December
2002
Volume 26 •
No. 11
Stanford gets high marks in managed-care plan's quality report
Promotion criteria clarified for professoriate
School of Medicine faculty and staff physician rank structure
SHC readies for madate requiring outcomes data on coronary bypass
Santa Clara County hospitals adopt uniform emergency codes
Dr. O retires after four decades of dedication
One-day SEIU strike passes; negotiations still under way
Instructions: Radiology Imaging Studies Available via Web
SHC
readies for mandate requiring outcomes data on coronary bypass
Stanford Hospital is ahead of the game on a new mandate requiring that California hospitals report risk-adjusted outcomes data on their coronary artery bypass graft operations.
The requirement comes from Senate Bill 680, which was signed by Gov. Gray Davis in October 2001. The legislation requires all California hospitals to report their risk-adjusted CABG mortality data to the Office of Statewide Health Planning and Development beginning in January 2003.
The law directs OSHPD to produce an annual CABG "report card" starting in July 2004 that will allow consumers to compare hospitals' results. Beginning in 2005, the report must present the data by surgeon as well as by hospital - the latest sign of a trend toward giving consumers more specific, objective information on health-care quality. California is the fourth state to require public reporting of CABG outcomes.
Though the new requirements will create extra work for hospitals statewide, Stanford is well-prepared for them, hospital leaders say. First, Stanford has been reporting CABG outcomes to the state since 1998 under a voluntary program developed by a unique private-public partnership. Second, the hospital's Quality Improvement Department recently hired a cardiac clinical data manager - a new position - who will coordinate and monitor the process of collecting the data, verifying its accuracy, reporting it to the state and sending it to physicians as a tool to help them improve their practice.
"We're well-prepared for these requirements," said Brenda Fischer, director of quality improvement. "We're actually one of the best-prepared hospitals in California, because we've developed an infra- structure specifically for CABG reporting."
A key concern for Stanford is whether the publicized data will adequately reflect the acuity of its patients. Of the approximately 300 CABG cases done annually at Stanford, 20 percent are referred by hospitals that do cardiac surgery - indicating that these are complex cases with higher-than-average risk.
"The refrain from hospitals is, our CABG mortality rate is this way because our patients are sicker," said Bruce Reitz, professor of cardiovascular surgery and chair of cardiothoracic surgery. "At Stanford we can truly make that claim."
The good news is that cardiothoracic surgeons have been actively involved in developing the state's risk-adjustment formula, and they'll have a key role in making sure the published data are fair and accurate. Under SB 680, physicians must be able to review the state's CABG report before it is released and, if they believe the report contains unfair or inaccurate information, they can appeal to a binding physician panel.
Hospitals such as Stanford that have participated in the state's voluntary reporting effort - the California CABG Mortality Reporting Program - have valuable experience collecting, analyzing and submitting their data. The program was established in 1997 by OSHPD and the Pacific Business Group on Health, a coalition of large California health-care purchasers. The program was aimed at giving consumers useful quality data on the 79 participating hospitals and spurring those hospitals to improve their quality. The program's first public report was released in July 2001.
Despite this valuable preparation, mandatory reporting will require Stanford to track and report its CABG data in a more systematic, detailed way than in the past, explained Chris Gershtein, the hospital's new cardiac clinical data manager. Under Gershtein's direction, the hospital is developing a new, more efficient and comprehensive CABG database and data-entry system.
Thanks to the hospital's current and previous efforts, Reitz said, "We're confident that our data will be accurate and will enable us to be fairly compared with other hospitals."
Once the new process for tracking CABG outcomes is working smoothly, Gershtein said, it could be applied to other procedures at Stanford.
Meanwhile, the state has plans to expand mandatory outcomes reporting to other surgical procedures beyond CABG - though it isn't yet clear which procedures will be targeted next, or when.
"The CABG reporting is a sign of things to come," Gershtein said. "Once consumers start getting this kind of information, they're going to want more."
