Another problem facing public reporting comparison initiatives is differences in healthcare utilization and spending across U.S. regions with similar levels of patient illness, says Stephanie Jackson, MD, a hospitalist with PeaceHealth and a member of SHM’s Public Policy Committee.3 The public cannot look at data it doesn’t have. For example, when Dr. Jackson asked researchers for data on coronary stroke rates, she was informed some physicians asked the data be held back because they didn’t like what it showed. “Why aren’t we demanding [that data]?” Dr. Jackson asks.
Essentially, then, quality data utilization is an evolving story. ”An ongoing debate exists between proponents of public reporting who believe that the best way to improve measures is to start using them,” Dr. Lindenauer says, “and those who advocate a more cautious approach and argue we should not rush to publicize data until we are clear about what the numbers signify and what to measure.”
Some hospitals use more than 10 criteria as the benchmark for core measures, and 10 additional dimensions hospitalists use to assess their own internal performance (see Figure 1, pg. 41). Beyond that, metrics vary from hospital to hospital.
What Hospitalists Can Do
“It is very challenging to find doctors who are well-versed in public reporting of quality data,” says Latha Sivaprasad, MD, medical director, quality management and patient safety at Beth Israel Medical Center in New York City. Dr. Jackson believes the more hospitalists know about quality data, the more they will want to use it. “Even though some hospitalists may be afraid to find out how they are doing,” she says, “in general, the better we get at measuring individual performance, the more hospitalists can examine their performance and how they can improve as individuals, as a group, and as an institution.”
Additionally, the era of value-based purchasing (pay for performance) is here—in the form of CMS’ Physician Quality Reporting Initiative. For the past year, physicians have reported on specific performance measures tied to a 1.5% bonus payout. Of the program’s 74 measures in 2007 and 119 measures in 2008, 11 have reporting specifications applicable to hospitalists.
“Three to 5% of the DRG [diagnosis-related group] reimbursement could be at stake for hospitals to achieve certain benchmarks,” Dr. Torcson says. “This will be a great opportunity for hospitalists to partner with their hospitals to develop synergy in achieving performance goals that are going to help maximize hospital quality initiatives and reimbursement.”
Hospitalists can get more involved with quality measures by:
- Joining the hospital quality improvement or patient safety teams;
- Creating toolkits to educate physicians in using quality data;
- Setting up unit-sponsored interdisciplinary teams on the floors to marry all lines of care; and
- Educating the public.
“The conventional wisdom is that the more procedures that an institution does, the better their performance,” Dr. Alexander says, giving as an example a specialized cardiac hospital. “But you really want your surgery in a hospital where they manage at least a moderately high number of procedures and have a very high” success rate treating complications.
Dr. Sivaprasad believes the public wants guidance on medical care quality, legal ramifications of care, physician-specific volume, and the significance of physician hospital privileges. “Maybe we should be more public about system outcomes changes that resulted from root-cause analyses performed,” she adds.
Whatever the level, hospitalists should get involved, Dr. Vidyarthi says. “Quality improvement is an area where you as hospitalists may be asked to engage—and you’re needed.” TH
Andrea M. Sattinger is a medical writer based in North Carolina and a frequent contributor to The Hospitalist.