Hospital Performance Data Made Public—A New Wave of Transparency

Effective July 2004, hospital payments from the Centers for Medicare & Medicaid Services (CMS) will be linked for the first time to hospital participation in quality-of-care reporting initiatives. Previously, CMS paid for patients' hospital services regardless of whether hospitals participated in such programs. Dubbed "Project Public Trust," the National Hospital Quality Initiative (NHQI) not only ties reimbursement to reporting on quality of care, but also makes hospital-quality data publicly available on the Internet. Also in July 2004, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will make additional quality-performance information on accredited organizations available on its Web site.

Local, state, health plan, and other federal quality improvement efforts have in some ways spurred healthcare providers to improve the quality of patient care. For example, since 1999, the Pennsylvania Health Care Cost Containment Council (PHC4), an independent state agency charged with collecting, analyzing, and ensuring public availability of data about the cost and quality of healthcare in Pennsylvania, has provided hospital performance data such as inpatient mortality and readmission rates and information related to numerous clinical outcomes for specific conditions (e.g., diabetes, hip fracture surgery). However, NHQI is the first ever national Medicare initiative that links quality-of-care reporting to reimbursement. It has gained the attention of hospital leaders because hospitals get paid more for participating in NHQI and receive less reimbursement for not participating. Hospital leaders are also closely monitoring the publication of their facilities' quality data.

This "carrot and stick" approach to quality has ramifications for risk managers as well. Risk managers must educate themselves about NHQI and other quality initiatives driven by accrediting organizations such as JCAHO, quality groups, and purchasing coalitions. But for some risk managers and patient safety officers, participation in quality and safety initiatives is not new. "Ever since the release of the Institute of Medicine IOM report To Err Is Human, our organization has taken an aggressive approach to quality and patient safety. Even before that, we were developing things like patient harm scores to apply to medication and other errors," says Francine Miranda, director of risk management/patient safety officer, Lehigh Valley Hospital and Health Network (Allentown, Pennsylvania). "The quality-data collection and reporting under NHQI is not viewed as burdensome here, but rather as the right thing to do for our patients and for the community we serve," she says.

Risk managers can view the new quality efforts as a natural progression of the patient safety movement, which itself was spurred on by the now infamous 1999 report, To Err Is Human. And so it should come as no surprise when IOM's 2001 follow-up report, Crossing the Quality Chasm, served as the catalyst to a patient quality movement. So, to what degree should risk managers be involved with NHQI reporting? Organizational size, according to Miranda, will determine to a large extent the level of risk manager participation. "In a large facility with a fully developed and integrated quality department," she says, "the risk manager will probably not be directly...