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REMARKS BY:

Michael  Leavitt, Secretary

PLACE:

Washington, DC

DATE:

Thursday, June 21, 2007

Transcript as Delivered on Medicare Enhances Consumer Information on Hospital Care


SECRETARY MIKE LEVITT, HEALTH AND HUMAN SERVICES: Good afternoon. People need to know not only how much their health care costs, they need to know how good it is, and today we're going to show you a glimpse of the future.

For the first time in its history, Medicare and the Hospital Quality Alliance are providing the public with information about two important yard sticks of care, mortality rates for heart attack and heart failure. This is very important. It's important because, for most of its history, Medicare has been paying for services but not paying for results. The problem with that approach is that it doesn't provide any incentive to improve the quality or to lower the cost.

Today we're making a change to both.

This would have been possible, it would not have been possible, I should say, without the collective leadership of the HQA or the Hospital Quality Alliance, many of the partners of whom are here today. With me on stage is Rich Umbdenstock, who is the President and CEO of the American Hospital Association. Also Gerry Shea who is in charge of government relations for the AFLCIO, and Herb Kuhn, who is the acting Deputy Administrator at CMS.

Seated in the first two rows are other very valuable HQA partners. These HQA members are trailblazers in every sense of the word. Their work is to ensure that Americans get the best value at the lowest possible cost. The measures that we're announcing today demonstrate that the HQA continues to lead the movement for value-driven health care in this country.

Last year President Bush signed an executive order directing federal agencies to include four cornerstones of value-driven health care in the way that we buy and the way we organize health care. The four cornerstones are, first, having interoperable electronic medical records, second, transparency of quality, third, transparency of cost, and fourth, incentives to improve the quality and to lower the cost to make certain that everyone in the health-care system has a motivation to drive quality up and the cost down.

Until recently, none of this has been available across the health-care sector. The most basic information needed to make an informed choice, the information about the quality and the cost of care, has simply been missing.

Today's announcement demonstrates that the federal government is putting the four cornerstones into practice. The steps that we're taking today mean that patients will have the information they need to make decisions about their own care.

Last year Medicare, as our web site, logged 36 million page hits from people seeking information like we're going to be providing today. When that many people start comparing the quality and the cost of health care, the result can only be better care at a lower cost.

We can't take all the credit, however. The quality standards are best developed by the medical family and by hospitals, so I want to applaud the Hospital Quality Alliance for providing information that everyone can use and agreeing upon the benefits of consumers. I also want to look forward to their continuing work. We're going to get nothing but better at this. What you're seeing today is a glimpse of what's possible. If we were to be looking into the future, we will see an envisioned system where consumers very clearly can go online or in any other number of different ways and get information on a hospital-by-hospital basis, and ultimately a doctor-by-doctor basis, and have information about the quality of outcomes.

Now let me turn the mike over to Rich and to Gerry and to Herb who will give you additional details on what we're announcing today.

RICH UMBDENSTOCK, PRESIDENT AND CEO, AMERICAN HOSPITAL ASSOCIATION: Thank you, Mr. Secretary. Good afternoon. On behalf of the Hospital Quality Alliance, I'm really pleased to be here today to talk about this important milestone in making hospital quality information available to the public.

As Secretary Leavitt said, the Hospital Quality Alliance is a private public partnership that includes hospitals, physicians, nurses, federal agencies, quality experts, consumer and business groups, and it's through the work of all of these parties that we're here today.

We've come a long way from where we started five years ago when we all came together to work on giving the public information about hospital quality of care. Back in 2002 when the HQA first started, we set a goal to provide useful, meaningful information to consumers that they can use to make decisions about their care, and we wanted that information to be available to the public through the internet, so we developed the web site Hospital Compare at www.hospitalcompare.hhs.gov.

We started out by providing information on important steps that hospitals can take to properly treat patients with three common conditions: heart attack, heart failure and pneumonia. We soon added information on some steps that hospitals take to prevent surgical infections, and since we got started, the business community has joined us to make sure we're sharing information that they find helpful as well.

Today, as the Secretary said, for the first time, we're able to begin to give consumers information that they have long asked for, how heart attack and heart failure patients fare when they've been admitted to a hospital.

We're starting this effort by sharing information about how hospitals perform compared to the U.S. national rate. The national information we have today has never been available before. Through a new, sophisticated statistical analysis developed by Harvard and Yale researchers, we've been able to take into account a patient's medical history and then look 30 days beyond when a heart attack or heart failure patient is admitted to see how they fared, so we've taken an important first step in providing information about patient care outcomes, but this is by no means the last step. We'll be examining the information we have and looking for new ways to help patients choose a hospital that's best for them.

Perhaps the most important thing we'll be learning is how consumers use this information and what is most helpful to them when making important decisions about their care.

Again, hospitals look forward to continuing on this long journey of giving patients, their families and our communities useful information about hospital quality. We also look forward to working with our partners on these efforts, which will help us determine how to make the information on hospital compare most valuable to patients.

At this point, I'd like to invite Gerry Shea from the AFLCIO to share his perspectives.

GERRY SHEA, AFLCIO: Thanks, Rich, and good afternoon. On behalf of the AFLCIO and our 55 affiliated unions and on behalf of the various consumer organizations that participated in the Hospital Quality Alliance in a whole variety of quality improvement activities across the country, I want to thank the Secretary and the Department for all the hard work that they put into making this information available, and congratulate Rich as the leader of the AHA, and I want to add the other hospital organizations that have worked so hard over the past four years to get this reporting site to where it is today.

We have a milestone, as Rich has said, in terms of reporting a new kind of quality data that is outcome data, and if you combine, and you need to think about this in combination, if you combine the outcome data with the process data that we've already been reporting on cardiac care, you see a more robust picture, that is all of us as consumers and potential patients or actual patients see a robust set of information which we can use in our decision making, and this is so important in terms of the vision we have for people who can actualize and make actionable the information that we have on this terrific health system in the United States and use it in their decision making along with their clinicians. It really is breakthrough kind of information, and looking back on the four years of activity here, we know we have a long way to go. We need to add more measures to the Hospital Quality Alliance reporting through Hospital Compare, we need to make it more refined, and this is a good instance in today's reporting. We should look at how we can advance this data, as the Secretary has said, and make it more differentiating for consumers to look at and more useful to them.

But these are all building blocks in a - for a national system that is vastly different from what many of us grew up with in terms of health care today, and that's what we're striving for, that's why our unions and many consumer groups are so invested in this and so pleased with the progress that we've made to date and so committed to helping move this forward in the future, so thanks very much.

HERB KUHN, CMS: Good afternoon. I'd like to say a few words about where we are and kind of how we got to the point where we are now for this great accomplishment today.

The information that's being posted today on the Hospital Compare web site, that is mortality rates for heart attack and heart failure, and the first annual update of hospital pricing information and volume of procedures that are treatment in hospitals, are great additions to the array of information that's out there right now for hospitals and quality information that's going on out there.

But while we have this public information on quality, price, and soon to be patient satisfaction information, it's not yet really in the acceptable form for consumers to access it the way we'd all hope they would be able to access it, and we know people are hungry for this information. You heard the Secretary mention that right now in 2006 for the Hospital Compare web site, we had nearly 36 million page views throughout the year. That translates into 100,000 page views per day. People are looking for this information. They're seeking it out, and we're glad to be able to accommodate them with more information today with these postings.

So what we're doing today is going to continue to pull together this important information and also hopefully lead us, as you heard Gerry and others say, to more robust reporting on a go-forward basis, but we have a lot of work to do. The chart to my right, your left, is an illustrative example of perhaps what this information can ultimately look like when we'd be able to put it all together, that is quality, pricing and ultimately patient satisfaction information in a user friendly way that consumers, payers, purchasers, and anybody who's interested in health care, can be able to get this information and use it in an effective way.

We're not there yet in terms of being able to display this information in this form, but this is our objective, all of us, to get to this stage where we can use all this information for greater empowerment, greater accessibility, and actionable items for people to use in terms of making important decisions about their health care.

But let me make just a few comments now about the mortality information and the significance of what we're talking about today. The information is going to be displayed in kind of three arrays, basically in three different categories, that is: no different from the U.S. national average, better than the U.S. national average, or worse than the U.S. national rate or average that's out there.

The mortality rates that we're putting out there are risk adjusted. That means it really does level the playing field from one hospital to another so you can get a true apples-to-apples comparison as we go forward. We don't set out specifics about how hospitals have lowered mortality, but we do expect hospitals to have informed conversations internally to talk about how they coordinate care, how they plan for discharge, and what they can do even further to protect patients that they care for in their institutions. It's our belief that by bringing this kind of information forward, we can shed a little sunshine on the overall effort and provide this as a kind of a catalyst to push for improvement in health care as we go forward.

And in this regard, hospitals have received already detailed reports in terms of their mortality rates, how they compare to their peers, and in terms of where they are in the overall array. Are they at the average, are they above the average, or are they below the average. And we hope this will information that'll be useful to them in order to work to reduce their mortality rates in their institutions.

In addition, we have contacted our quality improvement organizations, who are also known as the QIOs, and share with them the list of hospitals and how they're reforming, and encourage them and they've already been in contact with the hospitals around the country that are at least below the average to offer their assistance to be a catalyst to help them move forward.

In addition, the American College of Cardiology and the American Heart Association have supported this and supplied their leadership in terms of being ready to assist these hospitals in any way they can to improve overall. What you're seeing is a lot of people coming together to try to improve quality as a result of this release of this information.

But many of you may recall that this agency, or its predecessor agency, the Healthcare Financing Administration, released some mortality information in the late '80s and early '90s, and to be quite candid, that release didn't go too very well for all of us, but this year is very different, and very different in a number of different ways.

First, as indicated earlier, we have highly respected researchers from Yale and Harvard who helped develop these measures. The provider community, as you've already heard, have embraced these measures as we go forward, and we also have the fact that the National Quality Forum has approved these measures through their national consensus process, a much different effort than what we went through two decades ago, but it took us two decades to get here, and I think we are going to be very pleased with the results that we're seeing.

Also, I would say that we're being very conservative in terms of this release of this information. We only put hospitals in the worst or better category if their results had a high level of certainty. We wanted to be accurate, we wanted this to be meaningful, but as you've heard already, we're going to continue to refine this and this will change over time, but the first time out of the gate, we wanted to make sure that we had it as accurate as possible, so we probably will see hospitals in that middle category that perhaps should have been in the worst category, and yes, we may see some hospitals in that middle category that probably should be in the above average category, but we thought this was the best way to go on this first time out.

Our aim here is to raise overall quality in all hospitals across this country. Full, transparent information on both quality and cost generates care that's right for patients, and we're very glad to be able to join the HQA today in announcing this new information because let's be very clear what we're talking about. Outcomes are critical. It's what really matters when you think about health care and the delivery of health care in this country, and what we are talking about today are two of the most common diagnosis where mortality is a key indicator of successful treatment.

With that, Mr. Secretary, I'll turn it back to you to lead us through the questions.

LEAVITT: Are there questions?

Yes, ma'am?

QUESTION: This paper here, does this contain the most recent data on heart failure? And I'm just asking because I noticed that you've got 35 hospitals that are in the worst category for heart failure. It seems like on the surface this is where you need the most improvement. What does that mean? Does that mean certain hospitals may be treating sicker patients? And can you give me an idea of what that number means? OK.

KUHN: Sure. What we have here is the data that's arrayed here is basically data from July of 2005 through June of 2006, a year's worth of data that's information out there. As I indicated in my remarks, we wanted to be pretty conservative in terms of our approach that's out there. We wanted to be certain that we have significant - statistical significant information as we went forward.

We're not trying to embarrass hospitals. We're really designed to try to get information improvement as we go forward. And so yes, what you see here in terms of these hospitals and heart failure, we had 38 that are better than the national average, we had 35 that were below. For AMI, we had 17 that were better and seven below.

And those are the hospitals, I think, at least the ones that are below the average, where we want to have conversations with. But I think we want to have conversations with all these hospitals.

And as I envision this, I think we'd like to see three different types of conversations around this country, one with the hospitals that are below the average, and I think they need to have conversations about what they can do to improve to get above that line, and even further maybe into the better category. With those in the average category, I think they would aspire to be above average at all times, and those that are above average, how can they improve and how can they stay in that area, so we hope we have many different kinds of conversations in communities all across this country with hospitals as they try to use this information as a catalyst to improve.

LEAVITT: Let's talk about some patients worse than others …

KUHN: Yes.

LEAVITT: … and how you dealt with that?

KUHN: Yes. And this is all risk adjusted, to be sure, so it truly is an apples-to-apples comparison as we go forward and we look at this information. Thank you, Mr. Secretary, and we really want to make sure that we had a good comparison model, and I think statistically we have that in terms of the good research and the development that went out there, so I think it's fair information, it's been field tested with these hospitals, and they have seen the information, they've been able to validate it with us, so it's about as accurate as we think we can be at this time.

LEAVITT: I have often used a metaphor to describe our effort here. We, I believe, all can envision a system in the future that will allow a consumer to go online or to any other source and to be able to query the results of a hospital against standards that have been widely accepted so that we can determine which hospital's providing the best care, and again, not just to eliminate hospitals or create winners and losers, but to help everyone improve. That is a big vision and takes a lot of work to get there.

I was walking through an airport and saw a stock car that was actually a formula one car, and I thought to myself, that's the picture of the vision, it's this large powerful machine. But what we're really developing today is a go-cart with a set of wheels and a frame and a small motor. And we're learning to make it go around the track and demonstrating that it can happen. And we'll let that go-cart then begin to grow into what will become this robust system of quality. And this is a very important demonstration that it can be done and that it works. And it has value in its form today.

But it will get nothing but better as time goes on and our capacity will help IT to gather the information, our quality measures become refined, our capacity to provide it uniformly will all improve. This is a very important first step, but I think we're all emphasizing it is a first step.

Yes?

QUESTION: ...talk about some of the things that you - talk about some of the decisions you made not to be specific in some of these records. I mean, it looks like you're sort of giving thumbs-up, thumbs-down, and thumbs-sideways. Why not give specific numbers associated with these hospitals? Why not expand the universe beyond just sort of seven on the bottom, 20 on the top? I mean, what would - it seems like you had a variety of compromises here. Talk about those compromises and when we can expect, as the Secretary said, a little bit more information, more detailed information. Is that going to be next year? Is that going to be the year after? Is that going to be five years, 10 years? What?

KUHN: Actually, those hospitals that I mentioned, the 38 and the 17 and the 35 and seven, we're happy to share that - those names with you now. I mean, after the meeting, just see us. We'd be happy to share that information with you. It's all public on the web site now. The information is out there.

We're being as transparent as we possibly can. This information's out there, the hospitals already know it. We've indicated that we've already been in contact with our QIOs, they've been in contact with the hospitals to help them begin starting efforts to improve, so we're as transparent as we possibly can about this information, so it should all be available and we'd be happy to give you those lists afterwards.

QUESTION: I'm sorry (INAUDIBLE) talk about the compromises you made in terms of why not more hospitals, why not be more specific...

KUHN: Oh, in terms of what we are - in terms of the conservative approach here.

You know, really, what we really wanted to do was we - it really wasn't an attempt here to embarrass hospitals in any way, shape or form. It really was a chance to prompt people to look closely at this information, to drive improvement the best we could, and that hospitals are going to be able to get these detailed reports that were out there.

For the first time out, and these are very complicated algorithms and the statistical information that we went out with, and we can have the statisticians come and talk to you afterwards if you'd like about this. We really wanted this to be as statistically significant as possible, and so we tried to draw this in a way that we could be as certain as possible, so this was the decision we made, and I think we wanted a 95 percent confidence level going in on this first time. That could change over time as we get refinements, and my guess is by the time we get into reporting next year, this will have changed and we'll have more refinements at that time, but we thought going in for the first time, this was an appropriate responsible way to begin this process.

SHEA: Can I, Mr. Secretary?

LEAVITT: Please.

SHEA: It might be useful to just - for me to add in from the consumer's perspective. We had some discussion on this from a - I had quite a bit of discussion on the hospital quality lines, and we decided to take this conservative approach that Herb has mentioned in part because of the history which is 20 years ago there was national mortality data released and it got a huge pushback and then disappeared from the public scene.

Now 20 years later, we have come back to that, so we thought it was prudent to take the conservative approach, which is to have a very high statistical reliability standard for this. We realized as we did this that a number of states use more differentiating categories, and we're going to look at those and we look forward from, speaking from the consumer point of view, to more differentiated categories for this reporting.

But you know, when you look back on the - when I look back on the four years, I should say, of the hospital quality initiative, we have achieved a number of things which are extremely important in terms of what the vision that we have for the future. We have proven, we have shown that hospital quality data can be measured and can be reported, and we have now the vast majority, the overwhelming majority of hospitals saying, "We're fine with this."

When we started this stuff, and you could ask Rich Umbdenstock, that's not where the hospitals were. They were like, "Pardon me? You want me to do what? What is this going to mean? How is it going to affect my business?" All of these kind of - sort of anxieties which are natural. We've worked through that stuff, we've established a standard of national performance measures which can be reported that people are comfortable with. We now need to expand the number of the standards and refine those standards to make them as exacting as possible, and we're going to look forward to that, and this outcomes data is a new arena for us, and we want to attack that as aggressively as we're going to attack other areas.

UMBDENSTOCK: Maybe this is stating the obvious, but we didn't know how many hospitals would fall where as we went into this process, and as you look at where hospitals fall, the last thing you want to do is then start jigging the process because you're not sure that the outcome that you achieved matches up with what you thought you were going to find.

So as we've gone through this process, we've had to agree on how to categorize the patients, how to analyze the information, and how to array the information, as I mentioned earlier, in a way that is most useful to various audiences. And as the Secretary said, I think absolutely right on spot, this is a beginning. We will learn as we go, and we'll continue to play out the process and refine the process and get better and better at it over time.

But as Gerry just said, this is a process that's supported by a wide array of constituent groups, and I think that's the most important message of all. We're started, we're on the way, and it will just be refined from here.

LEAVITT: I want to be just a little more specific on this in this context. The vision is competition based on value. Value is the nexus between quality and price. When you have a well-refined definition of what quality is that's widely accepted and a way of comparing price, that is, the people have confidence in, you can then draw conclusions about value, competition based on value.

This year you've seen heart attack and heart failure. Next year you'll likely see something on pneumonia. We'll then begin to move in other surgical outcomes. Between now and, say, two or three years from now, you will see a slow - or hopefully a rapid increase in the number of measures and the way they are displayed. I believe that within three years, two to three years, you'll see an increasing number of these, and you'll see them begin to merge with the price information.

Five years from now, the word "value" will be a regular part of the medical lexicon in this country, and 10 years from now this system will be ubiquitous, and it'll just be the way it works. Consumers between now and then will see a slow increase in the available information, but what we have today is a long ways of what - ahead of what we had last year at this time, and it will continue to improve.

Yes?

QUESTION: My question is how receptive do you think consumers will be to the idea of value? You know, someone who's just had a heart attack, do you think he'll really go online and say, "Well, the mortality rate is higher, but it costs $1000 less so I guess we'll go to Hospital X"?

SHEA: That's just a sensible question and one that's on the mind of a lot of people who are observing this process. I would take you back to the comments that have made about what we're doing here is trying to build the system, and in the Secretary's analogy, we don't yet have the formula one version. We have the go-cart version.

So we're trying to put together the reporting system, and frankly, we're learning as we go. What we haven't - I think we've proven, as I said a minute ago, that we can measure quality, we can ask hospitals and other providers, by the way, to report quality, and we can get that up and make it available publicly, and it can be valuable information to the more sophisticated consumers, that is, clinicians at this moment, so when I talk to my physician about any decision I might have to make, a special procedure, some site to go to for care, my physician, I know from experience, can go to the Hospital Compare web site and look at the information that's available or some of the other sources. Purchasers can do this because they have the resources to do it.

What we're looking for here, as the Secretary said, is making this totally transparent and immediately available to individuals, all of us. We're not there yet. That's just fair to say. And we have a lot of work to do on making the information available in a usable way, and we have a lot to do about educating consumers about how to use this information. So there are two parts to this next phase or one of the next phases in this process, and we need to work on both, but that's well within the context of the work that the HQA has been doing and what we intend to pursue, so.

LEAVITT: I think it would be important to say that if you're having a heart attack, you ought not to go to the web. You ought to go to a doctor or to a hospital, and we would emphasize that.

However, 75 percent of all health care costs in this country are from chronic conditions that can be managed, and over time, we'll continue to when you're - if you're going to have a valve replaced very shortly, you may well want to go to the web site and determine where the best outcome will be held. We're beginning to see an increasing amount of information about the quality of what goes on. Various states are now dealing with hospital infections. Information must become available in order for us to have competition based on value, and when we see value being compared and people using the information like this, we know that the costs will go down and the quality will go up. That's the key.

Yes, sir?

QUESTION: Regarding the lower end 42 hospitals, has CMS attempted to quantify what type of resources or what investment might be necessary to help them move up, and to the extent that CMS has done so, is CMS funding additional - putting additional resources into the process to help these hospitals?

UMBDENSTOCK: We have. We've already contacted the hospitals in two ways. One, with our quality improvement organizations, have already been in contact with them and are going to be there to support them and help them in any way that they can. The second way is with the American Heart Association and the American College of Cardiology, who've really stepped up with some great leadership positions to offer their assistance to be helpful to these hospitals as well.

And then finally, we at CMS ourselves, through our Chief Medical Officer, Dr. Barry Straub (ph), has already been in contact with these hospitals to let them know that the QIOs are there to assist them, so we've already contacted them, we want to provide them the support that we can, but we also think that there'll be some good conversations in those communities and they'll want to be very motivated to improve, and so we want to be there to assist them in any way that we can.

LEAVITT: I will just close by adding to that that we have seen this work in the nursing home and long-term care industry already. We have provided, and there is information available on the quality and the cost provided, and a predictable thing occurs. When people get information that demonstrates that there are areas where they can improve, they do, and not just because they want to improve their place in the market, though that clearly has an impact, but they also want to provide good quality care. And for that reason, the information that we've talked about today will be provided to the hospitals in more detail than we're releasing it on a hospital-by-hospital basis, and they'll have an opportunity to find the areas where they can improve, and we feel confident they will.

Thank you.

END

Last revised: March 13, 2008