HMC: AHRQ quality report too little too late?
By Shelley Burns
I am a hospital. Unless I have my head under a rock, I know that healthcare quality is a hot-button issue for the government, the public, think tanks and the media. I am taking flak from all sides: Medication errors are killing 100,000 annually. Methicillin-resistant Staphylococcus aureus (MRSA) and other infections are rampant. We have been woefully unprepared for the swine flu epidemic. People complain that my bills are too high – but I know my margins are thin, payments are often delayed, or they are less than my costs.
To help cure healthcare’s quality ills (a good thing), the government publishes a report where I can learn how to fix quality problems. It cites increases of post-operative sepsis and post-operative Catheter Associated Urinary Tract Infections (CAUTI) through 2007 as an indication of how well (or how poorly) efforts to reduce hospital-acquired infections have been? Please.
In the 28 months since the last data bit was captured for this report, a lot has changed. Almost 18 months ago, the Centers for Medicare & Medicaid (CMS) stopped reimbursing for a long list of hospital-acquired conditions and infections, including CAUTI. In 2007, billing and coding data were not required to carry a Present-On-Admission (POA) flag – making it difficult to readily ascertain whether an infection was due to hospitalization or, oddly enough… present on admission. It’s required, now.
More importantly, in the past 28 months, we hospitals have made big changes internally. We’ve had a paradigm shift – we know that good quality healthcare costs less and that variation – in cost, in practice, in utilization – is cause for investigation. We’ve improved our tracking programs, implemented electronic medical records (EMRs), posted our quality data to multiple sites, and beefed up our technology and education to help us eradicate our quality issues. We’ve done a lot in 28 months.
So how about giving me some data I can use? Help me identify my quality issues, how big they are and what I might do to fix them. Give me a recent and repeatable picture of the quality at my hospital so I can set goals and measure my progress. Give me real time dashboards so I can see when my quality issues get out of control. Just don’t tell me my quality isn’t improving based on what I was doing 28 months ago.
Well, I have a suggestion for the here and now. Want to see how your hospital cost and quality stacks up and whether you’re improving? Want best practices that are actually in practice (and not just on paper) at other hospitals? Want a dashboard to monitor quality events in real time? Call HMC.
Shelley Burns is director of knowledge management for HMC.
