This advisory is being sent jointly to the members of the American Hospital Association (AHA), the Association of American Medical Colleges (AAMC) and the Federation of American Hospitals (FAH) to bring you up to date on our efforts to develop a common framework for the public disclosure of quality measures of hospital care. Please read it carefully and share it with key members of your management, medical staff and governance. It provides additional information about the important voluntary initiative to provide publicly disclosed quality data that we first described to you in a Quality Advisory dated November 21, 2002.
Imperative – A Time for Hospital Leadership
Every hospital leader in America knows firsthand that pressure for more and better publicly available information about the quality of hospital care is coming from every direction. In our November 21 Quality Advisory, we noted many of the quality measurement activities underway at the Centers for Medicare & Medicaid Services (CMS), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), insurers and other payors, the business community, consumer organizations, commercial enterprises that compile and sell “report cards,” and the media. The potential to confuse the public with incomplete, poorly analyzed, conflicting and misleading information is enormous.
We also noted our understanding that the public expects hospitals to exercise leadership, use candor in describing the care provided and ensure that the information they get is accurate and helpful.
To fulfill these commitments, hospitals must continue to improve quality internally and be publicly proactive, rather than reluctant responders. The issue no longer is whether quality data are to be made public – that already is happening. For hospitals, the issue is how to work with others to play a leadership role in forging a shared national strategy for quality measurement and public accountability.
The AHA-AAMC-FAH Approach
Following discussions with our boards and policymaking panels, our organizations took the lead by convening a meeting that brought us together with CMS and the Agency for Healthcare Research and Quality (AHRQ) from government, the JCAHO and the National Quality Forum (NQF). The purpose of our discussion was to develop a mutually agreeable process to set priorities for improvement efforts, associate measures with those priorities, and then support voluntary reporting of performance data by hospitals to the public.
An Agreement is Announced
These discussions have resulted in an unprecedented collaboration that was announced today, December 12. In addition to the participants in this effort to date, several supporters spoke at today's event, including U.S. Health and Human Services Secretary Tommy Thompson and representatives of the AARP and the AFL-CIO. As we move ahead, the entire spectrum of stakeholders, including employers, consumers and clinicians, will be engaged. Also part of the announcement was a framework for the release of performance data within these priorities. Many details still need to be worked out, and you will receive additional advisories from us as those details emerge. Meanwhile, here are the major elements of the framework that was announced today:
- The effort will be structured around the priority conditions for quality measurement and improvement that the Institute of Medicine (IOM) is developing under contract for AHRQ. The IOM's list will contain approximately 15-20 conditions or aspects of care (e.g., pain management) and is expected to be released within the next two weeks. There will be an opportunity for public comment on these priorities.
- Quality measures, with special emphasis on those likely to be meaningful to the public, will be drawn from those adopted by the NQF's voluntary consensus process and associated with these priority conditions.
- JCAHO and CMS will facilitate the flow of data from hospitals to a publicly available Web site, and the associations will support the development of ways to make the data understandable and useful to the public. The associations will urge their members to voluntarily report these data.
- Assistance and information will be provided to hospitals that seek to improve the quality of care for these conditions, including information from research (from AHRQ and CMS), best practices (from AHRQ, CMS and JCAHO), and technical assistance (from AHA, JCAHO and CMS through its Quality Improvement Organizations).
- Because it will take time to develop this full data collection, reporting and improvement effort, hospitals will be asked as a first step to voluntarily report on the 10 measures of care for acute myocardial infarction, congestive heart failure, and community acquired pneumonia so that the data can be shared with the public beginning in the summer of 2003. Hospitals currently participating in JCAHO’s ORYX data collection or the CMS Seventh Scope of Work will be asked to voluntarily release the data for these measures. Since hospitals are not required to collect all of these measures for ORYX, they will be asked to expand their data collection to include all these data elements.
Attached to this Advisory is the press release that was sent out describing today's announcement. Also attached is a document that describes this collaborative effort in more detail. It includes the 10 measures to be voluntarily reported by hospitals that will be shared beginning in the summer of 2003.
Again, additional advisories will be sent to you as the parties involved – hospitals, government and accreditors – work out the details.