With several healthcare reform-related programs already beginning to demand an extremely broad range of data reporting from providers, and the meaningful use process under HITECH continuing to move forward, healthcare IT leaders are faced as never before with a menu of data reporting mandates that are set to redraw the landscape of healthcare. In this cover story package, we look first at the overall picture, and then offer case studies from the pioneering organizations that are already moving forward into the future of healthcare, one organized around the industry's new accountability agenda.
Part I: The New Landscape of Accountability
With several mandates around data reporting coming out of various federal government initiatives these days, healthcare IT leaders are on the cusp of a new era, one that will not only be driven by data, but shaped by it as well. Given three mandatory programs and two voluntary programs coming out of the Patient Protection and Affordable Care Act (ACA)-the comprehensive federal healthcare reform legislation passed by the U.S. Congress and signed into law by President Barack Obama in March 2010; as well as the ongoing meaningful use process under the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act, established through the federal stimulus program of February 2009-there has never been a time in the healthcare industry's history when data reporting requirements have been so intense and demanding.
ONE THING WE NOTED IN PUTTING TOGETHER THE WHITE PAPER IS THAT, WHEN PEOPLE WERE WRITING ABOUT HEALTHCARE REFORM, THEY KEPT USING THE FUTURE TENSE. AND WE NOTICED THAT SOME OF THE DATES DIDN'T SEEM ALL THAT FAR IN THE FUTURE. -JANE METZGER
Indeed, the complexity of the situation is such that industry experts are warning CIOs and other healthcare IT experts they need to be actively engaged right now in intensive work to satisfy all the requirements involved. Among the industry leaders in this area, Jane Metzger, principal researcher in the Waltham, Mass-based Global Institute for Emerging Healthcare Practices, a division of the Falls Church, Va.-based CSC, co-authored a white paper in August along with colleagues Caitlin Lorincz and Marta Arthur, entitled “The Hospital Agenda for Accountability,” which laid out the various data reporting requirements under healthcare reform and articulated the concept of the “new accountability agenda in healthcare” that the various programs represent.
When put together, the data reporting requirements are daunting in their breadth and scope, Metzger and her co-authors point out in their white paper (available at http://assets1.csc.com/health_services/downloads/CSC_Hospital_Agenda_for_Accountability.pdf). First, there are the requirements coming out of the three mandatory programs under healthcare, to be administered under the Medicare program: the value-based purchasing program, the readmissions reduction program, and the healthcare-acquired conditions reduction program. Then there are the requirements emerging out of the two broad voluntary programs under healthcare reform, also administered through Medicare: the accountable care organization (ACO) shared-savings program and the bundled payments shared-savings program. And of course, there are the many requirements under Stages 1 through 3 of the meaningful use process under the HITECH Act.
Not surprisingly, many hospital leaders will find the overlaps in the data demands involved in these various programs, as well as their overall breadth of scope, confusing and challenging. Such diverse areas as mortality statistics, infections, patient falls, the administration of certain types of drugs, the provision of patient discharge summaries, and patient experience measures, are all implicated. Not surprisingly also, each of these programs involves its own particular complexities, including around the fact that some of the data regimes are based on calendar years and others on fiscal years.
“One thing we noted in putting together the white paper,” Metzger says, “is that, when people were writing about healthcare reform, they kept using the future tense. And we noticed that some of the dates didn't seem all that far in the future. For example,” she notes, “probably the most significant element is data collection for chart-abstracted measures for the first year of value-based purchasing, which started on July 1, 2011. So we decided that some of these elements weren't well-understood. And the ACA is over 1,000 pages and is very complex. These programs under the ACA are on separate timetables, and have different elements to them.” Unless healthcare leaders begin to educate themselves rapidly and thoroughly in the data reporting requirements under the three mandatory programs (and certainly the two voluntary ones, too, if they are interested in participating in those), Metzger argues, they will quite quickly fall perilously behind.