Forcing Transparency?

Maureen Larkin, for HealthLeaders Media, April 24, 2008

In what appears to be a push to transparency, the Centers for Medicare and Medicaid Services wants to add 43 more indicators to the list of quality measures that hospitals are required to report on if they are to receive the full update to their fiscal year 2009 payment rates. Last week I wrote about how CMS’ new list of proposed “never events” will affect hospital reimbursement for 2009, but these 43 new quality measures promise to have an equally big effect.

Earlier this year I had a chance to speak with hospitals that are leading the transparency movement. They’ve embraced their data and made them a part of their hospital experience -- offering the information online for consumers to examine before they even walk in the door. The majority of them told me that when they started sharing data, the CMS core measures were the first to be posted. The data were there, they had to be collected, and they were valid, so why not share them with consumers?

Maybe that’s what CMS is hoping for. By increasing the number of indicators, and therefore the effort to collect and report data, does CMS think that hospitals will just say, “Oh, what the heck, let’s be transparent?” After all, the information will be available on CMS' site, and as those transparency leaders told me, once it’s there, consumers will have questions. Those who are interested in helping consumers understand these data will have to post it on their own site—along with explanations of why they are relevant to the consumer and what the hospital is doing to maintain a good score or improve a poor score.

Norton Healthcare is one organization that has taken the lead in transparency. Its data reporting story started as an internal improvement process, in which it used CMS indicators to improve quality at its four hospitals. But its leaders believed that true transparency was the best strategy for the organization and before long, consumers were able to access the organization’s CMS measures and other publicly reported scores on Norton’s Web site.

When I interviewed him a few months ago, Norton’s Vice President of Medical Affairs Steve Hester told me why it is so important for hospitals to not only report data to CMS, but take the lead and explain the information on their own Web sites. “I think education is the key piece—as it is with so many things in our society. I can present lots of data, but unless I educate the user, it is of little value,” he says.

There are many organizations out there that have resisted transparency for one reason or another. They may question whether consumers will be able to understand the data, or have interest in it. Others—in many cases the nation’s smallest hospitals—have avoided it because it’s simply too much for their already small administrative staffs to handle. But if this CMS proposal goes through later this year, every hospital will have to start paying more attention to its data if it wants to get paid.

CMS must believe that consumers are paying attention and with its new proposed quality measures, its forcing hospitals’ hands when it comes to transparency. How will your organization respond to these proposed reporting requirements? Who will take on the burden of collecting and organizing these data? Will you take the extra step to post them for consumers to view? I’m interested to hear how you think CMS’ proposal will change the way data is viewed at your hospital.

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