1. Hospital Public Reporting & [insert your name] an Overview Arizona’s Hospital Public Reporting Pilot and the National Voluntary Hospital Reporting Initiative

2. Public Reporting is Not New At least 36 Web sites provide hospital information—some sites charge the viewer Several states mandate public reporting, to a greater or lesser extent CMS began public reporting with a three state pilot

3. What is New? Public reporting sponsored by government and other prestigious stakeholders –Centers for Medicare & Medicaid Services (CMS) –American Hospital Association (AHA) –Federation of American Hospitals (FAH) –JCAHO –National Quality Forum (NQF) –AARP –AFL-CIO

4. Three State Pilot Began November 2002 Involves 325 hospitals from Arizona, Maryland, and New York Maryland and, to a lesser extent, New York have mandated public reporting in place

5. Arizona’s Uniqueness Unlike other non-mandated states, Arizona has a high proportion of hospitals participating ( 47 hospitals—70%) Hospitals actively participate in monthly meetings, provide feedback, offer suggestions, and support one another

6. The National Voluntary Hospital Reporting Initiative (NVHRI) Program began December 2002 Supported by the AHA, AAMC, and CMS Data reports are the same for NVHRI and the three state pilot

7. Why Now? This is CMS’s answer: Stimulate QI activities Provide patients with information to assist them in making health care decisions “Hospitals should be leaders in sharing information with the public they serve” April 2003, Recruitment Letter signed by CMS, AHA and AAMC

8. First Step Data publicly posted 10/9/2003 Posted to the CMS Web site for health care professionals (www.cms.hhs.gov) 47 hospitals from Arizona are represented 415 hospitals, nationally, have data posted

9. 1,238 (30%) volunteered 415 (10%) submitted data for Oct. 9 47 (70%) volunteered 27 (40%) submitted data for Oct. 9 Of 4,143 U.S. Hospitals Of 69 AZ Hospitals Hospital Participation

10. Data is fragmentary Data validation is minimal Data is difficult to compare First posting is JCAHO hospitals only Limited indicators Interpretation is Complex

11. Data is Fragmentary 47 Arizona hospitals participate Low participation by non-mandated states –New Mexico, 7 hospitals submitted data (18%) –Alabama, 2 hospitals submitted data (16%) –Minnesota, 9 hospitals submitted data (10%) –California, 74 hospitals submitted data (20%)

12. States that Mandate Reporting –Connecticut, 31 out of 32 reported (97%) –Maryland, 48 out of 49 reported (98%) –Rhode Island, 11 out of 11 reported (100%) Yet, Arizona—without mandating reporting— has 70% of hospitals participating

13. Arizona is the only state where most hospitals have freely volunteered and where, as a result, there is little selection bias

14. Selection Bias Why are such a limited number of some states’ hospitals participating? –Possible reasons for lower participation... Participation involves commitment to public reporting Hospitals are not yet comfortable with publicly reporting data Data results are not satisfactory to the hospitals

15. Arizona Participation Arizona hospitals want to be involved All Arizona hospitals collected and reported data for all indicators and all projects during the 6th Scope of Work All but one Arizona hospital is participating in the 7th Scope of Work

16. Validation is Minimal The process for validating data is being implemented, but was not in place for the first posting of data In the future, Arizona hospitals will have records randomly chosen for validation Data will be considered valid at 80% accuracy

17. Data is Difficult to Compare First step was limited to JCAHO hospitals only Hospitals with small sample sizes were not included Hospitals were given the opportunity to not publish results during the first release of data

18. Congratulations [insert hospital name] has been actively participating since [insert date here] Participation has included –Providing opinion on the Web site design –Advising the national program about recruitment and retention –Posting data

19. Quality Indicators Three clinical conditions Heart Attack (AMI) Heart Failure (HF) Pneumonia Ten clinical indicators

20. Quality Indicators Heart Attack –Aspirin on arrival –Aspirin at discharge –ACE-I for LVSD –Beta blocker on arrival –Beta blocker at discharge Heart Failure –LVEF assessment –ACE-I for LVSD Pneumonia –Oxygen assessment –Pneumonia immunization –Antibiotic administered within 4 hours of admission

21. Insert Your Results

22. The Future of Public Reporting Data is scheduled to be posted quarterly National mandated reporting by all hospitals in 2005 Additional indicators Coronary Artery Bypass Graft Surgery Hip and Knee Replacement Patient Satisfaction Financial incentives may be tied to results

23. Financial Incentives from the Premier Hospital Quality Incentive Demonstration Project Top Performers –Top 50% are recognized on the Web site –Top 10% rewarded with 2% bonus –Top 20%–10% rewarded with 1% bonus

24. Financial Incentives from the Premier Hospital Quality Incentive Demonstration Project Poor Performers –Lowest 10%, lose 2% if no improvement in 3 years –Next lowest, 20%–10%, lose 1% if no improvement in 3 years

25. Final Thoughts Participation is an opportunity to prepare for mandatory reporting This experience will prepare us for financial incentives Arizona hospitals are working together for mutual benefit