Stop whin­ing

Modern Healthcare - - Opinions Letters -

I’ve been read­ing a re­cent edi­tion of Mod­ern Health­care, and my blood started sim­mer­ing again.

Re­porter Mau­reen McKin­ney’s ex­cel­lent over­view of what’s com­ing down the road with more CMS re­port­ing re­quire­ments for hos­pi­tals to qual­ify for their an­nual full mar­ket­bas­ket ad­just­ments gives us a sense of where the govern­ment is go­ing to ac­com­plish two over­ar­ch­ing goals (“Can’t drive 55,” April 26, p. 6): 1. Im­prov­ing qual­ity of care across the coun­try. 2. Gen­er­at­ing sig­nif­i­cant cost sav­ings by with­hold­ing Medi­care pay­ments for of­fqual­ity events. It’s a con­tin­u­a­tion of a phi­los­o­phy that started with DRG fixed re­im­burse­ment in the mid-1980s: If hos­pi­tals won’t re­duce length of stay and re­source uti­liza­tion vol­un­tar­ily, the CMS will force them to con­tain costs and let mar­ket forces al­low the strong­est to thrive. The roll­out cal­en­dar looks a bit like this: Jan. 1, 2011: Ten new mea­sures to be re­ported (eight hos­pi­tal-acquired con­di­tions, in­clud­ing: blood in­com­pat­i­bil­ity, uri­nary tract in­fec­tions and other catheter in­fec­tions, and ef­fects of poor glycemic con­trol, plus two Agency for Health­care Re­search and Qual­ity pa­tient-safety in­di­ca­tors, in­clud­ing post­op­er­a­tive pul­monary em­bolism/deep vein throm­bo­sis and post­op­er­a­tive res­pi­ra­tory fail­ure) with fi­nal ap­proval pend­ing.

2011: Thirty-five ad­di­tional mea­sures re­ported, but these would not be used to de­ter­mine an­nual pay­ment up­dates un­til 2013.

2012: Four more mea­sures re­ported (two for emer­gency room through­put and two for im­mu­niza­tions) for an­nual pay­ment up­dates in 2014.

Fu­ture: Twenty-eight more mea­sures not re­quired for re­port­ing, but used for fu­ture rule­mak­ing.

So nat­u­rally the bick­er­ing has started around how ex­pen­sive it will be to col­lect the data, how ac­cu­rate the data will be, how the mea­sures aren’t rooted in sci­ence, how the re­port­ing pa­ram­e­ters aren’t clear, how ru­ral hos­pi­tals will carry an un­due bur­den, etc. Blah, blah, blah.

I re­vert back to my ear­lier ob­ser­va­tion of what the fed­eral govern­ment’s long-term strat­egy is: If you won’t do it your­self, we’ll force the waste out of the sys­tem and let Dar­winian the­ory play out. Do you think the CMS re­ally cares about how you get there? You’re all smart peo­ple mak­ing nice salaries. You fig­ure it out.

We’ve seen many Health­care Man­age­ment Coun­cil clients demon­strate ma­jor im­prove­ments be­tween 2008 and 2009 in sev­eral AHRQ off-qual­ity in­di­ca­tors, such as de­cu­bitis ul­cers, post­op­er­a­tive pul­monary em­bolism/deep vein throm­bo­sis, and post­op­er­a­tive res­pi­ra­tory fail­ure.

Yes, some may be from bet­ter doc­u­men­ta­tion of present on-ad­mis­sion sta­tus, but most of the im­prove­ment stems from ac­tu­ally do­ing some­thing about re­duc­ing the in­ci­dent rates for these in­di­ca­tors. This trans­lates into huge cost sav­ings and bet­ter pa­tient care. And it’s hap­pened only be­cause now they are at risk for los­ing re­im­burse­ment. It’s amaz­ing what can hap­pen when your sur­vival de­pends on it.

The truth is that most fa­cil­i­ties are al­ready cap­tur­ing the data for most of these in­di­ca­tors, and they have struc­tures, data­bases and re­sources in place to han­dle these and the ad­di­tional mea­sures. The fact that re­im­burse­ment will con­tinue to be with­held for un­der­per­form­ers is no longer ne­go­tiable. These are events that for the most part shouldn’t be hap­pen­ing in hos­pi­tals any­way, so stop your whin­ing and start fig­ur­ing out how you’re go­ing to im­prove care. John Whit­tle­sey

Prin­ci­pal Health­care Man­age­ment Coun­cil

Bos­ton

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