Quality of Coronary Disease Report Cards
Over the past two decades, there have been numerous approaches to lowering cost in the United States health care system including capitated insurance, contracting for services by large purchasers, prospective hospital and outpatient reimbursement, and Medicare physician reimbursement fixed to the growth in the national economy. While these approaches have marginally controlled expenditures, no system is currently in place to assure that health care quality does not suffer as a result of fiscal constraints. This critical need for information about quality, as well as dramatic advances in computerized data, techniques with which to make balanced comparisons among these data, and electronic media have ushered in the “report card era.” Beginning with publicly reported comparisons of hospital mortality by the Centers for Medicare and Medicaid Services (CMS) in 1986, a precedent was established whereby medical care providers are scrutinized according to their outcomes. A large number of reports have focused on cardiology, including the New York State Cardiac Surgery and Coronary Angioplasty Reporting Systems, the Pennsylvania Health Care Cost Containment Council’s Focus on Heart Attack and Hospital Performance Report, the California Hospital Outcomes Project, the Cooperative Cardiovascular Project (CCP), and the National Acute Myocardial Infarction Project (NAMIP) [1-6]. Provider-specific report cards regarding cardiac care also can be found on the internet including www.Healthscope.org and www.Healthgrades.com. Pharmaceutical sponsored initiatives such as National Registry of Myocardial Infarction (NRMI), and the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association guidelines (CRUSADE) combine marketing with quality improvement [7,8]. Since July 1, 2002, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has mandated that hospitals collect performance measures for two of four conditions: acute myocardial infarction (MI), heart failure, community-acquired pneumonia, and pregnancy and related conditions. Beginning in 2004, the data will be used by the JCAHO for site evaluations and will be publicly reported on the JCAHO website. Most recently, the US Congress tied hospital reimbursement to the public reporting of quality of care data for acute MI, heart failure, and pneumonia in the Medicare Prescription Drug, Improvement and Modernization Act of 2003.
