A public-private reporting initiative on hospital quality intends to unveil as early as this week a major expansion that will more than double the number of clinical best-practice measures for which participating hospitals will be held accountable.
The new reporting requirements generally broaden the scope of testing and intervention expected of hospitals in treating heart attacks, heart failure and pneumonia, the three conditions targeted when the CMS and several hospital associations launched the voluntary initiative 15 months ago with a "starter set" of 10 measures (Dec. 16, 2002, p. 8).
In addition, hospitals also will be responsible for adhering to three proven practices for managing antibiotics to prevent surgical infections. In all, the program will report hospital performance on 22 quality measures by May 2005, according to a CMS spokesman.
The impending expansion came amid calls last week in Congress for the hospital industry to pick up the pace of reporting beyond the original set of measures.
In a House Ways and Means Committee hearing on healthcare quality last week, Rep. Jim McCrery (R-La.) asked Carolyn Clancy, director of the Agency for Healthcare Research and Quality, when HHS plans to add measures beyond the 10 now in the voluntary reporting initiative, arguing it is "important to expand the 10 indicators to less well-established conditions."
Clancy said HHS "absolutely" intends to build on the initial 10 measures, which represent only a first step. HHS' approach, she told the congressional panel, is an incremental one that will soon involve town hall meetings around the country to educate healthcare providers about the measures.
The American Hospital Association declined to disclose the specifics of the expansion prior to a formal announcement. But Modern Healthcare learned that most of the additional measures already are required by the Joint Commission on Accreditation of Healthcare Organizations as part of its Oryx program, which documents clinical performance for use in accreditation.
The JCAHO worked with the CMS to match its slate of Oryx measures with those compiled by the federal government and promoted by Medicare quality improvement organizations, said Jerod Loeb, JCAHO's executive vice president of research.
The CMS-backed measures served as performance guideposts for hospitals independent of the reporting initiative, said Todd Ketch, vice president of government affairs for the American Health Quality Association, a trade group for quality improvement organizations.
"Any hospital that's treating (for example) a heart attack patient should be doing these things," Ketch said. The national hospital reporting program's plan for expansion will fold the rest of the acknowledged elements of good care into the mix and round out what's currently an incomplete assessment, he said.
Though the initiative broke new ground by reaching consensus on measures of quality and enabling hospital-specific comparisons, it left out at least half the total number of quality indicators that work as a package to afford a complete picture of how hospitals respond to acute heart problems and severe pneumonia, Loeb said. "The measures were created in sets for a good reason," he said.
For example, remembering to give aspirin and beta-blocker drugs at arrival and prescribe them at discharge are important actions in treating patients for a heart attack-all were included in the original set of hospital reporting measures. But also crucial to quality care are actions to administer clot-busting drugs or primary angioplasty within a short time after a patient gets to a hospital. Those actions are among the additions to the hospital reporting program, Modern Healthcare has learned.
Another measure to be added assesses how often hospitals provide detailed discharge instructions for heart failure patients and their families. Two existing measures assess how often patients are tested for inadequate heart pumping and receive drugs called ACE inhibitors. But experts say the chronic disease has to be well understood and managed outside the hospital to avoid new emergencies.
Three of the new measures, where applicable, require advising patients recovering from episodes of heart attack, heart failure and pneumonia to quit smoking.
-with Jeff Tieman