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Hospital Public Reporting &[insert your name]
an Overview
Arizona’s Hospital Public Reporting Pilot
and the
National Voluntary Hospital Reporting Initiative
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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
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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
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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
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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
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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
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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
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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
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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
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• Data is fragmentary
• Data validation is minimal
• Data is difficult to compare• First posting is JCAHO hospitals only
• Limited indicators
Interpretation is Complex
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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%)
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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
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Arizona is the only state where most hospitals
have freely volunteered and
where, as a result, there is little selection bias
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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
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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
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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
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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
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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
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Quality Indicators
• Three clinical conditions• Heart Attack (AMI)
• Heart Failure (HF)
• Pneumonia
• Ten clinical indicators
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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
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Insert Your Results
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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
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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
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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
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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