Medicare already provides a web site to let the public compare nursing homes on various metrics. It's time we had a similar site for hospice data.
I have to wonder why there isn’t a Hospice Compare already. Congress should say that's unacceptable. There should be a national hospice quality database because of the tremendous variation in quality. The hospice industry continues to operate in a pre-health care-transparency mode, but technology forces will drive another outcome. The name of the game with Health Information Technology these days is standardization of data flows and increased transparency for governmental data.
CMS isn't the only game in town, of course. But since Medicare pays for most hospice care, its already sitting on a gold mine of raw data. There are three types of metrics that could be used: descriptive data, cost data, and quality data.
- Descriptive data such as location, length of stay, annual death count, number of facilities, etc., are not debatable and could be included right away. We might disagree with what they mean, but at least we know what they are.
- Cost data is also easy (sort of), As an information technologist, when I see what Medicare is already doing with consolidation of existing data feeds, I believe they could decide to post hospice cost report data next week and call it Hospice Compare Version 1.0. It's not rocket science. If providers want Medicare to pay them, they have to fill out forms. Anything that goes on a form can wind up on a public web site. I'm sure if CMS did that hospices would be outraged, but then the hospice industry would have to negotiate with CMS to come up with a reporting system they liked better. What would follow would be healthy conflict.
- Quality is in the eye of the beholder, it seems. Several different approaches to quality metrics are under discussion within the hospice industry itself. Larry Bereford is working on a review of those approaches. What the hospice industry may not appreciate fully is that the drive for data transparency in government spending may accelerate the appearance of a Hospice Compare website designed without their control.
Other groups such as the Joint Commission also give out report cards, such as their new data on "most difficult" compliance metrics for various healthcare provider types (See: http://www.jointcommission.org/Library/jconline/jco_11_04_09.htm). Notice the absence of "Hospice" as a reporting category there. I wonder what it would take to change that?
