What's next on the patient safety front now that the Food and Drug Administration has buttoned up its bar-code regulations?
Kenneth Kizer, president and chief executive officer of the National Quality Forum, predicted public reporting on hospital performance measures would increasingly consume the national agenda.
"I think the whole issue of reporting and how much and who will be reporting is something we are going to sequentially work through over the next months and years," Kizer said. "Ultimately, public performance reporting will be the norm."
Kizer said the National Quality Forum would soon be looking at the feasibility of a mandatory reporting system, a last request of former CMS Administrator Tom Scully as he headed out the door for the private sector. Details are still to be worked out as the CMS regroups under new leadership, but Kizer said the CMS still wants the National Quality Forum to attack the fundamental question-whether the CMS should mandate that hospitals report their performance results. In the months before his departure, Scully waffled on the issue. In February 2003, he said a patient satisfaction survey would become a condition of Medicare participation, but by June, the initiative had been quietly converted into a voluntary initiative (July 7, 2003, p. 4). Eventually the Medicare reform package linked hospital participation to higher Medicare reimbursements.
Some people question why nursing homes are required to make their performance report cards publicly available but hospitals are not, Kizer said. "I think it's a good question, but whether it becomes a matter of public policy warrants a thoughtful debate," he said.
Performance measures for physicians are also on the agenda. The National Quality Forum soon will be recommending ways to evaluate doctors' performance with the support of a Robert Wood Johnson Foundation grant, Kizer said. "From consumers and purchasers' perspective, they feel there is a compelling argument (for evaluating physicians) and I feel CMS somehow will be involved in that. I don't see how they can't be involved in that," Kizer said.
Pay for performance will no doubt be linked to performance measures now that "the philosophical divide has been crossed" by the CMS pay-for-performance demonstration project with hospital alliance Premier, Kizer said (June 30, 2003, p. 6). "The question in my mind is not whether payment will be linked to performance, but it's the details," he said.
Finally, Kizer said he wondered if standardized safe practices-the National Quality Forum has so far endorsed 30 wide-ranging standards for hospital care-would become a condition of participation in Medicare. "Everyone agrees it should be done, but is that something we hope everybody does or in fact something that the government requires?" Kizer said. "When it comes to safety and saving lives, we certainly seem to like that in other industries. Should we have a lesser standard when taking care of patients?"