"Laying it All Out on the Table" by Michael V. Sack

Transparency. Measures. Outcomes. Information for informed choices. Laying it all out on the table.

Call it what you want but the trend in health care, and certainly a main focus of the reform law and of “Reform II”, the cost-containment bill, is to generate more information, submit it to an ever-increasing number of sources, and ensure that it’s all posted online where it’s …. well, oftentimes it’s ignored.

Right now, the state is putting the finishing touches on a Cost & Quality website. The Massachusetts Hospital Association has had its Patients First website up and running since 2005, posting nurse staffing data and, now, data relating to “nursing-sensitive” measures, such as how often patients fall in a hospital or develop bed sores.

The national Hospital Compare website (operated by the U.S. Department of Health and Human Services on behalf of the public/private coalition known as the Hospital Quality Alliance) reports voluntarily-reported hospital-specific data on about two dozen best practices/processes of care – for example, does a hospital administer antibiotics one-hour prior to surgery? Or give a pneumonia patient a thorough assessment and influenza vaccination? More such measures will be added this year and next.

Many Massachusetts insurers already use these data in assembling their various hospital “honor rolls” for use by their subscribers.

Private sector organizations such as The Joint Commission and the Leapfrog Group evaluate and report on hospital adoption and implementation of proven quality improvement and patient safety practices.

Massachusetts hospitals began to report infection rate data on ICU central-line infections and selected surgical site infections to DPH earlier this year for public reporting in the not-distant future. And hospital-specific data on risk-adjusted mortality rates for many conditions are already reported on Hospital Compare and the EOHHS/DHCFP website. We’ll begin posting readmission rates as well.

By one accounting, there are currently more than 150 measures of one sort or another used by one group or another in Massachusetts. Too many independent measurement initiatives risk overwhelming hospitals and other health care providers and undermining the likelihood that measurement and reporting will lead to actual improvement in the quality and safety of patient care.

I’ve written about this before but I want to repeat it now because lately the drumbeat for more reporting has increased, and the criticism about lack of reporting has heightened. “If we only had more information, if only hospital hewed more closely to proven ‘intervention’ strategies for reducing infections, we could all lower costs,” is the common refrain.

Now, I’ll concede that continuous learning is needed in the health care field, but we have to be sure we’re not just collecting data for the sake of collection. And we have to be honest about why we’re collecting data. I don’t think it’s for the public. People go to hospitals their doctors tell them to go to, or ones that are close by. Quality websites don’t often assist this process but they do generate a “creative tension” among providers. Hospitals see how they compare to their peers and, yes, their competitors and they learn from each other.

We’ve come along way, and still have far to go. Let’s make sure that our plans for the future are based on a full appreciation of where we stand today.

Michael V. Sack
President and CEO, Hallmark Health

This program aired on September 22, 2008. The audio for this program is not available.


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