With only 10% of the acute-care hospitals in the country reporting quality-of-care data in the first stage of a massive industrywide initiative, CMS Administrator Tom Scully threatened last week to make the process mandatory if participation in the effort does not increase, and quickly.
Even as consumer groups, industry executives and labor unions praised the effort, known as the National Voluntary Hospital Reporting Initiative, the scant participation level provided more fodder for those skeptical of a voluntary quality program.
Last week, the healthcare industry gathered to share the first results from the initiative, launched last December by the American Hospital Association, the Association of American Medical Colleges and the Federation of American Hospitals (Dec. 16, 2002, p. 8). Only 415 of about 4,100 acute-care hospitals nationwide reported data, prompting Scully to say, "We are extremely disappointed at the level of participation by hospitals so far ... unless participation increases significantly and soon, we will have to consider Plan B." The statement was posted on the CMS' Web site, cms.hhs.gov.
A call to the CMS seeking comment from Scully was not returned by deadline.
At the news conference, CMS officials said they had no target figure, but that 415 hospitals was clearly less than had been hoped for. If the numbers don't go up, Scully said he would talk with HHS Secretary Tommy Thompson about making the report mandatory. Last year, the CMS started requiring nursing homes that participate in Medicare to submit quality information, posting the data on its Web site beginning November 2002.
The CMS also is publishing the voluntary hospital quality information on its Web site for use by providers and consumers.
When the initiative was first made public, hospital industry officials said hospitals were lining up to participate and that many hospitals already were collecting quality information as part of their accreditation by the Joint Commission on Accreditation of Healthcare Organizations.
But voluntary reporting of healthcare data has had a mixed history of participation, raising questions about the usefulness of such information to consumers and providers. Most recently, in June just half of California's hospitals participated in the Patients' Evaluation of Performance in California, a voluntary survey of inpatient experiences (June 23, p. 6).
"When you have (a voluntary system), it becomes self-selective, and when it's self-selective, you tend to get good numbers and the public then assumes all hospitals do well," said Charles Inlander, president of the People's Medical Society, an Allentown, Pa.-based consumer group.
In a written statement, John Rother, the AARP's director of policy and strategy, also expressed concern about the voluntary nature of the initiative.
"If voluntary efforts do not achieve full participation then other steps will need to be taken to ensure that consumers have access to the comprehensive quality data they need and deserve," Rother said.
Participants at last week's news conference, however, tried to downplay the lack of participants, saying that though only 415 hospitals reported at least one measure, 1,238 hospitals originally pledged to take part in the first round of data collection but missed the mid-July deadline for submitting data.
According to Nancy Foster, senior associate director of policy at the AHA, 1,700 hospitals currently have agreed to submit data, representing about 43% of all acute-care beds in the country and 46% of all admissions.
Richard Davidson, president of the AHA, called Scully's criticism surprising and disappointing, and pointed to the scope and novelty of the effort.
"The quality initiative is a first-of-its kind collaboration between hospitals, government, accreditors, consumer groups and others. All involved knew the task would not be easy, but we continue to believe that this approach better serves the public in the long run," he said in a written statement.
Representatives of the hospital industry said they are continuing recruiting efforts to get more participants. Barbara Paul, director of the quality measurement and health assessment group at the CMS, said the organization would make staff members in its regional offices available to help more hospitals get involved as well.
The first round of information, published on cms.hhs.gov/quality/hospital, looks at how hospitals fared in 10 quality measures in three categories-heart attacks, heart failure and pneumonia. The next round of information will be released in February 2004 when information from more hospitals will be posted. The deadline for hospitals to report their data is Nov. 15.