Data and Difficult Decisions

Maureen Larkin, for HealthLeaders Media, August 14, 2008

Is there a point where CMS' demands will become more important to hospitals than providing actual patient care? I suspect that most CEOs would immediately answer "No!" But as CMS reporting requirements continue to increase, there may come a time when healthcare organizations are forced to choose between collecting data and providing patient care.

The 13 new reporting requirements added by CMS late last month probably won't add too much of an additional reporting burden on most hospitals. Most of the 13 added indicators are already calculated from Medicare billing information. But by adding these 13 requirements, CMS is sending a clear message to hospitals that data reporting is the way of the future, and many in the industry believe these new mandates are the tip of the iceberg. There may come a day when a hospital will have to choose between hiring an additional nurse for the intensive care unit, or an additional staffer to collect and report data.

Which will you choose?

Answering that question will no doubt be difficult. Hospital executives know how important reimbursement from CMS is to the financial health of a hospital, and they must do everything they can to position their organization to receive the appropriate amount. But on the other hand, making someone a data collector rather than a caregiver seems to go against the mission of any hospital. And as patients get more demanding, the care you offer them can also have a financial impact on your organization.

Studies have shown that patients remain unconcerned with data when it comes to healthcare, and they are even less interested when the data is something that they don't understand. Most patients, for example, don't know why the time between when a patient comes out of surgery and when he or she receives a beta blocker is important. What does matters most to patients is that they have a nurse who responds quickly when they hit the call button, gives them medication on schedule, and helps them out of bed to use the restroom. For patients, quality is receiving the care they need when they need it. And if they don't receive the care they want, they're likely to take their business elsewhere, and that of friends and family who hear about their poor hospital experience.

Thankfully, the 13 additional reporting indicators that CMS will require in this year's rule won't be significantly taxing to a hospital's resources. The new requirements are significantly less than the 43 the agency proposed earlier this year. However, I'm not convinced that the 30 requirements that didn't make this year's cut are gone forever. Down the road, CMS will place further reporting mandates on America's hospitals, and at some point, executives might have tough choices between patient care and the organization's financial wellbeing.

Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at
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