Hospital Public Reporting & [insert your name] an Overview

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

Of 69 AZ Hospitals Hospital Participation Of 4,143 U.S. Hospitals 47 (70%) volunteered 27 (40%)submitted data for Oct. 9 1,238 (30%) volunteered 415 (10%) submitted data for Oct. 9

Interpretation is Complex • Data is fragmentary • Data validation is minimal • Data is difficult to compare • First posting is JCAHO hospitals only • Limited indicators

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 hospitalshave freely volunteeredand 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

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 Quality Indicators

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 Incentivesfrom 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 Incentivesfrom 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

Hospital Public Reporting & [insert your name] an Overview