Mandatory Reporting of Healthcare
Performance Measures
Visit In My State to view current and
pending legislation.
Back to
top
Introduction
After years of percolating on both the federal and state levels,
mandatory reporting of healthcare-associated infection data has
become a reality in four states, and has quickly re-aligned itself as a
priority issue for APIC. Key APIC leaders have been addressing this
issue with other organizations to identify and develop informational
resources to assist our members at the local level.
Entities such as the Centers for Medicare and Medicaid Services
(CMS), consumer groups, quality improvement and patient safety
organizations, the Centers for Disease Control and Prevention (CDC)
Healthcare Infection Control Practices Advisory Committee (HICPAC),
state and federal legislators, and the National Quality Forum are among
those pursuing this issue on various levels.
APIC has for years promoted the use of infection surveillance data in
performance improvement activities. Many healthcare organizations use
this data to identify potential problem areas and to target performance
improvement interventions to reduce the risk for infection. In order to
provide consumers and healthcare providers with accurate healthcare
performance information, a performance measurement system should target
specific healthcare outcomes or processes, use standardized criteria for
defining both the event being monitored and the population at risk for
experiencing the event, and use standardized data collection
methodology, consistent surveillance intensity, a risk adjustment
method, and appropriate methods for calculating rates.
The following provides some initial informational resources to guide
APIC members when addressing this issue on the state level. Additional
resources will be added to this site.
Back to
top
Background and
Discussion
Since the early 1990's there has been a proliferation of healthcare
quality report cards focusing on outcomes and processes of healthcare.
Consumer demand for public reporting of healthcare quality data has
increased since the 1999 publication of the Institute of Medicine's " To
Err is Human: Building a Safer Health System" which reported 98,000
deaths in US hospitals per year and 29 billion dollars spent per year
associated with medical error.
The Centers for Medicare and Medicaid Services (CMS) has several
programs that focus on providing information to consumers regarding
quality of healthcare in hospitals and long term care facilities. These
programs include the National Voluntary Hospital Reporting Initiative,
the Premier Hospital Quality Incentive Demonstration Project, the
Hospital 3-State Pilot Project (Arizona, Maryland & New York) and
the Nursing Home Quality Initiative. Information on these programs can
be obtained by accessing the CMS websites noted below.
Beginning in 2005, CMS will begin to link payment with performance by
requiring hospitals to submit data on 10 quality measures (see http://www.cms.hhs.gov/quality/hospital/Listof10Measures.pdf).
These 10 performance indicators measure processes of healthcare such as
"pneumonia patients who receive their first dose of antibiotics within 4
hours after arrival at the hospital." Hospitals were to submit this data
by July 1, 2004 to comply with the Medicare Prescription Drug,
Improvement and Modernization Act. CMS states that "hospitals that do
not submit performance data for the 10 quality measures will receive 0.4
percent smaller Medicare payments in fiscal year 2005 than hospitals
that do report quality data." Additional information can be found on the
CMS Hospital Quality Initiative website under "Reporting Hospital Data
for Annual Payment Update."
Private sector purchasers of healthcare have joined forces to promote
initiatives to increase the quality of healthcare. An example is the
Business Roundtable, an association of Chief Executive Officers of
leading U.S. corporations that founded the Leapfrog Group. The Leapfrog
Group is composed of more than 150 public and private organizations that
provide healthcare benefits. The Leapfrog Group works with medical
experts throughout the U.S. to identify problems and propose solutions
that it believes will improve hospital systems.
State agencies have also begun collecting, analyzing and reporting
healthcare quality indicators. While these quality indicators have
generally focused on other clinical measures, several states have
recently mandated reporting of healthcare-associated infection
measures.
Consumers and purchasers of healthcare have a right to expect quality
healthcare and responsible public reporting of performance indicators.
APIC has supported this right in its Position Paper entitled "Release of
Nosocomial Infection Data". The position paper addresses responsible
public reporting, including the use of standardized definitions of
Infection, consistent surveillance intensity, a risk adjustment method,
and appropriate calculation of rates.
NEWCDC HICPAC Offers Guidance to
States on Developing Systems for Public Reporting of
Healthcare-Associated Infections
The CDC released the HICPAC Guidance document on public reporting of
healthcare-associated infections on Monday, February 28, 2005
at 12:30 PM EST during a live press teleconference.
Presenting the document was Dr. Denise Cardo, Director, Division of
Healthcare Quality Promotion, CDC; Dr. P.J. Brennan, HICPAC Chair, and
Kathleen Meehan Arias, MS, CIC, APIC President-Elect.
Access the HICPAC Document
Guidance on Public Reporting of Healthcare-Associated
Infections: Recommendations of the Healthcare Infection Control
Practices Advisory Committee is available here: http://www.cdc.gov/ncidod/hip/PublicReportingGuide.pdf
Access a Transcript of the Teleconference Releasing the HICPAC
Document
You may access a transcript of the
telecast at: http://www.cdc.gov/od/oc/media. The Webcast will remain archived on
CDC’s media relations Website.
View recent testimony submitted by APIC to
HICPAC
APIC Testimony - October 5,
2004
Back to
top
Recommended Reading
APIC Surveillance Initiative Working Group. Release of Nosocomial
Infection Data. 1998. Available by clicking here.
Quality Indicator Study Group. An approach to the evaluation of
quality indicators of the outcome of care in hospitalized patients, with
a focus on nosocomial infection indicators. Infect Control Hosp
Epidemiol 1995;16:308-316. SHEA position paper - available at http://www.shea-online.org
Burke JP. Infection control: a problem for patient safety. N Eng J
Med 2003;348:651-656.
Gaynes R, et al. Feeding back surveillance data to prevent
hospital-acquired infections. Emerg Infect Dis, March-April 2001,
7(2):295-98. Available at http://www.cdc.gov/ncidod/eid/vol7no2/gaynes.htm
Archibald LK, Gaynes RP. Hospital-acquired infections in the United
States. The importance of interhospital comparisons. Infect Dis Clin
North Am 1997. Jun;11(2):245-55.
Back to
top
Web Sites with Information on
Healthcare Data Public Reporting
Centers for Medicare and Medicaid Services (CMS)
CMS Hospital Quality Initiative
http://www.cms.hhs.gov/quality/hospital
CMS has several efforts in progress to provide hospital quality
information to consumers and others and improve the care provided by the
nation's hospitals. The CMS Hospital Quality Initiative web site
provides links to the following quality reporting projects:
- The National Voluntary Hospital Reporting Initiative (NVHRI)
- The Premier Hospital Quality Incentive Demonstration
- Building on the Foundation -- Hospital Measures for Public
Reporting
- Patient Perspectives on Care (HCAHPS)
- CMS Hospital 3-State Pilot Project (Arizona, Maryland & New
York)
- Reporting Hospital Data for Annual Payment Update
An overview of the CMS Hospital Quality Initiative can be downloaded
from http://www.cms.hhs.gov/quality/hospital/overview.pdf
Centers for Medicare and Medicaid Services (CMS)
CMS Nursing Home Quality Initiative
http://www.cms.hhs.gov/quality/nhqi
CMS releases quality measure information on all Medicare and Medicaid
certified nursing homes on the Medicare website (www.medicare.gov). The CMS Nursing Home
Quality Initiative Web site provides links to the following:
- Nursing Home Quality Initiative
- Nursing Home Compare
- Quality Measures (National Quality Forum)
An overview of the CMS Nursing Home Quality Initiative can be
downloaded from http://www.cms.hhs.gov/quality/nhqi/Overview.pdf
The National Quality Forum (NQF)
http://www.qualityforum.org
The National Quality Forum issued the "National Voluntary Consensus
Standards for Hospital Care: An Initial Performance Measure Set." This
report presents 39 measures to promote public accountability and quality
improvement. The Executive Summary and the 39 measures can be accessed
through the NQF home page.
CMS Public Meetings: Building on the Foundation -- Hospital
Measures for Public Reporting on the Clinical Quality of Hospital
Care
The objective of the five public meetings was to provide CMS with
feedback and comments which, together with input from CMS's
collaborators in the NVHRI, will be incorporated in a final set of
clinical quality measures which CMS will take forward in late 2004.
These public meetings provided a unique opportunity to assess the face
validity of and demand for measures proposed for the next round of
public reporting on the clinical quality of hospital care, as well as to
obtain more general opinions from audiences of end-users.
With input from public and private sectors and consumers, CMS
identified a robust and prioritized set of measures, some of which are
ready for the immediate next phase of public reporting and others of
which might require refinement or further testing, as well as areas
where additional measures development will be necessary to adequately
address priority areas identified by the Institute of Medicine and
others.
The meetings were held on:
Boston, April 27, 2004
Orlando, May 17, 2004
Dallas, June 8, 2004
San Francisco, June 14, 2004
Chicago, June 28, 2004
Recordings of the proceedings have been placed on the IPRO
website at http://providers.ipro.org/index/cms_conferences
For more information or to offer suggestions for consideration on
this topic, please email Denise Graham, Manager of Government Affairs at
dgraham@apic.org.
Back to
top
Key
Stakeholders
While the issue of mandatory reporting of infection rates is of
great importance to many groups and individuals, APIC has identified
what it believes to be the key stakeholders involved with this issue.
This list will be updated as needed. (Updated
11/3/2004)
Back to
top
State
Legislation
Click here for information on how
specific states are handling the issue of mandatory reporting.
Back to
top
Mandatory Reporting
Draft Talking Points
Mandatory reporting of
healthcare-associated infection data has become a high priority issue
for APIC. Key APIC leaders continue to address this issue with
other stakeholders and to identify and develop informational resources
to assist our members at the local level. To this end, we
are providing our members with a DRAFT document of key talking points to
be used with legislative and regulatory officials. We recommend
that you revisit this site as this document is a work in
progress.
Mandatory Reporting Draft Talking
Points
Back to
top
|
