The federal government is planning for the first time to issuedetailed ratings of the quality of care provided by nursing homes,Medicare health plans, dialysis centers and eventually hospitals anddoctors, a senior Bush administration official announced yesterday.
The Health Care Financing Administration (HCFA), using newspaperadvertisements, the Internet and toll-free telephone numbers, plansto release numerical scores for every Medicare provider four times ayear based on a half-dozen criteria, ranging from medical credentialsto staffing levels.
Relying on both government inspection reports and customersurveys, the plan would provide the most comprehensive, objective wayto evaluate health care providers, going far beyond the limitedinformation currently available to consumers.
'Collecting data and publishing it changes behavior faster thananything else,' Thomas Scully said yesterday in his first speech ashead of the agency that oversees Medicaid and Medicare.
Similar to the publishing of automobile crash test data, the planhas far-reaching -- and controversial -- implications for millions ofAmericans, and for an industry that has been slow to adoptstandardized quality measurements.
Proponents say scorecards will help give consumers the power toaggressively shop for health care. Even more significantly, consumer-friendly, numerical ratings appear to be the best way to force thehealth care industry to raise its standards.
'There is a lot of evidence that the people who use this type ofinformation the most are providers,' said Nancy-Ann DeParle, formerhead of HCFA. 'They look to see how they are doing versus otherproviders.'
Representatives of health care groups, however, questioned theplan, saying the government's data could be misleading because itfails to take into consideration factors such as whether facilitiestreat a sicker patient population. For such reasons, groupsrepresenting doctors, hospitals and other health care providers havelong opposed the release of such ratings.
The federal government now spends about $300 million a yearcollecting information on the thousands of health providers thatserve the 70 million people in Medicare and Medicaid. But the datahas never been presented in an easy-to-understand way.
Scully said the new approach should also help governmentinspectors focus on poor-performing facilities. 'Bad actors should beinspected a lot more frequently,' he said during a luncheon addressat the U.S. Chamber of Commerce. It is illogical, he argued, toinspect safe, high-quality, nursing homes as often as the decrepit,dangerous ones. If a facility scores poorly, he warned, 'we'll be inthere every day.'
Details of the proposal are still being worked out, but HCFA staffmembers said they are confident the agency has the data, money andauthority to move quickly.
Scully hopes the effort will enable Americans to scan a list ofscores for every nursing home or dialysis clinic in the community,comparing cost, client profiles, staff credentials, medicaltreatments and customer satisfaction.
'HCFA already collects a fairly substantial amount of data,' hesaid, predicting the agency will settle on a list of criteria 'fairlyquickly and start using it.' He hopes to add ratings for hospitalswithin a year and for physicians after that.
Spokesmen for the nursing home industry said they have nocomplaint with objective, quality scoring. But they said the data nowavailable is at best insufficient and perhaps misleading.
The information HCFA collects is essentially a collection oflists, said Larry Minnix, chief executive officer of the AmericanAssociation of Homes and Services for the Aging, which represents5,600 not-for-profit health centers for the elderly.
For instance, government reports indicate how many patients at aparticular facility had bedsores on a particular day, 'but it doesnot tell you if they take more of those patients or if the home has aparticular program for treating those wounds,' Minnix said,suggesting it would take two to four years to develop a workablerating system.
Carmela Coyle, senior vice president for policy at the AmericanHospital Association, warned that any quality data must be given inthe proper context. She noted that several years ago, the governmentpublished hospital mortality rates. But the rates did not factor inwhether a hospital served a high-risk population such as those inpoor neighborhoods or performed experimental treatments -- both ofwhich could elevate the rates.
Scully said the ratings plan is part of a broader effort tooverhaul his agency. By the end of the month, he and Health and HumanServices Secretary Tommy G. Thompson plan to revamp virtually everyaspect of the agency, from its name to how it markets programs.
For example, the agency is planning an aggressive fall ad campaigntargeted at Medicare recipients. The goal is to enroll 30 percent ofAmerica's retirees in Medicare's managed-care program, dubbedMedicareChoice.
