Monday, October 31, 2011

Ohio steps backward on transparency

After expressing enthusiastic support for many quality initiatives by hospitals in Ohio, I must report with disappointment an action by their trade association to dismantle the state's hospital transparency website.  This article summarizes:

The Ohio Hospital Association (OHA) is backing a piece of recently introduced legislation that would free hospitals from the requirement to report performance data such as measures of heart and surgical care, infection rates and patient satisfaction.

The reason?  Alleged duplication of effort with the CMS Hospital Compare website.  According to an OHA spokesperson:

The time and effort spent on reporting the data to the state as well as the federal government reduces the resources Ohio hospitals can devote to patient care.

To which I reply, "Bull twaddle!" (This is a family blog, or I would use stronger terms.)

First, let's acknowledge that the data presented in the the CMS site is old, very old.  It accomplishes little or nothing with regard to transparency.  As I have noted:

While you cannot manage what you do not measure, trying to manage with data that are a year or two or more older is like trying to drive viewing the road through a rearview mirror. The principles of Lean process improvement and other such systems suggest that real time "visual cues" of how the organization is doing are essential. Why? Because that kind of data is indicative of the state of the organization right now, not what existed months or years ago.

Second, let's be real about the amount of time this state-run site "takes away" from delivering patient care.  This data would be collected regularly by hospitals, as part of delivering patient care, even if there were no federal or state reporting requirements.  It is not an incremental responsibility.

Next, the Ohio Department of Health says:  “It was an unfunded mandate for ODH to collect the information and make it public."
To which, I can only repeat the above, "Bull twaddle!"

Since when does a state agency get to complain about unfunded mandates from the legislature that supervises it?  (You only get to complain about unfunded mandates if a higher level of government imposes a cost on a lower level of government.)  The staff of the agency get funded every day they work there.  This is a matter of priorities.  In any event, this is a gross overstatement of the amount of effort needed for this task.

I am willing to bet that a graduate student or health care club at OSU, Case Western, or one of the other fine schools in Ohio would gladly set up and maintain a voluntary website for the Ohio hospitals.  Each hospital could enter through a password-protected portal to enter real-time data about the metrics that are of value in pursuing important quality and safety goals.  At virtually no cost.  It would take seconds, not even minutes or hours, to enter it once a month or once a quarter.  As I have noted:

Such data are collected in hospitals on a current basis. If their main purpose is to support process improvement, they do not need external validation or auditing to be made transparent in real time.

Come on, Ohio.  Don't step backward.


Tom Emerick said...

Paul, I could not agree more with your post. This is nothing more than yet another attempt to keep the public in the dark about what goes on inside the walls of a hospital. I would hope that corporate benefit executives take note of this and support Leapfrog and other efforts to promote voluntary reporting.

Anonymous said...

Mr. Emerick, funny you should mention the Leapfrog group; the link below indicates that 3 prominent hospitals will cease reporting of their HAI rates to Leapfrog as it duplicates CMS reporting. I would assume Paul's objections would still pertain.

While I have you, as you seem to consult with large employers - perhaps you can shed some light on why employers do not make better use of their clout to knock heads together between the insurers and providers and force better control of costs. If the problem is bad enough to have driven the automakers into bankruptcy and damaged other companies' competitiveness, one would think it would be priority #1 to solve, for corporations.

nonlocal MD

Kathy Day said...

From Facebook:

I'm afraid Maine is doing the same thing. The Maine Quality Forum, part of Dirigo Health, has been a tremendous organization for improved quality and safety in our Hospitals. Our current Governor, who is all about business, corporate profits and deregulation has declared "DIRIGO GONE!" I'm sure he does not have the tiniest clue about the work of the MQF. No information seems to be available about who will take on the tasks of quality oversight in Maine. It will just take this State back decades on transparency and accountability.

Anonymous said...

I am as disappointed as you, being an Ohio resident. It is a shame, because we are making strides in healthcare quality that will not be known to the public in a timely manner.

Tom Emerick said...

To anonymous non-local MD,

Your question is why big employers aren't using their clout to create big change is an excellent one. Government will never make the right changes. After all every congressman sees it as his or her duty to "protect" hospitals and "providers" in their districts. Real change can only come from private employers.

Some companies are making very promising changes, but doing so very quietly for fear of media and political demagoguery.

The "popular" media attacks companies that try to implement real change openly. That's bad for business. I've had to go before congressional committees's not pretty.

One of the most promising changes some companies are making is contracting directly with hospitals and clinics that get superior results for high cost and complex tertiary cases, which cases account for about 80% of spending in a typical company health plan. Another way to say that is that some companies are moving patients away from tertiary centers that don't perform well.

Why? There is gross variation among tertiary providers in the U.S. in terms of outcomes, diagnostics, quality, death rates, and net cost. Some companies see this and are reacting the right way. If this takes hold in a big way it will be the largest evolution in health plan management since the advent of PPOs and HMOs.

Of course there will be winners and losers among hospitals and clincs. The underperforming centers will either make necessary improvments or lose many of their patients. In benefit plans today about 10% of members are spending 80% of plan dollars. Redirecting a good number of these "outliers" within the U.S. is entirely feasible and is being done today by leading companies.

Some companies have been doing this for a decade or more but doing it very stealthily. Their results have been quite good.

There are other reasons why companies aren't being more aggessive, but they are too complex to explain here. I'm presently writing a book that will cover this question in some detail. Please wish me luck in getting it published.

Anonymous said...

Couple of responses. Agree with you that alleged duplication of effort with CMS Hospital Compare website is a poor excuse - what about those services NOT covered under Medicare, namely maternity? In all the focus on CMS, we lose sight that one of the largest reasons for hospitalization is childbirth. There are very few websites reporting on maternity outcomes of interest, not to mention RECENT data.

Second, though, I think your claim is a bit overstated: 'graduate student or health care club ... would gladly set up and maintain a voluntary website for the Ohio hospitals. Each hospital could enter through a password-protected portal to enter real-time data about the metrics that are of value in pursuing important quality and safety goals. At virtually no cost. It would take seconds, not even minutes or hours, to enter it once a month or once a quarter."

If it's voluntary, who would enter data? If it's a slapdash effort with no credible organization ensuring valid data, what hospital would consent to participate? Here in California, efforts are underway to create a data center of this type for maternity reporting only but it has not been cheap, fast or easy. Would love to hear more about why you think such an approach would be feasible....