Discussion of Outcomes Reporting Options
OUTCOMES REPORTING STATES: All 50 states report CMS healthcare process measures, and will likely support participation in the Physician Voluntary Reporting Program that includes similar process measures and that started in January 2006. However, the 13 States identified here provide extensive outcomes reporting that extends well beyond the processes of healthcare. The States include:
- Cardiac Procedures for facilities & physicians (CA, NJ, NY, PA)
- Cardiac Procedures identifying facilities only (MA, OH, OR, RI, VA)
- Non-cardiac Procedure facility-identified Outcomes (CA, IL, OH, PA, RI)
- AHRQ Inpatient Quality Indicators - IQIs (CO, ME, NY, TX)
13 States report outcomes in at least one of 4 categories. 3 of 4 States with AHRQ Inpatient Quality Indicator (IQI) reporting programs are private/public collaborations (Colorado, Maine, New York), and Oregon's cardiac surgery outcomes reporting is a voluntary, physician-driven, private initiative that is endorsed by the Oregon Medical Association with participation of 10 of the State's 12 heart surgery programs. All other outcomes reporting programs are mandatory programs under State control.
States with Multiple Outcomes Reporting Programs
Five (5) of these 13 outcomes reporting States (CA, NY, OH, PA, RI) report more than one type of outcome and are represented in the interactive States map and in the table above. New York has both public-mandated reporting of Cardiac Outcomes and collaborative public/private reporting of AHRQ's Inpatient Quality Indicators by the Niagara Health Quality Coalition. California, Ohio, Pennsylvania, and Rhode Island have reported both cardiac and other procedure-related or diagnostic group outcomes.
- • Cardiac Procedure Outcomes Reporting (9 States)
- ◊ Heart-center Facilities and Physician Reporting (4 States)
Four states mandate reporting of coronary artery revascularization procedures for both heart-center facilities and for the physicians that perform these procedures, but these states differ in what is reported
- √ New Jersey: New Jersey publishes outcomes for coronary artery bypass (CAB) surgery and interventional coronary angioplasty on the DHHS website,
- √ New York: New York publishes outcomes for coronary artery bypass (CAB) surgery, valve surgeries, and interventional coronary angioplasty on the Department of Health (DOH) website,
- √ California: California publishes outcomes for CAB surgery alone on the OSHPD website,
- √ Pennsylvania: Pennsylvania publishes outcomes for CAB surgery only on the PHC4 website.
Facility-identified and physician-identified procedure outcomes are reported annually on the website for each state and public agencies have addressed outliers with remedial efforts.
Cardiac procedure reporting in these 4 States represents the ONLY instances across all States in which physician-identified outcomes are reported in a report card format.
- ◊ Heart-center Facilities Only Reporting (5 States)
- √ Massachusetts: Massachusetts publishes both cardiac surgery and percutaneous coronary angioplasty (PCI) annual reports.
- √ Ohio: Four of Ohio's 9 reportable Health Care Services include annual reports of adult heart catheterization, adult cardiac surgery, pediatric heart catheterization, and pediatric cardiac surgery.
- √ Oregon: The Oregon program is an entirely voluntary physician-led initiative that has participation of 10 of 12 State heart surgery programs that is endorsed by the Oregon Medical Association. Facility-identified data is available on the Health Data Research website [PDF].
- √ Rhode Island: Rhode Island published 3-5 year-old data in 2000 [PDF] and 1 year-old data in 2002 [PDF] for heart catheterization, angioplasty, and cardiac surgery. However, no subsequent reports of 2002-2006 data have been publicly reported.
- √ Virginia: Virginia Health Information (VHI) publishes annual cardiac reports that feature facility-identified ‘medical’, ‘invasive’, and ‘open-heart’ service lines.
- ◊ Heart-center Facilities and Physician Reporting (4 States)
- • Non-Cardiac Outcomes Reporting (5 States)
Facility-identified outcomes include procedure mortality and volume, at a minimum, and are reported for scattered non-cardiac procedures.
- √ Ohio: Ohio does not license hospitals but mandates reporting for 9 hospital Health Care Services. These risk-unadjusted self-reported mortalities are inconsistently and irregularly published. Nursing homes and 6 other licensed facility types report risk-unadjusted mortality and other outcomes.
- √ Illinois: Illinois' Hospital Report Card Act of 1994 mandates monitoring of Hospital Acquired Infection and neonatal/pregnancy outcomes.
- √ Rhode Island: Rhode Island has reported Neonatal ICU and heart/liver Transplantation outcomes [PDF], but none have been published since 2002.
- √ California: California's Hospital Outcome Project (CHOP) evaluates risk-adjusted mortality for myocardial infarction, hospital-acquired pneumonia, and other conditions, while CALICO evaluates ICU outcomes.
- √ Pennsylvania: Relative to other States, the Pennsylvania Health Care Cost Containment Council (PHC4) publishes the most extensive analyses of healthcare utilization and outcomes for multiple conditions.
The Agency for Healthcare Research and Quality introduced the Inpatient Quality Indicators (IQIs) in 2002, and they have been adopted as quality indicators in four states through 2006. Three of four states have collaborated in private/public partnerships to bring about public release of facility-identified data on the Internet. Texas's initiative was initiated and is managed entirely by a state authority.
- √ Texas: Texas is the only state that publishes IQIs under a public mandate. Beginning in 2004, the Texas Health Care Information Council (THCIC) began publication of the IQIs, using 2-year-old data, on the THCIC website. Facilities' role in data analysis is entirely passive following the UB-92 data submission that is sent to the THCIC.
- √ Colorado: Colorado is one of 3 states that publishes IQIs as a collaborative public/private collaboration. The Colorado Health Quality Initiative began in April 2005 under sponsorship of the Colorado Health and Hospital Association's Performance and Quality Group [PDF].
- √ New York: New York is one of 3 states that publishes IQIs in a collaboration between private stakeholders and public regulatory authority. The Niagara Health Quality Coalition has published the New York initiative since 2004, funded by the State and Alliance for Quality Health Care (AHRQ) sponsorship.
- √ Maine: The Maine effort is published by Health Web of Maine. The initiative is a collaboration between Maine Health Data Organization and the Phoenix Foundation of Portland, Maine. The website provides all 3 AHRQ quality indicators using 2002-03 Maine data, . . . i.e, Inpatient Quality Indicators (IQI), Patient Safety Indicators (PSI), and Prevention Quality Indicators (PQI).
37 States, plus the District of Columbia, do not report any facility-identified and/or physician-identified outcomes.