Transparency at Our Hospitals

Ten years ago, the idea of tying Medicare or Medicaid reimbursements to hospitals’ performance on specific clinical measures would have been unthinkable. Today, not doing it is unthinkable.

Having worked in the hospital and healthcare industries for decades and in many states, we have seen firsthand how others approach quality improvement efforts. What business leaders, opinion makers, and patients in Massachusetts need to know is that — far and away — hospitals here are leading the nation when it comes to taking on quality improvements efforts. The type of work underway to improve patient safety through increased transparency and public reporting is unlike anything going on around the country. And it is voluntary.

Well before federal Medicare officials announced their recent plan to no longer pay for certain preventable hospital errors, including falls and pressure ulcers (or bedsores), Bay State hospitals were collecting data in these very areas. This week, Massachusetts hospitals, using a consumer-friendly Web site, started reporting data on falls to the public and will unveil bedsore data later this year.

Also, while the Institute for Healthcare Improvement is urging hospitals nationwide to get trustees more involved in the quality and safety agenda, Massachusetts hospitals, through a grant from the Blue Cross Blue Shield Foundation, are developing a model trustee curriculum that is being piloted around the state.

This is not just a sampling of hospitals or a majority of our healthcare facilities. One hundred percent of hospitals in Massachusetts are reporting their numbers, sharing best practices with one another, and implementing new clinical protocols. We are finding that transparency and openness breed new conversations, a heightened focus on correcting problem areas, and ultimately, improved care.

It is not just the federal government looking at ways that payments can move the needle on hospital quality. In August, the Medicaid program in Massachusetts also introduced plans to make the payment-quality connection. Unlike the federal government’s plan to withhold payment for hospital errors, the state, in partnership with Massachusetts hospitals, developed a “pay for performance” initiative, which in effect gives hospitals an added bonus for a job well done in certain areas.

Under the plan, hospitals in Massachusetts can earn bonuses totaling $20 million for more effectively managing such concerns as pediatric asthma, pneumonia, surgical infections, and racial and ethnic health disparities. In many of these areas, hospitals are already reporting and being transparent with the public about how they are doing. The last item, health disparities, is new and exciting territory for payers to be involved in. For years, hospitals — particularly

those in urban areas — have been retooling their delivery systems to meet the changing needs of a diverse patient population. Interpreters and disease prevention programs aimed at curbing illnesses more prevalent among certain minority populations have been the norms for Massachusetts hospitals. Under the new Medicaid regulations, all hospitals will have an added incentive to look more closely at the issue and will be rewarded for a job well done.

Why have Massachusetts hospitals placed such an emphasis on being open with the public? The single most important reason is that we owe it to our patients. Having a loved one hospitalized can be a heart wrenching and stressful time. Reducing the number of questions around healthcare quality can inform and ease the minds of our patients. Also, as transparency efforts become the standard in Massachusetts, the industry will take the lead in managing healthcare costs, a goal we can all support.

Virtually anywhere you look in this country you can find easily accessible performance information in many different industries. An airline’s on-time arrival performance or your local school’s standardized test results are two good examples. It is only common sense that information on how well your local hospital treats certain illnesses should be there for you to look at as well.

Lynn Nicholas is president and chief executive of the Mass. Hospital Assoc. Robert Norton is president and chief executive of North Shore Medical Center. This article first appeared in the Boston Globe.