Hospital Public Reporting &[insert your name]

an Overview

Arizona’s Hospital Public Reporting Pilot

and the

National Voluntary Hospital Reporting Initiative

Public Reporting is Not New

• At least 36 Web sites provide hospital information—some sites charge the viewer

• Several states mandate public reporting, to a greater or lesser extent

• CMS began public reporting with a three state pilot

What is New?• Public reporting sponsored by government and other

prestigious stakeholders– Centers for Medicare & Medicaid Services (CMS)

– American Hospital Association (AHA)

– Federation of American Hospitals (FAH)

– JCAHO

– National Quality Forum (NQF)

– AARP

– AFL-CIO

Three State Pilot

• Began November 2002

• Involves 325 hospitals from Arizona, Maryland, and New York

• Maryland and, to a lesser extent, New York have mandated public reporting in place

Arizona’s Uniqueness

• Unlike other non-mandated states, Arizona has a high proportion of hospitals participating (47 hospitals—70%)

• Hospitals actively participate in monthly meetings, provide feedback, offer suggestions, and support one another

The National Voluntary Hospital Reporting Initiative

(NVHRI)

• Program began December 2002

• Supported by the AHA, AAMC, and CMS

• Data reports are the same for NVHRI and the three state pilot

Why Now?

This is CMS’s answer:

• Stimulate QI activities

• Provide patients with information to assist them in making health care decisions

• “Hospitals should be leaders in sharing information with the public they serve”

April 2003, Recruitment Letter signed by CMS, AHA and AAMC

First Step

• Data publicly posted 10/9/2003

• Posted to the CMS Web site for health care professionals (www.cms.hhs.gov)

• 47 hospitals from Arizona are represented

• 415 hospitals, nationally, have data posted

1,238 (30%) volunteered

415 (10%) submitted data for Oct. 9

47 (70%) volunteered

27 (40%) submitted data for Oct. 9

Of 4,143 U.S. Hospitals

Of 69 AZ Hospitals

Hospital Participation

• Data is fragmentary

• Data validation is minimal

• Data is difficult to compare• First posting is JCAHO hospitals only

• Limited indicators

Interpretation is Complex

Data is Fragmentary

• 47 Arizona hospitals participate

• Low participation by non-mandated states– New Mexico, 7 hospitals submitted data (18%)– Alabama, 2 hospitals submitted data (16%)– Minnesota, 9 hospitals submitted data (10%) – California, 74 hospitals submitted data (20%)

States that Mandate Reporting

– Connecticut, 31 out of 32 reported (97%)

– Maryland, 48 out of 49 reported (98%)

– Rhode Island, 11 out of 11 reported (100%)

Yet, Arizona—without mandating reporting— has 70% of hospitals participating

Arizona is the only state where most hospitals

have freely volunteered and

where, as a result, there is little selection bias

Selection Bias

Why are such a limited number of some states’ hospitals participating?

– Possible reasons for lower participation . . .• Participation involves commitment to public

reporting

• Hospitals are not yet comfortable with publicly reporting data

• Data results are not satisfactory to the hospitals

Arizona Participation

• Arizona hospitals want to be involved

• All Arizona hospitals collected and reported data for all indicators and all projects during the 6th Scope of Work

• All but one Arizona hospital is participating in the 7th Scope of Work

Validation is Minimal

• The process for validating data is being implemented, but was not in place for the first posting of data

• In the future, Arizona hospitals will have records randomly chosen for validation

• Data will be considered valid at 80% accuracy

Data is Difficult to Compare

• First step was limited to JCAHO hospitals only

• Hospitals with small sample sizes were not included

• Hospitals were given the opportunity to not publish results during the first release of data

Congratulations

• [insert hospital name] has been actively participating since [insert date here]

• Participation has included– Providing opinion on the Web site design– Advising the national program about

recruitment and retention– Posting data

Quality Indicators

• Three clinical conditions• Heart Attack (AMI)

• Heart Failure (HF)

• Pneumonia

• Ten clinical indicators

Quality Indicators

• Heart Attack– Aspirin on arrival

– Aspirin at discharge

– ACE-I for LVSD

– Beta blocker on arrival

– Beta blocker at discharge

• Heart Failure– LVEF assessment– ACE-I for LVSD

• Pneumonia– Oxygen assessment– Pneumonia immunization– Antibiotic administered

within 4 hours of admission

Insert Your Results

The Future of Public Reporting

• Data is scheduled to be posted quarterly• National mandated reporting by all

hospitals in 2005• Additional indicators

• Coronary Artery Bypass Graft Surgery• Hip and Knee Replacement• Patient Satisfaction

• Financial incentives may be tied to results

Financial Incentives from the Premier Hospital Quality Incentive Demonstration Project

• Top Performers

– Top 50% are recognized on the Web site– Top 10% rewarded with 2% bonus– Top 20%–10% rewarded with 1% bonus

Financial Incentives from the Premier Hospital Quality Incentive Demonstration Project

• Poor Performers

– Lowest 10%, lose 2% if no improvement in 3 years

– Next lowest, 20%–10%, lose 1% if no improvement in 3 years

Final Thoughts

• Participation is an opportunity to prepare for mandatory reporting

• This experience will prepare us for financial incentives

• Arizona hospitals are working together for mutual benefit