The American Hospital Association last week gathered seven competing patient-survey firms to solicit their comment on a standard survey that the Centers for Medicare and Medicaid Services recently decided hospitals should administer voluntarily rather than as a condition of Medicare participation.
AHA President Richard Davidson invited the vendors to the association's Washington office, where they discussed how to proceed with the survey that at the urging of the hospital industry has been folded into a voluntary quality initiative run by several healthcare associations (July 7, p. 4).
"It was a cordial and open and frank discussion," said Melvin Hall, chief executive officer of the South Bend, Ind.-based survey firm Press Ganey Associates, one of the seven firms present (See box). Also present was a representative of the Gallup Organization, which sued the CMS and its administrator, Tom Scully, over his alleged preference for certain vendors. Scully has denied those allegations.
Participants in last week's meeting focused on how to develop a survey that improves healthcare quality without adding new cost, Hall said. Others said the companies gathered to develop comments that the AHA will aggregate and send to the CMS in response to a June 27 Federal Register notice calling for industry guidance on the survey. The deadline for public comment on the notice is July 28.
By the end of the two-hour meeting, vendors had at least preliminarily agreed that the questions submitted to patients should gauge their opinion of nursing care, physician care, pain management, patient safety, willingness to recommend the hospital, coordination of care, communication and overall satisfaction.
More specific conclusions-such as how to word each question and how to administer the surveys-were not reached, sources said.
The AHA did not invite anyone from the CMS to attend the meeting, even though the agency is a partner in the industry quality initiative, launched last December, through which hospitals are asked to make voluntary efforts to measure and publicly report clinical quality (Dec. 16, 2002, p. 8).
At deadline, CMS officials had not responded to requests for comment.
"It would not have been very smart to have CMS in the room," said Richard Wade, senior vice president of communications for the AHA, which was part of a lobbying trio that helped persuade Scully not to make the surveys mandatory. In addition, Wade said, it would be a violation of federal rulemaking laws to have a CMS representative present at a meeting where public comments were being discussed.
All vendors but one, Lincoln, Neb.-based National Research Corp., also known as NRC/Picker, said the survey patients fill out should be no more than eight questions.
NRC/Picker President Mike Hays argued for a longer survey, sources said. Hays was not available for comment at deadline.
"Every research vendor except NRC stated that the shorter the better, especially from a consumer perspective," said Tom Hutchinson, who attended the meeting and is senior vice president of the Jackson Organization, a survey firm that serves some 400 healthcare clients.
The draft survey first issued by the Agency for Healthcare Research and Quality in February includes 68 questions, which is "far too long and far too detailed to accomplish what it wants to," Wade said.
Representatives from the Federation of American Hospitals and the Association of American Medical Colleges, which aided in the lobbying effort to scrap the mandatory plan, also joined last week's meeting.
Bringing together competing survey firms in a closed-door meeting does not represent a potential antitrust violation if the purpose of the meeting is to petition the government, said William Kopit, a healthcare antitrust lawyer in Epstein Becker & Green's Washington office.
"Coordinating comments would not be problematic," Kopit said.
Meeting participants contacted by Modern Healthcare said vendors agreed that the final survey should be one hospitals can easily incorporate into their own survey with no disruption to everyday operations.
After talking the CMS out of its mandatory proposal, the hospital lobbies are counting on high hospital participation in their voluntary program to stave off another push by the CMS to make measuring patient satisfaction a requirement of Medicare participation.