August 22, 2007
When researchers at the U.S. Government Accountability Office interviewed hospital leaders about performance reporting, they found universal agreement: Hospitals are using quality data to improve processes and to give quick feedback to clinicians on how they can better care for patients.
Many hospital leaders value the measures required by Centers for Medicare & Medicaid Services (CMS) so much that they calculate their organizations' performance monthly, rather than wait for CMS' quarterly report. An article in the July 2007 issue of Consumer-Directed Healthcare newsletter offers suggestions to providers on balancing the requirements of healthcare performance reporting and improving patient care.
The proliferation of performance measurement initiatives is nothing short of overwhelming. The latest iteration of Premier | CareScience's compendium of industry performance measures includes about 300 measures. No hospital reports on all of these measures, of course, although Richard Bankowitz, MD, MBA, vice president and medical director at Premier | CareScience estimates that the average hospital is reporting about 70 measures each quarter.
The St. Louis-based Sisters of Mercy Health System, with 19 hospitals in the Midwest, reports more than 100 performance measures to a variety of organizations including:
- CMS
- The Joint Commission
- A few state-level programs, including a Medicaid pay-for-performance program and an infection-control initiative
- The Institute for Healthcare Improvement
- The CMS/Premier Pay-for-Performance Demonstration
- Programs that benchmark specific service lines, including neonatal intensive care and cancer care
- A handful of health plans
"A lot of people out there think up a measure and they think it'd be relatively easy to collect," says Sherry Kwater, BSN, MSN, executive director for clinical excellence at Sisters of Mercy.
Not so, says Hoangmai Pham, MD, MPH, senior health researcher at the Center for Studying Health System Change and author of a Health Affairs study about the reporting burden. Most reporting efforts require nurses to flip through paper records, sometimes trying to mesh paper and electronic information to determine a code. "Most of them just sort of plod through by brute force," says Pham.
Setting Reporting Priorities
The Mercy system is enthusiastic about some quality reporting efforts. Sue Sinclair, RN, CCM, the system's director of quality management, says system leaders "highly encourage and support wholly" clinicians who seek to compare their performance to their peers with the goal of improving the quality of care.
But the sheer number of reporting requests has prompted the system to start setting priorities and trying to influence new measurement efforts. For example, Mercy recently discontinued its participation in Leapfrog Group for Patient Safety program.
The health system is not alone in wanting to pare down quality reporting. Pham says she is hearing of other hospitals opting out of reporting initiatives as well. "Frankly, you can make the case to a health plan or an employer that reporting is really not what quality is about," she says. "It's the types of quality improvement activities that you engage in and the quality of the metrics that you're being measured on."
Pham suggests that hospitals leaders use a two-step, priority-setting process in choosing non-regulatory required reporting programs to participate in:
- What programs will help the hospital improve care delivery the most? For example, the Institute for Healthcare Improvement's 5 Million Lives campaign is a reporting program that prescribes specific actions. "Hospitals love that because they can actually do something concrete rather than just report," says Pham.
- What programs will support the hospital's marketing plan?
Kwater at Sisters of Mercy says her system looks for other ways to limit the reporting burden. For example, some Mercy hospitals have encouraged payers to use nationally recognized measures rather than develop their own.
IT to the Rescue?
After the GAO reviewed the reporting burden under which hospitals are living, it recommended that the U.S. Department of Health and Human Services should identify specific steps that the department will take to promote the use of health IT for the collection and submission of data for CMS' quality measures. CMS agreed. But that is scant relief to hospital officials who need to report data every quarter now.
While many hospital officials expect the expensive electronic medical record technology they are buying will make quality reporting easier, Pham says that is only somewhat true. "Hospitals that are already wired have a really hard time pulling the data that they need for quality reporting out of the electronic medical records for a whole host of reasons," she says. Among the reasons:
- Physicians may record an essential data element--say, an order for a specific test--in a text field that cannot be automatically extracted.
- Measures are constructed from many data elements. A seemingly simple question--for example, "Was aspirin given to a heart attack patient upon arrival?"--requires 11 data elements: "What time did the patient arrive?" "If an aspirin was given, at what time?" "Did the patient have one of several contraindications for aspirin, such as internal bleeding or allergies?" And the list goes on.
Peering into the Future
The performance reporting burden is likely to get worse before it gets better. Two reasons to brace yourself:
- More measures are coming. CMS--the most influential data requester--has identified new types of measures it could potentially collect starting in 2010: efficiency, clinical outcomes, emergency care, care coordination measures, safety and structural. "It has the potential to be very expansive," says Bankowitz.
- Consolidation of measures will be limited. Although some efforts to use the same measures are emerging, the competitive marketplace does not encourage that trend. Dr. Pham says health plans and even providers want to differentiate themselves via "red Ferrari-type" measures.
- "It's not clear that the commercial payers will have bought into the idea of harmonizing the measures," says Bankowitz. "Will everyone agree on a set of standards? That is the hope."
Source:
- Reducing the Burden of Performance Reporting, Consumer-Directed Healthcare newsletter, July 2007
: Beginning with the next (September) issue, Consumer-Directed Healthcare will be called HFMA's Patient Friendly Billing® newsletter. The newsletter will continue to provide practical, how-to articles on consumer-related topics. In addition, the newsletter will keep readers informed and up to date on important developments in the nationally recognized PATIENT FRIENDLY BILLING® project.
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HFMA Wants You to Know ISSN: 1540-0697. Volume VI, Issue 17. Copyright 2007, Healthcare Financial Management Association. All rights reserved.