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Who's Being Transparent With HAC Data?

Cheryl Clark, for HealthLeaders Media, April 14, 2011

And truth be told, it's not as great an incentive for hospitals to improve as is the threat that the numbers are now public.

Two sets of anticipated federal regulations will further penalize hospitals with high rates of medical errors that cause patient harm, and they'll be publicly viewable too. One is the rules for value-based purchasing criteria; the other is a set of rules that specifically penalizes hospitals with high rates of HACs.

Jim Conway, senior vice president of the Institute for Healthcare Improvement, says that despite the CMS' spreadsheets flaws, public release of these hospital specific details is essential for the sake of transparency as long as people understand the limitations "and don't use it as a club."

In Massachusetts, he recalls, when members of the Commonwealth Quality and Cost Council were debating whether to make quality data public "one member said 'It may not be perfect, but it will allow us to ask questions we didn't know to ask before. This has to be about transparency.' "

With the CMS' data, Conway emphasizes, the numbers are as revealing for what they do not show about rates of HACS as for what they do.

"There are a number of organizations that reported none. I am more concerned about the 'none' than I am about (those that) reported a lot, because I want to know if the culture at those organizations that reported none encourages reporting," he says.

"When you're on this journey, you have to become expert at looking for trouble, the more you find," he adds. "I'm worried a 'zero' means ... the organization didn't know there were any. We know there's a lot more harm in the healthcare system than we now know."

Conway adds that these statistics are important not just for patients to use for comparison, but for payers and health plans to benchmark against their competition, for providers to reduce their misuse of services, for employers who are choosing providers and for policy leaders to see ways to reduce variation.

Gina Pugliese, vice president of the Premier Healthcare Alliance Safety Institute, says that hospitals are gradually coming to understand that public reporting of these numbers is inevitable. That has prompted organizations to "really raise the stakes in investing in, developing and supporting programs to minimize these HACs. I do think ... it's helping hospitals prioritize."

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