The National Quality Forums annual meeting held in Washington late last month didnt have a particular theme, but it could have been: the healthcare industry is making progress, but its not there yet. Or, the more things change, the more they stay the same.
Many high-level quality officials, government and insurance representatives and healthcare practitioners gathered in Washington for the membership meeting and policy conference. Many of them spoke eloquently on the need for better standards, improved performance measurements and financial incentives that award high performers. These initiatives are hardly new, and they are generally accepted by the healthcare community to be worthy, if still unattainable goals.
One speaker offered a unique method of success along the American journey of leaner, better healthcareto move down the path, leaders have to slay four dragons, said Arnold Milstein, medical director of the Pacific Business Group on Health and chief physician at Mercer Health & Benefits.
The dragons to overcome are transparency, performance sensitivity, clinical engineering and sustainable reliability, according to Milstein, who gave the opening keynote address during the Sept. 26-28 conference.
The key to all four issues is to improve the capturing of efficiency, he said.
But capturing efficiency in a system that awards inefficiencyreimbursement largely is paid on a complaint-by-complaint basis, so when a patient returns for care from a condition that was already treated, the hospital is paid againis one of the bigger issues that in itself could seem dragonish. CMS will solve the problem its own way when a new reimbursement policy that does not pay for conditions acquired after hospital admittance goes into effect.
Not to mention the number of standards and measurements that are touted by several different groupsthe CMS, for one, and the NQF has its 200 endorsed standards as well. Other organizations such as Leapfrog Group and the Institute for Healthcare Improvement follow those standards as well as ones developed by the Agency for Healthcare Research and Quality.
Speakers pointed to the need to harmonize these standards so hospitals had one set of evidence-based measurements on which to support outcomes.
There are a number of programs under way by various stakeholders attempting to create local communities that promote a set of standards, the adoption of healthcare information technology and rewards/incentives programs. Building a network of networks, will ensure the best data is used to measure quality in systems that talk to each other and information is exchanged easily and securely, said John Loonsk, director of the interoperability and standards office in the Office of the National Coordinator for Health Information Technology. ONCHIT is involved with efforts to improve the health IT systems certification process with the integration of performance measures into electronic health records.
All the drivers seem ultimately to lead to the patients. Most of the standards and performance measures are to be evidence-based and publicly reported so consumers can make informed healthcare decisions and choose one hospital over another for heart care or see a particular specialist because of higher scores. The conference speakers said this type of value-based healthcare will increase quality and safety of care while lowering costs.
This sounds good, except consumers dont seem to mind inaccuracies or variations in reports. Milstein pointed to one 2007 study that asked consumers whether they would tolerate errors in healthcare public reportingroughly one-third of respondents said they would tolerate reports that were up to 50% inaccurate.
Reports variations are not limited to the healthcare industry. Validity is hardly an issue for people choosing restaurants: the rating guide Zagat might give a location four stars while the Michelin Guide dismisses its cuisine. And chefs, like physicians, might wonder how the research was conducted to produce the variation in the number of stars awarded.
That doesnt stop people from dining out: We are quite tolerant of inaccuracy in other industries, Milstein said.
Whatever the goal iscreating accurate reports, increasing consumer awareness, creating more efficient careconference speakers were enthusiastic that the healthcare industry is moving forward even if achievements are slow in coming.
Milstein, however, urged participants to move a little faster in that regard.
At the rate the healthcare industry is spending money and costs increase only Bill Gates will be able to afford healthcare in the United States; and eventually, his resources will run out as well, Milstein said.
Jean DerGurahian, based in Chicago, covers quality and patient safety issues. She can be reached at [email protected].