When hospitals' mortality results were first publicly reported nationally, providers thought it be would be the death of them.
In the 1980s, CMS predecessor HCFA started making hospital mortality rates available to the public. But hospitals complained the data did not reflect the care being delivered because the information wasn't properly risk-adjusted. Studies and journal articles backed up their concerns and the practice ended in the 1990s.
HCFA officials "were trying to do the right thing," said Donna Marshall, executive director of the Colorado Business Group on Health. "But the methodology wasn't quite ready for prime time, and I don't think hospitals were ready for that type of transparency."
Now that quality experts and consumers are pushing for greater transparency, the reporting of mortality rates is likely to become ubiquitous as healthcare embarks on "the new world of performance measuring," said Kenneth Kizer, president and chief executive officer of the National Quality Forum. For example, Colorado last week joined a handful of states-including Texas and New York-to start posting hospital risk-adjusted mortality results on the Internet so consumers can gain insight into the quality of care.
Marshall's group and the Colorado Health and Hospital Association spearheaded the voluntary project. The state adopted the Agency for Healthcare Research and Quality's measures and risk-adjusted formula, called the Inpatient Quality Indicators, which take into account patient severity in determining a hospital's ranking.
Philip Mehler, associate medical director for 266-bed Denver Health Medical Center, said he's happy patients' conditions are being considered but that it's difficult to come up with a perfect system because there are so many factors-such as past medical care-that can contribute to a patient's death. It's more difficult for a hospital to save a heart attack victim if that person is uninsured and hasn't been receiving care compared with an insured patient who has been receiving regular checkups, he said.
The NQF has been working with the CMS to establish national criteria for risk-adjusted mortality results for the three conditions-heart attack, heart failure and pneumonia-Colorado is posting. The NQF hopes to complete the project by October. The initiative is part of the CMS' plan for voluntary public reporting on hospital quality.
Within the next month, Colorado will also post mortality results for three other conditions-stroke, hip fracture and bleeding within the stomach-along with patients who underwent a specific procedure such as hip replacement or heart bypass, said Larry Wall, president of the state hospital association. Also to be released are volume measures that gauge whether outcomes improve when a hospital performs a procedure more frequently.
Colorado, which launched the hospital quality.org site on April 4, wanted the project's unveiling to coincide with the CMS' Hospital Compare Web site. The CMS site is different in that it compares hospitals based on 17 process measures but not on mortality (April 4, p. 4).
Last week the AHRQ released aggregated state data on how providers are delivering healthcare. An example of one of their measures is "percent of women age 40 and over who report they had a mammogram within the past two years."