Share your ideas on Transparency
How can HHS promote accountability, improve public understanding of what HHS does, help illuminate what’s going on with respect to the nation’s health and well-being, help spark action and innovation to bring Americans inside HHS and our operating divisions? (Examples: web casting, video, data sets we should publish, feedback on the quality of the data, etc.)
I have been checking out your posts for the last couple of hours, and it all has been very informative and well written. I just wanted to tell you that for some reason this post doesn't seem to work in Internet Explorer. On a side note, I was wondering if you wanted to swap blogroll links? I hope to hear from you soon! http://serelaxmental.blog.com
I would like to make a suggestion that for all your partners with datasets that have location attributes. You would be doing all a great service if you could take the extra step not only to be able to consume an RSS feed of this data, but a Geo-enabled feed as well, called GeoRSS (http://www.georss.org) This would facilitate utilizing these datasets directly within other web-based GIS applications. I do applaud the current efforts, however.
Re: Part D Government is supposed to be open. Should not drug plans supported by the government also be open? Is there now a site in which all Part D providers post their formularies on to a specific site, with place for usersâ€™ comments? If not, I suggest that such a site be established. In addition, if a provider changes its formulary, which removes the prescription that the client uses, then client may change provider. Providers must post, and give notice 60 days in advance, so that clients may have time to change. This would end the terrible headache of my friends trying to work out what plan to take. My friend is paying $400 a week for a drug not on her formulary.
Again, a survey Q in the abstract is not likely to produce much in the way of meaningful feedback. It would seem more effective to go to an interested group, such as ACOR, to explore specific challenges which can then be posted for universal comment.
Publish csection rates for all US hospitales versus the standard in other developed countries.
HealthGrades relies on access to a number of data sets to accomplish its mission of Guiding America to Better Healthcare. The federal government is an important partner, allowing HealthGrades to purchase or access data that is then processed through HealthGrades filters and equations and then provided free to patients and consumers seeking health care providers. The end product is easily accessible and interpretable information about hospital, physician and nursing home characteristics and performance. Our studies have shown there can be major differences among providers. For example, across 17 common procedures and diagnoses, patients admitted to top-performing hospitals have a 72% lower chance of dying than if they were admitted to the worst performing hospitals, according to HealthGrades Twelfth Annual Study of Hospital Quality released last fall. As comprehensive as the data is today, there are still some important gaps that can be filled to provide patients with more insightful and actionable information. On behalf of the 8 million patients who visit HealthGrades.com each month to research health care providers, we have identified three specific recommendations for HHS to consider within its open government plan. In each case we have identified a data gap and offer a recommendation with respect to data availability and/or a change in policy/management that will result in greater transparency and continued innovation. TRANSPARENCY 1) Ability to identify patients who were readmitted to a short-term acute care hospital within 30 days of discharge The administration is attempting to reduce provider costs by tracking readmission rates and eliminating payments for potentially preventable ones. Currently, patient identifiers are stripped out of publicly available data such as MEDPAR, so if a patient is admitted to a hospital twice within 12 months, it appears as two completely separate discharge records that cannot be linked. HealthGrades recommends assigning a random number or key to each patient so that readmission could be tracked and data could be reported about each patient experience for each provider. HealthGrades believes this can be accomplished within HIPAA guidelines. Nearly one in five Medicare patients are readmitted within 30 days of discharge, according to CMSâ€™s proposed inpatient prospective payment system (IPPS) rule for fiscal year 2009. Thirteen percent of the readmissions â€” $12 billion worth â€” were â€œpotentially avoidable,â€ the IPPS rule states. Similar statistics were reported by Kaiser Health News in May, 2009, stating that 18% of Medicare beneficiaries return to the hospital within 30 days of leaving, costing approximately $17.4 billion for unplanned readmissions in 2004. Why is this important to patients? Readmissions to the hospital within 30 days of discharge can be used as a probable marker for both poor quality of care and an unneeded use of resources driving costs higher. Patients need to understand how well or poorly hospitals avoid preventable readmissions across a wide-array of common Medicare hospitalizations before making a physician and hospital selection. Studies show that a more engaged patient can result in better outcomes, including reduced likelihood of readmission. 2) Add Medicare Advantage hospital discharge information to currently available data sets The MEDPAR file currently does not contain any data related to Medicare Advantage care activity. For some providers, particularly closed systems that do not take Medicare fee-for-service patients, the MEDPAR data does not include information related to their patient care due to this. HealthGrades recommends the federal government add Medicare Advantage data to the MEDPAR data set and make this information available to the public. Why is this important to patients? The Medicare Advantage program has grown dramatically and now accounts for a large percentage of hospital inpatient admissions in many markets. According to the Kaiser Family Foundation in April 2009, the majority of the 45 million people on Medicare are in the fee-for-service program, with 22 percent now enrolled in a private Medicare Advantage plan, or 10.2 million Americans. Since 2003, the number of Medicare beneficiaries enrolled in private plans has nearly doubled from 5.3 million in 2003 to the current level of 10.2 million (as of March 2009). This means that almost one in four Medicare patients do not have equal access to hospital quality information, as compared to their Medicare fee-for-service counterparts. Nor do they have an alternative source of hospital quality information. 3) Physician Transparency â€“ Make physician data available as part of the MEDPAR file Physician identifier information is not made available in the MEDPAR data feed. This prevents organizations such as HealthGrades from displaying quality-focused information, such as the annual volume and type of procedures each physician performs. HealthGrades recommends the addition of physician identifiers and volume information to the MEDPAR data file. We also recommend adding physician identifiers to physician billing information. This would allow for the public reporting of physician utilization rates and identification of outliers within markets. Why is this important to patients? Volume is an important indicator which allows patients and others to understand how experienced a physician is at managing the type of care the patient needs, particularly for elective procedures. Inclusion of physician identifier information further enables full transparency which leads to improved decision making by patients. Numerous studies have identified a quality-outcome relationship at the physician level. As a result, some states, including Pennsylvania (www.phc4.org), have created state-run report cards on named physician volume, morbidity and mortality for patients to become more informed and to have a more meaningful decision-making process. Unfortunately, while some states have taken Pennsylvaniaâ€™s lead, most states have not. When patientsâ€™ lives are at stake, they should have meaningful comparative data on physicians that go beyond reputation and educational background, for which neither have been demonstrated to correlate with quality. HealthGrades extensively surveys the 8 million patients visiting our site each month. Through this process, we know that 74% of these patients are selecting from two or more physicians, and 91% will be visiting a physician within 60 days. By incorporating physician identifiers into the MEDPAR platform and adding physician volume, patients will have quantifiable information to help in their decision making process. By coupling these new data elements with existing data streams, public/private partnerships will be enabled to enhance the information patients are seeking to help them make informed decisions with respect to quality and cost performance by providers. By enhancing the government-controlled data platforms as recommended above, the government will allow innovation to continue and patients will have more tools to help them.
Please publish in easy to access form the c-section rates for all hospitals in the country. Please find and publish data sets about morbidity for mothers from c-sections.
I recognize that this is a very specific recommendations, but it falls into the solicited category: "data sets we should publish". I think HHS should pilot and evaluate the inclusion of cesarean section in low-risk first time mothers among procedures reported in the Hospital Compare database. C-section is the most common operating room procedure in the United States and a large body of literature suggests that practice variation across facilities (and providers) is wide and not fully explained by differences in risk/health status, malpractice environment, population density, and other expected factors. A report issued last week by Amnesty International and a Sentinel Event Alert issued by the Joint Commission earlier this year both singled out cesarean surgery as a contributor to rising rates of maternal mortality in the U.S. Unlike many of the conditions and procedures reflected in the current Hospital Compare database, cesarean section occurs in women who typically have a long interval of time to consider which hospital they will use and are not in crisis (i.e., experiencing an acute event such as a heart attack or processing a life-threatening diagnosis such as cancer) when they make their choice. For these reasons, pregnant women are theoretically an ideal population to make effective use of publicly available performance and cost data. In addition, a 2005 study by Hibbard and colleagues demonstrated that the quality of obstetric care improved more in response to public reporting than other medical or surgical specialties. The c-section rate in nulliparous women with term, singleton pregnancies (NTSV cesarean rate) is already a Healthy People measure. In addition, it was endorsed as a perinatal quality care measure by the National Quality Foundation and was recently adopted by the Joint Commission as a core measure in the perinatal core measures set. Grassroots efforts to compel state departments of health to release this data have encountered stiff resistance. HHS can help. It is a matter of critical public health importance. Thank you. Citations: Baicker, K., Buckles, K. S., & Chandra, A. (2006). Geographic variation in the appropriate use of cesarean delivery. Health Affairs, 25(5), w355-67. doi:10.1377/hlthaff.25.w355 Hibbard, J. H., Stockard, J., & Tusler, M. (2003). Does publicizing hospital performance stimulate quality improvement efforts? Health Affairs, 22(2), 84-94. Hibbard, J. H., Stockard, J., & Tusler, M. (2005). Hospital performance reports: Impact on quality, market share, and reputation. Health Affairs, 24(4), 1150-1160. Main, E. K., Moore, D., Farrell, B., Schimmel, L. D., Altman, R. J., Abrahams, C., et al. (2006). Is there a useful cesarean birth measure? Assessment of the nulliparous term singleton vertex cesarean birth rate as a tool for obstetric quality improvement. American Journal of Obstetrics and Gynecology, 194(6), 1644-51.
Being transparent, at agency level, starts with acknowledging your agency’s core competencies, which are factors that are central to the business you do; the things you know and do well. It is about being honest, accountable and responsible, and being open about facets of your operations that are in the interest of your stakeholders. Transparency is about being truthful. It is about articulating the specific purpose and objectives of your agency’s existence. Any impending changes in the operations of the agency should be communicated to the stakeholders well in advance and provision should be made to seek open feedback from them about the anticipated changes. Surprise changes can be disorienting and frustrating. Create a presence of yourself in the media and use public tools such as Twitter, Facebook, My Space etc. to stay in touch with your stakeholders. Have a plan to reach stakeholders who are offline as well. Do not shy away from public feedback. It helps you understand your strengths and weaknesses. Most agencies use the social media to enhance visibility. To achieve this, effectively, they have to provide timely information about their operations. If anomalies and problems arise, they should be addressed in a timely manner. Be careful to assure the stakeholders that you are aware of the anomaly and are addressing it. Agencies are created to be of service to communities. Therefore, it is imperative for them to understand and strive to meet the unique cultural interests and demographics of their stakeholders. Otherwise the agency will lose its relevancy and become a white elephant, so to speak. Reigh Simuzoshya, Ph.D.
OMB Watch encourages the Department of Health and Human Services to release to the public more information about regulatory decisionmaking. For information related to rulemakings, any documents, communications, or other material HHS's rulemaking agencies (e.g. FDA, Centers for Medicare and Medicaid Services) choose to disclose should be placed in the electronic rulemaking docket accessible to the public at Regulations.gov. Specifically, we suggest disclosure of the following types of information: - Any study, research, or other input used during the rulemaking, regardless of whether the information ultimately informed the decisionmaking; - All written communications among federal offices and agencies, including the White House Office of Management and Budget; - All substantive communications, both written and oral, between the agency and an outside party pertaining to the rulemaking. Online disclosure is critical to meaningful transparency. We recognize that some of these materials may already be routinely available in agencies’ paper dockets or through a FOIA request, but, in the Internet era, the public expects online access to documents of interest. Online rulemaking dockets available at Regulations.gov should become the authoritative dockets, that is, identical to those maintained by the agencies in hard copy. Matthew R. Madia Federal Regulatory Policy Analyst OMB Watch