On August 17, researchers in the Waltham, Mass.-based Global Institute for Emerging Healthcare Practices, a division of the Falls Church, Va.-based CSC, released a white paper entitled “The Hospital Agenda for Accountability.” As Jane Metzger, Caitlin Lorincz, and Marta Arthur, explain in that document, “Accountability for care is already here for any hospital that treats Medicare Inpatient Prospective Payment System (IPPS) patients, regardless of whether the hospital is planning to be part of an Accountable Care Organization” (ACO), under the shared savings program launched earlier this year by the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS).
In fact, the authors note in their report, three healthcare reform-related programs under Medicare—the Value-Based Purchasing (VBP) Program; the hospital readmissions reduction program; and the hospital-acquired conditions program—will all begin to require that hospital-based organizations provide a very broad range of quality, patient safety, and administrative data that over time could result in significant positive or negative impacts to individual hospitals’ bottom lines. Some of the data points being demanded match those being required under the ACO shared savings program, while others harmonize closely with the meaningful use-related data requirements under the American Recovery and Reinvestment Act/Health Information Technology for Clinical and Economic Health (ARRA-HITECH) program created in February 2009.
What many hospital leaders will find confusing and challenging will be the overlaps in the data demands involved in these various programs, as well as their overall breadth of scope. 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. 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.
Principal researcher Jane Metzger spoke recently with HCI Editor-in-Chief Mark Hagland regarding the white paper’s findings and the challenges facing healthcare IT leaders in all these areas. Below are excerpts from that interview.
What are the broadest themes in the white paper that you and your team have written?
The paper is really about “accountable care,” in lower-case letters, versus the formal ACO concept under the shared savings program. The thing is that, ever since the passage of the ACA [Accountable Care Act], most of what you read about healthcare reform has been about the ACO program; and that’s pretty understandable, because it requires new organizational structures or partnerships, and really doing things in a different way, and additional IT infrastructures, and it’s really a big deal. But we really think that’s distracted people from a lot of other elements in the Accountable Care Act; because there are three other programs in the ACA. So that was one observation. And the other thing we noted was 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, probably the most significant element is data collection for chart-abstracted measures for the first year of value-based purchasing, one of those three programs, 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; and it’s a very complex subject, and a very moving target. So we said we think these three programs—value-based purchasing, the readmissions reduction program, and the hospital-acquired infections penalty program—need to be looked at. So we put together the performance measures for all three programs, and we decided also to sort them by timeframe, by looking at the first year in which measurement for a measure will actually influence reimbursement. That cuts through all these many different applicable dates.
And when we did that, it turned out, as we suspected, that the future is now; and regardless of what happens with the ACO rule and whether hospitals participate in the shared-savings program or not, there is this pretty significant accountability agenda hitting the industry. And none of these other programs are voluntary.
The overlap of the different measures appears significant. They don’t conflict, broadly, do they?
No, they don’t. and there are sort of four parts to the accountability agenda. One is familiar process measures; and they all come from the IQR (inpatient quality reporting) program [the Hospital Inpatient Quality Reporting program, mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003]. And that’s good news, because people have been measuring those things, and they’re familiar measures, and most organizations have been trying to improve those. There are a bunch of claims-based measures focused on readmissions and hospital-acquired conditions involved in that program, for example.
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