A move to have the federal government standardize and oversee quality improvement initiatives has some health policy executives questioning the long-run viability of programs already in existence. With one streamlined organization to report to, the reasoning goes, how many overworked and underfunded hospital quality managers would continue to send their data to scores of other programs?
The answer, hospital managers said, is not many.
To be certain, most healthcare executives lauded the recommendations from the Institute of Medicine's Dec. 1 release of Performance Measurement: Accelerating Improvement, which in part called for HHS to oversee a national set of performance measures that would lay the groundwork for pay-for-performance programs (Dec. 5, p. 8). The IOM also recommended that HHS develop a National Quality Coordination Board, which would create and routinely tweak a set of standardized performance measures.
But the praise comes with a catch. Quietly, some healthcare associations said they are concerned about their current roles in the quality improvement movement, adding that if the federal government steps up its position as performance measurement gatekeepers, their roles would be diminished.
"Upping the Ante" is a recently published report in the Journal of the American Medical Association which says that hospital patient safety is not yet meeting IOM expectations (See story, p. 10).
Kenneth Kizer, the recently departed chief executive officer at the National Quality Forum, said he is split on what effect the report may have on his group's future; the NQF has positioned itself as a leader in performance improvement.
"Basically, the report is a good news story for the forum," Kizer said. "It certainly underscores the need to continue to focus on healthcare improvements and to have resources to support a comprehensive system. Most of this is something I have been saying for years."
Still, if the IOM's recommendations are accepted, the NQF and other organizations that collect, analyze and otherwise share data on any number of quality measures, will find themselves in a position where a government-run program could take away from some of the work they have been doing.
At this point, he said, it's too early to predict what impact the recommendations would have, but concedes that the IOM carries substantial political clout. "If the forum isn't needed, then great," Kizer said. "We did our shtick and we'll move forward. There's no use keeping it around unless it serves some function."
For the most part, hospitals rely on a team of performance improvement staff to cull measures on everything from community-acquired pneumonia to acute myocardial infarction. Once collected, the hospital has a vendor send that data to any number of organizations that seek it. It's a costly and cumbersome project, said Joseph Cacchione, senior vice president at St. Vincent Health System in Erie, Pa.
For instance, St. Vincent sends its data to more than 20 different agencies, such as the Joint Commission on Accreditation of Healthcare Organizations and the CMS, as well as a number of ratings agencies such as HealthGrades. By his estimate, Cacchione said that up to $1 million is budgeted annually to handle the process.
The more the data collection process can be streamlined, the better, he said. "I think in theory it would be a good idea if it would become the surrogate for all data and quality measures," Cacchione said. "What I fear though, in keeping with the federal government, it would be another parallel database that would require additional resources."
David Schulke, executive vice president of the American Health Quality Association, which oversees U.S. quality improvement organizations, said he sympathizes with hospitals when it comes to the myriad reporting agencies. Still, many of those groups are likely to survive even if the government takes over, he predicted.
Schulke said that as is, with hospitals reporting to a lot of different groups on close-but-not-identical measures, the quality management departments have become overtaxed.
But Kizer and others say they are skeptical that anything tangible will come from the recommendations. The culture and political climate is one that is not likely to cede this to the federal government, he said.
Carolyn Clancy, director of the Agency for Healthcare Research and Quality and a member of the IOM committee, said she sees a vital role for those outside organizations that collect and tally performance data. "I don't see the work they are doing going away," she said.