Medicare Compliance & Reimbursement

CMS chief Tom Scully isn't happy about early results on voluntary reporting.  Last December's agreement by the hospital industry to begin voluntary reporting of quality data bore its first tangible fruit Oct. 9, when industry and government officials and other stakeholders unveiled a Web site featuring 10 quality measures on treatment of heart attacks, heart failure, and pneumonia. But in a statement on the site, Centers for Medicare & Medicaid Services Administrator Tom Scully said he was "extremely disappointed" in the level of hospital participation. He warned that "unless participation increases significantly and soon, we will have to consider" mandatory reporting by hospitals. Initial metrics for the "National Voluntary Hospital Reporting Initiative" come from the ORYX data set that hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations already submit to JCAHO. Examples include how often heart-attack victims receive aspirin and beta blockers at admission and at discharge, and how much time passes before pneumonia patients receive their first antibiotic treatments. Four-hundred-and-fifteen hospitals currently have data for at least one of the ten initial measures. Industry representatives said over 1,700 hospitals have pledged to participate, but most did not meet the mid-July cut-off for getting data to CMS. The 415 reporters represent about ten percent of the 4,141 acute-care hospitals of over 25 beds eligible to participate, although only the 3,424 JCAHO-accredited hospitals could participate in this first stage, which uses JCAHO data. The next posting, in February, will utilize information from CMS' clinical data warehouse, allowing all eligible hospitals to participate. Barbara Paul, director of quality management at CMS, said her boss has not set a fixed minimum number of hospitals that must report by February, but needs to see "some real significant improvement" to be convinced that voluntary reporting is working. She acknowledged that some hospitals experienced technical problems but said that, for the most part, the 3,400 JCAHO hospitals could have posted data if their leadership had made the commitment. To see more information on the quality reporting initiative, go to www.cms.hhs.gov/quality/hospital/. Lesson Learned: If more hospitals don't voluntarily report quality data, a mandatory reporting requirement may be in the offing.