Medicare Providers to be Rated

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Tuesday | June 5, 2001

Medicare providers to be rated Public to get scores on nursing homes, hospitals, doctors 06/05/2001 By Ceci Connolly / Washington Post WASHINGTON – The federal government is planning for the first time to issue detailed ratings of the quality of care provided by nursing homes, Medicare health plans, dialysis centers and eventually hospitals and doctors, a senior Bush administration official announced Monday. The Health Care Financing Administration, using newspaper advertisements, the Internet and toll-free telephone numbers, plans to release numerical scores for every Medicare provider four times a year based on a half-dozen criteria, ranging from medical credentials to staffing levels.

Relying on both government inspections and customer surveys, the plan would provide the most comprehensive, objective evaluation of health care providers, going beyond the limited information currently available to consumers.

"Collecting data and publishing it changes behavior faster than anything else," Scully said Monday in his first speech as head of the agency that oversees Medicaid and Medicare.

Similar to the publishing of automobile crash test data, the plan has far-reaching – and controversial – implications for millions of Americans and for an industry that has been slow to adopt standardized quality measurements.

Proponents say scorecards will help consumers to aggressively shop for health care. Even more significantly, consumer-friendly, numerical ratings appear to be the best way to force the health care industry to raise its standards.

Provider interest "There is a lot of evidence that the people who use this type of information the most are providers," said -Ann DeParle, former head of the Health Care Financing Administration. "They look to see how they are doing versus other providers."

Representatives of health care groups, however, questioned the plan, saying the government's data could be misleading because it fails to consider factors such as whether facilities treat a sicker patient population. For such reasons, groups representing doctors, hospitals and other health care providers have opposed the release of such ratings.

The federal government spends about $300 million a year collecting information on the thousands of health providers that serve the 70 million people in Medicare and Medicaid. But the data have never been presented in an easy-to-understand way by geographic region.

Mr. Scully said the new approach also should help government inspectors focus on poor-performing facilities.

"Bad actors should be inspected a lot more frequently," he said during a luncheon address at the U.S. Chamber of Commerce. It is illogical, he argued, to inspect safe, high-quality, nursing homes as often as the decrepit, dangerous ones. If a facility scores poorly, he warned, "we'll be in there every day."

Details of the proposal are still being worked out, but agency staff members said they are confident the agency has the data, money and authority to move quickly.

Mr. Scully said he hopes the effort will enable Americans to open their newspapers and scan scores for every nursing home or dialysis clinic in their communities, comparing costs, client profiles, staff credentials, medical treatments and customer satisfaction.

"HCFA already collects a fairly substantial amount of data," he said, predicting the agency will settle on a list of criteria "fairly quickly and start using it." He said he hopes to add ratings for hospitals within a year and for physicians after that.

Spokesmen for the nursing home industry said they have no complaint with objective, quality scoring. But they said the data now available are at best insufficient and perhaps misleading.

The information the HCFA collects is a collection of lists, said Larry Minnix, chief executive officer of the American Association of Homes and Services for the Aging, which represents 5,600 not-for-profit health centers for the elderly.

For instance, government reports indicate how many patients at a particular facility had bedsores on a particular day, "but it does not tell you if they take more of those patients or if the home has a particular program for treating those wounds," Mr. Minnix said, suggesting it would take two to four years to develop a workable rating system.

Carmela Coyle, senior vice president for policy at the American Hospital Association, warned that quality data must be given in the proper context. She noted that several years ago, the government published hospital mortality rates. But the rates did not factor in whether a hospital served a high-risk population or whether it performed experimental treatments.

"Measuring quality is important," she said. "But quality measurement must be valid, it must be reliable, meaningful and responsible."

Agency overhaul Mr. Scully said the ratings plan is part of a broader overhaul of his agency. By the end of the month, he and Health and Human Services Secretary Tommy plan to revamp the agency, from its name to how it markets programs.

For example, the agency is planning an aggressive fall ad campaign targeted at Medicare recipients. The goal is to enroll 30 percent of America's retirees in Medicare's managed-care program, dubbed Medicare+Choice. Currently, about 15 percent of the 40 million Medicare clients are in such plans.

Martha Murdock, DirectorNational Silicone Implant FoundationDallas, Texas Headquarters

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