A new program announced by the American College of Cardiology (ACC) will make it possible for the public to access data submitted by hospitals to the National Cardiovascular Data Registry (NCDR) (J Am Coll Cardiol 2015;S0735-1097:07108-9). The program is voluntary and initially will focus on process measures from the NCDR’s percutaneous coronary intervention (CathPCI) and implantable cardioverter-defibrillator (ICD) registries. Gregory J. Dehmer, MD, who chairs the ACC’s public reporting advisory group, talked with Cardiovascular Business about the program and how physicians are responding to it.
Do you have a sense of what the participation rate will be?
We’re hoping participation will be very high. There are close to 2,000 facilities enrolled across the NCDR registries. The most recent data show about 215 unique facilities have signed up, and this is before we’ve even begun widely promoting the program. It’s important to note that the program will enroll facilities, not individual providers, because the NCDR collects data at the institutional level, not the provider level.
What has been the response from NCDR-enrolled hospitals and ACC members to public reporting and specifically to this new program?
A lot of people are interested in public reporting (see Figure). Policymakers are interested. Some insurance companies are interested and are collecting
their own data. There also are many independent organizations collecting data and producing public reports. But most of all, the public is interested. The last time you purchased an automobile or appliance, you probably looked online to see which ones had good or bad ratings. Deciding where to go for healthcare is probably a more important decision than what kind of refrigerator you buy. The interest in public reporting is a product of having so much information now available on the Internet.
As a group, physicians are a bit uncertain about this, and rightfully so. There is so much bad information out there, much of it based on administrative data or calculated by organizations using proprietary methods they won’t disclose. Administrative data were never intended for determining the quality of care. The flaws of administrative data when used for this purpose have been shown in several studies. Even though we are not reporting physician-level data, physicians are uncomfortable because such information has not been commonly available in the past.
|Patients, payers, policymakers/politicians and physicians are among the audiences interested in public reporting, although their reasons often differ. Source: J Am Coll Cardiol 2015;S0735-1097(15):07108-9.|
Would you prefer your patients didn’t comparison-shop for healthcare?
In the past, patients assumed the hospital or physician would provide the best care possible for their illness. Unfortunately, we now frequently see examples where that is not the case. Some facilities have higher complication rates for certain procedures or high rates of inappropriate procedures. We can no longer accept healthcare operating under a cloud of secrecy. Providing transparency may well promote comparison-shopping, but that has the potential to raise the bar for everyone.
Is the program intended to reassure the public about the quality of cardiovascular care?
I hope it will. While it makes some uncomfortable to provide public access to these data, we must accept that there is a growing desire for this information from the public. What used to be a profession that was viewed in the highest esteem has fallen several notches. The willingness of a facility to show what kind of job they’re doing deserves credit.
This program is not a popularity contest to see which facility is the best in the United States. What we’re trying to do is provide the public with information on the hospitals in their area. Suppose you have five hospitals to choose from in your area. If it turns out that all five are doing a wonderful job, that’s a great thing. Your community can know that, at least as far as the data we have, your local hospitals are doing a great job; no matter where they go, they will be well cared for.
Is there a plan to publicly report NCDR data at the provider level?
There is individual physician reporting on the Internet, such as through HeathGrades and Medicare’s PhysicianCompare website. One problem with that is demonstrated by the STEMI patient who will have care provided by the emergency department, the cath lab and the ICU. If there is an adverse outcome, it can be very difficult to achieve accurate attribution.
It will be a long time, if ever, before NCDR would drill down to that level. That doesn’t mean that reporting for a facility is not helpful. Individual facilities each have the responsibility to look at how they are doing and ask, “Whose job was that?” What you can see from reports at the facility level gives a sense of whether aspects of their process need to be improved. And if they improve, that’s what this is all about.
How will this program help facilities improve quality?
It’s like when the kids bring home report cards. You can see how they’re doing and determine how to help them where they’re not doing so well. If you don’t look, if you never got a report card, how would you know if they’re a genius or struggling? This is the same concept.
We’re going to encourage all hospitals to participate. There is some peer pressure. The opportunity to put scores out there allows facilities to show the public how they’re doing and provide reassurance to the public about the quality of care they provide.
Are there plans to expand reporting beyond PCI and ICDs?
Right now, we’ve limited our public reporting to measures endorsed by the National Quality Forum. We may use other metrics from the NCDR in the future. Considering the number of NCDR registries, the number of possibilities of things to report is substantial.
The other thing to consider is that it’s a disservice to the public to cover so many metrics that it becomes a bewildering display of information for the average person to assimilate. We’re looking now at developing composite metrics, modeled after the Society of Thoracic Surgeons composite score for CABG surgery. That will probably be the next announcement we make.
How does the program harmonize with value-based purchasing programs?
The value equation is quality divided by cost. We’re not focusing on cost, but we can provide incentives to drive up quality. It’s one way we can help improve patient care.