Patient Information Bill Criticized

The Des Moines Register described it

The article below entitled "Hospitals, regulators in battle over rules" may help explain, at least in part, why Iowa is so far behind other states in meaningful health care transparency... and heading in the wrong direction with this pending legislation. The Iowa hospital and medical industry lobbyists are strong and at work...unfortunately not in the public's best interest. Unless something changes, they will continue to get their way. The Director of the Iowa Department Inspections and Appeals is stepping up for the public. Where are the Director of the Department of Public Health and our other state officials?

Read the Article »

Note: Pay special attention to the readers' reactions to the story above at the end of the article.

Healthcare Reforms: Require Reporting of Errors, and Other Measures of Quality

It will promote public reporting of quality performance measures and create public awareness to educate consumers on smart health-care choices..."

Read Garth Bowen's complete article, which appeard in the March 25th Des Moines Register, by clicking no the link below »

Bowen Opinion »

Iowa State Legislative Briefing

Iowa Health Buyers Alliance, 2008

Numerous state initiatives are underway across the U.S. aimed at improving health care quality, patient safety, and the overall value of health care. Efforts focus on measuring and reporting to the general public quality and efficiency results of both hospital and physician performance. This type of public information is important for patients and their families, employers and other buyers. Since taxpayers pay a hefty chuck of costs through Medicare and Medicaid, hospitals and other providers should be held publicly accountable for the care they deliver. Requiring publication of quality and efficiency measures provides additional incentive for hospitals and other providers to implement practices that can reduce errors and otherwise improve quality and drive-out cost. There are many state efforts underway in the area of provider performance measurement and publication many of which support The Leapfrog Group. The Leapfrog Group is a national organization driven by health care buyers who are working to initiate breakthrough improvements in the safety, quality and affordability of health care for Americans.

Summary of state purchasing and public reporting efforts:

Minnesota: 1) Minnesota’s Smart Buyers Alliance which MN’s Governor has endorsed since 2004 is a coalition of public and private purchasers demanding quality and efficiency in health care. The State of Minnesota has joined private business and labor groups to drive quality improvements and efficiencies in the health care delivery system. The Governor also recently initiated Q-care which lays out hospital quality improvement and reporting benchmarks and factors in Leapfrog measures among other performance measures. 2) Minnesota adopted legislation in 2004 on public reporting of Adverse Health Events Reporting (“Never Events”). Minnesota was the first state to publicly report these results.

Maine: The State of Maine implemented an employee benefit program designed to encourage their covered people to choose Leapfrog-reported hospitals.

Massachusetts: The Massachusetts Group Insurance Commission (CIC) leads a Regional Roll-Out for Leapfrog; has a pay-for-performance program in place with its contracted health plans to encourage Leapfrog reporting; and posts Leapfrog data on its Website. The CIC lead in value-driven purchasing has informed the state’s recently enacted health care reform legislation.

Florida: The State of Florida leads the nation in public reporting of health care information to residents. Their website provides information on costs, quality and errors in hospitals. Florida adopted mandatory hospital infection reporting in 2004. In November 2005, Florida became the first state to publicly report infection and mortality rates in each hospital.

Pennsylvania: The Pennsylvania Health Care Cost Containment Council recently reported on the high costs of infections in both dollars and lives. Also, Medicaid in Pennsylvania has a hospital pay-for-performance program in place that incorporates some of Leapfrog measures.

Ohio: By the middle of 2007, consumers will be able to go to the Ohio Department of Health’s website to compare Ohio hospitals costs and quality of care. Governor Taft signed legislation to force hospitals to provide more information about the quality of medical care they provide and how much it costs (about 15 states have approved similar legislation); the State also leads Regional Roll-out for Leapfrog in Columbus.

Washington: Washington leads a Regional Roll-out for Leapfrog.

Connecticut: Connecticut adopted ”never events” legislation.

Indiana: Indiana initiated a new medical errors reporting requirement with its hospitals and cited Leapfrog.

The following states adopted mandatory reporting of hospital infections: California, Colorado, Illinois, Maryland, Missouri, New York, New Hampshire, Pennsylvania, Rhode Island, South Caroline, Tennessee, Virginia, and Vermont.

New Jersey: The state of New Jersey adopted “never events” legislation and is an active member of The Leapfrog Group.

Wisconsin: The Wisconsin Department of Employee Trust Funds is very active with the Leapfrog Roll-Out and has a pay-for-performance program in place with its contracted plans incenting them to encourage Leapfrog reporting.

Recommended Iowa Actions

1) Iowa Quality Purchasing Program Establish an Iowa quality purchasing initiative involving the State of Iowa as a purchaser and other public and private purchasers.

2) Four Cornerstones of Value-Driven Heath Care The State of Iowa through the Department of Administrative Services and the Department of Human Services (Medicaid) adopt and use the common set of RFI/RFP questions included in the HHS Four Cornerstones of Value-Driven Health Care, Version 1.0.

3) Support The Leapfrog Group and Co-sponsor Iowa Leapfrog Group Roll-Out The Leapfrog Group is a national initiative driven by organizations who buy health care who are working to initiate breakthrough improvements in the safety, quality and affordability of health care for all Americans.

Currently there are over 1,200 U. S. hospitals publicly reporting to The Leapfrog Group’s Hospital Quality and Patient Safety Survey. Only one (1) Iowa hospital reports, Genesis Medical Center in Quad Cities. The bordering states of KS, MO, MN, IL, and WI all include formal roll-outs of The Leapfrog Group survey. Leapfrog fields a voluntary online hospital quality and safety survey and states across the country are playing their part to encourage hospitals to report to the survey and other public reporting initiatives.

The Leapfrog Group measures are becoming main-stream as they are now endorsed by the National Quality Forum (NQF) and recently included in the U. S. Department of Health and Human Services Four Cornerstones of Value-driven Health Care’s RFI. Many states have led the way or have provided leadership in Leapfrog Regional Roll-outs. It’s time for Iowa to join-in on this important effort.

4) Enact Adverse Health Events Reporting (“Never Events”) Legislation Minnesota adopted legislation in 2004 under which its Department of Health is required to track and report on the occurrence of 28 serious medical errors that should never happen. These “never events” include leaving medical instruments in patients, surgery on the wrong body part, and a range of other events. It is being saluted as a major step forward to improve the quality of care for all Minnesotans.

While Minnesota is the first state to take action and actually report publicly on these standards developed by the National Quality Forum (NQF), they are being joined by others including New Jersey and Connecticut. Many other states are considering such action. Iowa should do so as well.

5) Enact Health Infection Reporting Legislation Hospital infections are the fourth leading cause of death in the United States according to the National Center for Disease and Prevention (CDC). Based on information from the CDC, the Consumers Union reports that every year two million Americans develop infections while in the hospital and an estimated 90,000 die as a result. The remainder often endures prolonged hospital stays and sometimes suffers lasting health problems. Recently, treatment of healthcare-associated infections has become more complex due to an alarming rise in antibiotic resistance.

The Iowa Healthcare Collaborative is working on a proposal for action: Healthcare Associated Infections (HAI). Their strategy is to employ a provider led voluntary exercise in self-reporting and clinical process improvement to accelerate the spread of best practice in Iowa.

Iowa legislation could recognize and couple these efforts with mandatory public reporting.

The Importance of Quality, Patient Safety and Transparency

Information about Iowa health care providers’ quality and patient safety performance, price and other information is essential. Transparency of this information has proven to be an important catalyst for improvement in health care. It is also important for consumers, patients and their families. Listed below are some examples of quality, patient safety and waste in health care issues:

  • Rand: Only 50% chance of getting the right care when visiting the doctor’s office.
  • Institute of Medicine (IOM): 98,000 preventable deaths in hospitals each year. In 2004 Health Grades reported this number to be 195,000 people, almost twice the number from the 1999 IOM report.
  • Center for Health Transformation: You are 2,000 times more likely to die in the hospital from a mistake than in an airplane.
  • The Leapfrog Group: The 1st three Leaps can save 58,300 preventable deaths and multiple times this # of disabilities; 522,000 medication errors; and at least $ 9.6 billion per year.
  • The Juran Institute/Midwest Business Group on Health: 30%+ of health cost due to poor quality/ineffective care.
  • Consumers Union: Every year, two million Americans develop infections while in the hospital and an estimated 90,000 die as a result. The remainder often endures prolonged hospital stays and sometimes suffers lasting health problems.
  • John Toussaint, MD, CEO of ThedaCare, Appleton, Wisconsin: “About 70% of what we do is non-value-added (waste).” (Institute for Health Care Improvement (2-16-05)). Note: Lean experts estimate 60% waste in health care.
  • The Institute of Medicine: “Between the care we have and the care we could have lays not just a gap, but a chasm. The current care systems cannot do the job. Trying harder will not work. Changing the systems of care will.” (Institute of Medicine’s: Crossing the Quality Chasm)
  • Pennsylvania Governor Rendell launched a new program in January, 2008 through the Department of Public Welfare to identify and stop payments for care related to preventable hospital errors. The state also will prohibit hospitals from charging patients for such errors.
  • Pennsylvania Health Care Cost Containment Council: During 2005 the sates hospitals reported 19,154 cases in which patients contracted hospital-acquired infections. The hospitalizations resulting from these infections amounted to 394,129 days and $3.5 billion in hospital charges. The average hospital charge for patients with hospital-acquired infections was $185,268 while the average charge for patients without hospital-acquired infections was $31,389. The average length of stay for patients with hospital-acquired infections was also longer at 20.6 days, compared with 4.5 days for those who didn’t contract hospital infections. Most telling, though, was the figures on patient deaths. The report said that while 2.3% of patients who didn’t acquire infections died, the mortality rate for those who did contract infections was 12.9%--- more than 5 ½ times higher.

For more information:
Iowa Health Buyers Alliance
100 Court Avenue, Suite 215
Des Moines, Iowa 50309