The Medicare Hospital Compare Update

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

In 2005, the US Centers for Medicare and Medicaid Services (CMS) began to participate in the Hospital Quality Alliance which makes information on hospital performance available to the public. Its goal is to help patients make informed decisions and improve hospital quality.

Neue Entwicklungen

In 2005, the Hospital Compare website only provided data on the treatment of heart attack, heart failure, and pneumonia (see also HPM report "The Medicare Hospital Compare Website"). The website has added three new measures:

• patients who receive phrophylactic antibiotics 1 hour before surgery, 
• patients who cease the use of phrophylactic antibiotics within 1 day after surgery; and 
• patients who have pneumonia receive antibiotics consistant with current guidelines.

One measure was modified to reflect current treatment guidelines - Acute Myocardial Infarction (AMI) patients who receive Percutaneous Coronary Intervention (PCI) within 120 minutes from hospital arrival time. Also, more data has been added to make better comparisons of rates. Changes to the overall presentation of the data has made it easier for viewers to navigate through the website. For example, users will now be able to view information for all hospitals, regardless of type, for a selected geographic region.

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral
current    previous

One of the main complaints after the implementation of the Hospital Compare website was that initially the website was not a good predictor of patient outcomes mainly because of the performance indicators that were used. With the addition of new indicators, the Hospital Compare website should result in being a better predictor of patient outcomes.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Initiators of idea/main actors

• Regierung: The CMS continues to make improvements to the Hospital Compare website which was first launched in April 2005.

• Leistungserbringer: Nearly all of the hospitals which treat Medicare beneficiaries currently report performance data for the website.

• Patienten, Verbraucher: Consumers will be able to view the information provided by the CMS website with the new changes.

Stakeholder positions

The views of the stakeholders have remained constant since the last reporting. The push for modifications to the Hospital Compare website has been by viewers of the website and research pushing for more effort to develop outcome measures.

Initially, Hospital Compare website users were critical about the layout and comprehensibility of the information on the website to the lay audience. However, Hospital Compare seriously considered these criticisms and has made the charts on the website more readable and has created mechanisms for users to easily compare data from different hospitals on the same page. According to the U.S. Department of Health and Human Services, in the April release of the website, users were unable to view and compare all hospitals in a geographic location, but rather had to perform separate searches according to hospital type. [1]This has been corrected.

[1]"What Was New or Different in the June 2007 Release of Hospital Compare?" HHS.Gov. 13 July 2007. U.S. Department of Health & Human Services. 30 Nov. 2007 www.hhs.gov/faq/healthprograms/hospitalcompare/956.html.

Actors and positions

Regierung
Medicare	sehr unterstützend		stark dagegen
Leistungserbringer
Hospitals	sehr unterstützend		stark dagegen
Patienten, Verbraucher
Patients/Consumers	sehr unterstützend		stark dagegen
AARP	sehr unterstützend		stark dagegen
current    previous

Influences in policy making and legislation

Changes have been made to the Hospital Compare website which reflect the criticisms that many users had. There has been an increase in data to better compare rates. The website will continue to update its data with information it recieves each quarter as well as the addition of new measures over time.

Congress is discussing focusing research on comparative effectiveness rather than current research that looks simply at whether or not technologies are effective.

Legislative outcome

Enactment

Actors and influence

Regierung
Medicare	sehr groß		kein
Leistungserbringer
Hospitals	sehr groß		kein
Patienten, Verbraucher
Patients/Consumers	sehr groß		kein
AARP	sehr groß		kein
current    previous

Positions and Influences at a glance

Adoption and implementation

At the beginning of the process, many hospitals were slow and reluctant to report performance data. However, after additional reimbursement was given to hospitals who participated in disclosing data, participation in the data collection increased significantly. Now almost 100% of hospitals participate in data reporting; hopefully public exposure of this data may urge hospitals to achieve higher standards.

Monitoring and evaluation

Although research has shown that there have been no significant improvements and that the Hospital Compare website is not a good predictor of hospital care, improvements are slowly being made. One study showed that the performance measures that had been initially published on the website were not tightly linked to patient outcomes and efforts must be made to do so. The Hospital Compare website has added more performance indicators and will do so continuously after careful evaluation.

Other improvements that have been made include the display of information and the overall website navigatebility for viewers.

Expected outcome

The Hospital Compare website represents an example of reporting data on quality from hospitals. However, many argue that the data that was initially presented on the website was not "user-friendly" in that it was hard to make comparisons among hospitals. Secondly, the performance indicators that were first displayed were limited and studies showed that these performance measures were not tightly linked to patient outcomes.

In 2007, the CMS made changes to the Hospital Compare website by adding data and new performance measures, as well as making the display of information easier to read. For example, comparisons can now be made by selecting "type of hospital" and there is a link to a glossary of terms.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch
current    previous

This website was one of the first of its kind to publish data on hospital performance. As more performance measures are added to the website, the Hospital Compare website should become a better tool in allowing patients to assess hospital performance.The website will continue to have a significant impact in both access to hospital data and ultimately achieving higher standards of health care.

References

Sources of Information

Bolger, Ann, Loren Hiratzka, Harlan Krumholz, Russel Luepker, Eric Peterson, and Veronique Roger. CMS Mortality Reporting and Your Hospital. American Heart Association. 6 Sept. 2007.

Werner, Rachel M., and Eric T. Bradlow. "Relationship Between Medicare's Hospital Compare Performance Measures and Mortality Rates." The Journal of the American Medical Association 296 2006. 2694-2701.

U.S. Department of Health and Human Services. "What Was New or Different in the June 2007 Release of Hospital Compare?" 13 July 2007. 6 Sept. 2007. www.hhs.gov/faq/healthprograms/hospitalcompare/956.html.

Author/s and/or contributors to this survey

Das, Kristina and Gerard F. Anderson

Johns Hopkins Bloomberg School of Public Health

Empfohlene Zitierweise für diesen Online-Artikel:

Das, Kristina and Gerard F. Anderson. "The Medicare Hospital Compare Update". Health Policy Monitor, October 2007. Available at http://www.hpm.org/survey/us/b10/2