The consumer website called Hospital Compare, www.hospitalcompare.hhs.gov, was unveiled on April 1, 2005. This resource provides instant, objective, easy-to-use and free information about the quality of hospital care in Colorado and nationwide. Under the Hospital Quality Initiative, hospitals voluntarily submit quality of care information so that consumers can compare care and make better-informed decisions. Hospital Compare was created by the Centers for Medicare & Medicaid Services (CMS) and the Hospital Quality Alliance, a public-private collaboration.

Quality Measures

The 24 quality measures, which are based on established guidelines, have gone through years of extensive testing for validity and reliability by CMS and the Medicare quality improvement organizations (QIOs), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and researchers. The National Quality Forum (NQF), a voluntary standard-setting consensus-building organization representing providers, consumers, purchasers, and researchers, has endorsed these measures.

Benefits of Participation

Hospitals benefit from publicly reporting quality of care information in several ways. Participation helps hospitals to highlight their successes and to identify and focus on areas for improvement in quality of care, as well as using national and local benchmarks to assess performance. Hospitals also have the opportunity to give consumers important information about quality of care to help them compare and make informed decisions. In addition to these benefits, hospitals receive technical assistance and hands-on training in submitting data and improving quality from quality improvement organizations (QIOs).

Which Hospitals Should Participate?

Most hospitals are subject to the RHQDAPU Initiative. They are designated as 'subsection d hospitals' and are defined in the Social Security Act under Section 1886(d)(1)(B).
Data is now available on Hospital Compare at www.medicare.gov or www.hospitalcompare.hhs.gov (links opens new windows).

Participation Information

The American Hospital Association (AHA), the Federation of American Hospitals (FAH), and the Association of American Medical Colleges (AAMC) have launched a national voluntary initiative to collect and report hospital quality performance information. This effort is intended to make critical information about hospital performance accessible to the public and to inform and invigorate efforts to improve quality. Voluntary reporting is an essential first step to realize this goal. This project builds upon previous CMS and QIO strategies to identify illnesses and/or clinical conditions that affect Medicare beneficiaries in order to: promote the best medical practices associated with the targeted clinical disorders; prevent or reduce further instances of these selected clinical disorders; and prevent related complications.

Objectives of the HQA

• Refine and standardize hospital data transmission and performance measures
• Provide useful and valid clinical information to the public
• Provide hospitals with a sense of predictability about public reporting expectations
• Stimulate improvement in hospital quality of care

HQA Measures

• AMI
  o Aspirin at arrival
  o Aspirin at discharge
  o Beta-blocker at arrival
  o Beta-blocker at discharge
  o ACE or ARB for LVSD
  o Percutaneous coronary intervention within 90 minutes of arrival
  o Fibrinolytic therapy received within 30 minutes of arrival
  o Adult smoking cessation advice/counseling
• HF
  o Left ventricular function assessment
  o ACE or ARB for LVSD
  o Discharge instructions
  o Adult smoking cessation advice/counseling
• PN
  o Initial antibiotics received within 4 hrs of hospital arrival
  o Pneumococcal vaccination
  o Oxygenation assessment
  o Blood culture before antibiotic
  o Adult smoking cessation advice/counseling
  o Influenza Vaccination
  o Initial antibiotic selection for CAP in immunocompetent patient
• Surgical Complication Improvement
  o Timing of prophylaxis antibiotic
  o Selection of antibiotic
  o Duration of prophylaxis
  o Recommended venous thromboembolism prophylaxis
  o Appropriate venous thromboembolism prophylaxis within 24 hours prior to surgery to 24 hours after surgery
  o Immediate postoperative normothermia

Comparison of CMS, JCAHO, and HQA Measures

CMS Timeline

Visit QualityNet or AHA for more information on Hospital Public Reporting.

The intent of the HCAHPS initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. While many hospitals currently collect information on patients' satisfaction with care, there is no national standard for collecting or publicly reporting this information that would enable valid comparisons to be made across all hospitals. In order to make "apples to apples" comparisons to support consumer choice, it is necessary to introduce a standard measurement approach. HCAHPS can be viewed as a core set of questions that can be combined with a broader, customized set of hospital-specific items. HCAHPS is meant to complement the data hospitals currently collect to support improvements in internal customer services and quality related activities.

To learn more about HCAHPS, please visit the following website:

http://www.hcahpsonline.org/

For information and technical assistance, contact the Arizona QIO: hcahps@azqio.sdps.org or 1-888-884-4007.

The Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) initiative was initially developed as a result of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003. Section 5001(a) of Pub. 109-171 of the Deficit Reduction Act (DRA) of 2005 set out new requirements for the RQHDAPU program, which build on the ongoing voluntary Hospital Quality Initiative.

That initiative is intended to equip consumers with quality of care information to make more informed decisions about their health care, while encouraging hospitals and clinicians to improve the quality of inpatient care provided to all patients. The hospital quality of care information gathered through the initiative is available to consumers on the Hospital Compare website.

The RHQDAPU initiative requires "sub-section (d)" hospitals to submit data for specific quality measures for health conditions common among people with Medicare, and which typically result in hospitalization. For fiscal year 2008, CMS requires that hospitals submit data regarding 27 quality measures. The data collected encompasses the following conditions: acute myocardial infarction, heart failure, pneumonia, surgical care improvement, 30-day mortality rates for acute myocardial infarction and heart failure patients, and the patients? experience of care through the HCAHPS patient survey.

Hospitals that do not participate in the RHQDAPU initiative will receive a reduction of 2.0 percent in their Medicare Annual Payment Update for fiscal year 2009. To avoid the reduction in their Annual Payment Update, hospitals must meet specific requirements outlined in the RHQDAPU participation steps (Reference Checklist) for FY 2009, PDF.

Visit QualityNet for additional RHQDAPU Information (link opens a new window).

For information on Hospital Public Reporting contact:

Michelle Mills, Project Director, at 303.847-1727, mmills@coqio.sdps.org  or
Marcy Cameron, Project Assistant, at mcameron@coqio.sdps.org or 303.695-3300, ex.3040.