room patients. This relates directly to research I am doing on ER capacity in Massachusetts. If you could please let me know where you obtained this standard, I would be very grateful.
Division of Health Care Finance and Policy
State of Massachusetts
Editor?s note: According to Richard Dellerson, administrative director of emergency services at Miami Children?s Hospital, the standard of one bed per 2,000 visits is set out in an American College of Emergency Physicians publication titled Emergency Department Design published in 1993. Dellerson points out that this is an estimate and may not hold true for all types of ERs.