Defining the strategies employed by hospitals to encourage adherence to reporting performance of quality measures is of relevance to current and planned efforts to improve perioperative care. CMS’s ongoing initiative to link payment to SCIP reporting , its planned expansion to include additional SCIP measures for 2010 and 2011 , and the proposed role of SCIP measures as a model for a Medicare pay-for-performance program [14, 15], all suggest that reporting of such measures will continue to grow in importance as a part of the structure of reimbursement for perioperative care in the US. As a result, policymakers and hospital administrators will have a growing need for information describing optimal strategies to encourage SCIP participation across a range of hospitals.
This pilot study of 1,426 anesthesia department chairs suggests that strategies to promote SCIP participation among anesthesiologists vary among hospitals. While the majority of our 421 respondents indicated voluntary participation in SCIP, we observed that a minority reported incentives or contractual mandates as primary or secondary reasons for SCIP participation. At these facilities, it appears likely that SCIP participation has been achieved without use of financial or other incentives (or contractual mandates) for the clinicians providing the data; while we did not collect data on actual adherence to SCIP measures, this finding offers a preliminary suggestion that anesthesiologists may be willing to participate in quality improvement initiatives on a voluntary basis.
These results should be interpreted in the context of multiple limitations. Our 29.5% response rate, combined with differences noted between respondent hospitals and those in the US at large, as indicated by the 2006 AHA survey, limits the degree to which our findings can be generalized to US hospitals at large. Eligible participants only received one mailing and no follow-up was completed. Further, as the study sample was constrained to hospitals over 200 beds our findings may not be applicable to smaller hospitals. We specified four potential reasons for SCIP participation a priori, yet some respondents likely participated in SCIP for other reasons, which we were unable to assess through the present survey instrument. Roughly 20% of survey respondents failed to provide a reason for their participation, which could indicate either the reason they participated was not offered as an answer option or that they did not know why they participated, limiting our ability to assess our principal hypothesis. Allowing respondents an answer option of ‘other, please explain’ would have given participants the opportunity to provide their alternative reasoning.
Further, although it cannot be determined from the present survey, the possibility exists that responses may have been influenced by the existence of a similar quality-reporting program whose goals overlap with those of SCIP. Specifically, the Physician Quality Reporting System (PQRS), Medicare’s pay-for-reporting initiative, includes measures related to antibiotic dosing ; thus, participation in PQRS could have been conceivably confused by survey respondents for SCIP participation. Both SCIP and PQRS are measures of quality compliance with overlap in multiple content areas. The key difference is that in PQRS, financial incentives are targeted at individual physicians or physician practices, while SCIP offers incentives to hospitals. Whether there was any confusion, given the similarities of these two measures, is unknown. Lastly, as we were unable to confirm the identity of the individual completing the survey, we have limited insight into the degree to which survey responses reflect actual hospital practices.
Despite these limitations, our findings have relevance to current and planned perioperative quality improvement efforts. As regulators and payers seek to promote improvements in the quality of hospital care through an increasing number of reportable quality measures , effective implementation of such quality improvement initiatives will require an understanding of the considerations affecting individual hospitals’ efforts to encourage individual physicians.