Uncle Sam and the Bed Pan Question

Health care costs continue to skyrocket nationwide, driving up government spending at double digit rates and hurting American economic competitiveness. But, instead of addressing this crisis head on by passing medical malpractice tort reform and pro-competition policies like medical savings accounts, the federal health care bureaucracy is getting ready to add new mandates and regulations that will further drive up the cost of providing health care.
The latest onerous regulation is Hospital CAHPS (HCAPHS), which will pile unnecessary new burdens on our nation’s hospitals with no discernable benefit. HCAHPS is a survey on hospital care dreamed up by Medicare and the Agency for Healthcare Research and Quality (AHRQ). Bureaucrats at these two departments have decided that all hospitals participating in Medicare—virtually every one in the nation—should “voluntarily” post patient responses to a new quality survey on the Medicare website. It is an exercise in regulatory overkill that expert after expert has indicated will actually hinder its supposed goal.

HCAPHS ignores that about 80 percent of our nation’s hospitals already survey a percentage of patients upon discharge. Hospitals already spend a lot of money on surveys because they want to improve the quality of care they provide, and the results speak for themselves. For example, all four hospitals that have been awarded the federal government’s prestigious Malcolm Baldrige National Quality Award are aggressive users of private sector survey products, and are outspoken advocates of quality initiatives. Hospitals as a group support public reporting of patient satisfaction data and have said they will voluntarily participate, but only if the government would not add a cost burden to their operations.

Unfortunately, HCAPHS does little or nothing to reinforce these ongoing quality programs. Despite a well-functioning private sector, Medicare and AHRQ bureaucrats have spent three-plus years developing a laundry list of ultra-specific questions for patients, including a pair about bed pan usage. The many incarnations of the HCAHPS questionnaire have ranged from 66 questions to 25; the present version is 27. During two separate comment periods, more than 1,900 hospital officials have recommended keeping the number of HCAHPS questions to between eight and ten, a range that would enable hospitals to include the government-sponsored questions in their own surveys and collect results at less of an added cost. Otherwise, existing data collection efforts will suffer and hospitals will have to engage in costly new practices—such as multiple mailings and telephone surveys—just to acquire enough feedback to keep federal regulators happy.

A shorter and simpler HCAHPS might be easier for patients, but the tremendous cost burden that will be placed on hospitals comes from simply having to send and collect data from two separate surveys. Studies by leading economists have concluded that the nationwide burden on hospitals of a lengthy HCAHPS could range from $100 million to over a half billion dollars over the next five years alone. Those millions of dollars are added to the bottom line of America’s health care bill.

Not surprisingly, the forces pushing for HCAHPS are the same forces that want to control and socialize private sector health care: the AARP and AFL-CIO. The union agenda is to force hospitals to adopt centralized systems of management that employ legions of (unionized) workers, and the AARP is a consistent supporter of the expansion of federal involvement in our health care system. HCAHPS questions can and will be designed to advance their specific left-wing policy goals. That is why, for example, we see two questions on labor-intensive bed pan performance, which is hardly an urgent measure of health care quality. The other group that loves a lengthy and invasive HCAHPS is the trial bar, a group already hard at work diminishing the quality and increasing the cost of American health care. The trial bar will surely distort the results of a complicated HCAHPS and use it to advance their organized fleecing of hospitals that are serving poorer and higher-risk patient populations.

The stakes, then, are huge. FreedomWorks expects the Department of Health and Human Services (HHS) to make a final decision on HCAHPS in the next few weeks. The Bush administration has a chance to stand up for common sense and limited government by ensuring the federal hospital survey known as HCAHPS does no harm to America’s health care providers.

Matt Kibbe is the president of FreedomWorks, a nationwide grassroots advocacy organization that fights for lower taxes, less government, and more freedom.

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