Okay, I am officially overwhelmed. I am about as well plugged in to the bureaucracy of medicine as any nonprofessional administrator can be. I am familiar with the joint commission audits, with the physician quality reporting program, with CMS core measures, with hospital compare, with HCAHPS, with meaningful use, with the hospital inpatient quality reporting program, with leapfrog and a variety of other patient safety and quality initiatives. Yet it seems that every time I turn around there is a new set of quality metrics being developed and implemented. I can't keep track of them anymore. It turns out, unsurprisingly, that our hospital is preparing for a new set of measures which will be tracked as of January 1, in addition to the measures that I was only vaguely aware of which they had already been tracking for the last 2 years.
This is, of course, the Hospital Outpatient Quality Reporting Program. You all knew about that one, right? Cause I didn't. So what this is, apparently, is yet another quality data reporting program. In these programs, the healthcare provider, in this case a hospital, is required to report their performance on certain quality performance metrics. If they comply with the reporting requirement, they receive the full payment update for their Medicare outpatient services, and if they do not report the measures, then they are penalized 2% of their Medicare outpatient dollars, a figure which can run into many millions of dollars for the typical hospital system.
It's important to understand, that at least at this time, hospitals are not being paid for how well they are performing these measures, simply for reporting them. It is not unreasonable to presume, based on experience with previous quality reporting initiatives, that ultimately payment will be linked with performance rather than just for reporting.
So what are the reported quality metrics which are relevant to emergency department care?
The existing metrics are:
- Acute MI: median time to thrombolysis
- Acute MI: thrombolysis within 30 min.
- Acute MI: median time to transfer for PCI
- Acute MI: aspirin on arrival
- Acute MI: median time to ECG
- Nontraumatic headache: Use of CT scan (medicare patients only)
- Troponin results within 60 min. for chest pain or MI patient.
- CT head interpretation for acute stroke within 45 min. of arrival
- Left without being seen rate
- Door to Doctor time
- Median time from arrival to departure for discharged patients.
- Discharge instructions
- Time from arrival to pain medication for long bone fractures
While I understand the overall crisis in healthcare costs in this country, and I understand the need to cut costs, and I also understand the need to improve standardization and quality of care, I do not like the fact that cost-cutting has essentially been piggybacked onto quality measurement. However, this appears to be an inexorable force that we are all just going to have to live with.
So, there you have it: enjoy! Another year, another set of quality metrics to measure and manage to.