The fi nal rules implementing the Illinois Hospital Report Card Act became effective on March 28, 2007. The stated purpose of the Hospital Report Card Act is to provide Illinois consumers access to the quality of health care in Illinois in order for the consumers to make informed decisions when choosing a hospital. To that end, the fi nal rules impose reporting requirements and public disclosure obligations on Illinois hospitals regarding hospitals’ staffi ng practices, infection control measures and staff vacancy and turnover rates.
Nurse Staffing Information
Hospitals are required to make nurse staffi ng information available to the public and also to report that information in a required format to the Illinois Department of Public Health (“IDPH”). Effective March 28, 2007, hospitals are required to notify the public of both their right to access nurse staffi ng information and the details of how to obtain that information. Although the information must be de-identifi ed, the actual patient care roster for each patient care unit must be made available to the public. In particular, requests for nurse staffing schedules related to an individual’s impending or current hospital stay must be made available within two (2) hours of the request, while requests for the actual nurse staffi ng assignment roster must be made available within two (2) hours during normal business hours and within four (4) hours on nights and weekends. If the request is unrelated to an impending or current hospital stay, the hospital must comply with the request within seven (7) business days by making those records available in a central location.
Hospitals are also required to submit quarterly reports concerning direct patient care hours. The reports include the following categories of data:
1) total inpatient days,
2) total direct care registered nurse (“RN”) hours,
3) total direct care licensed practical nurse (“LPN”) hours,
4) total direct care hours for nursing assistive personnel,
5) nursing hours per patient day,
6) licensed nursing hours per patient day, which is further subdivided into subcategories of employed and agency RNs, and employed and agency LPNs,
7) the average daily hours worked, also further subdivided into categories of employed and agency RNs and employed and agency LPNs, and
8) the average daily census per clinical service area. These reporting requirements will be phased in over time beginning on July 1, 2007. From July 1, 2007 through September 30, 2007, IDPH will educate hospitals about the reporting requirements. From October 1, 2007 through December 31, 2007, IDPH will conduct a voluntary pilot program for those hospitals that wish to participate, which will also allow IDPH to make modifi cations to the reporting format and process. Finally, from January 1, 2008 through March 31, 2008, all hospitals will gather data and then submit the fi rst data set by April 20, 2007.
Finally, hospitals are required to submit annual reports regarding the vacancy and turnover rates for licensed nurses per clinical service area. The calculations for both turnover and vacancy must be separately calculated and reported for both RNs and LPNs. These vacancy and turnover rates, in addition to the staffi ng reports, will be made available to the public through IDPH.
Infection Related Measures Information
The Illinois Hospital Report Card Act also requires mandatory quarterly reports concerning certain infection control measures. These infection control measures are measurements identifi ed in the Surgical Care Improvement Project (“SCIP”) for the Centers for Medicaid Medicare Services (“CMS”). The reporting of infection control measures will be implemented in stages as follows:
- Beginning July 1, 2007 for prospective payment system (“PPS”) and October 1, 2007 for non-PPS hospitals the following information concerning non-pediatric surgical patients must be reported;
- Prophylactic antibiotic received one (1) hour before surgical incision.
- Prophylactic antibiotic selection for surgical patients.
- Prophylactic antibiotics discontinued within twenty-four (24) hours post-operatively as measured from surgery end time.
- Surgical outcome measures by reporting post-operative wound infection diagnosed during index hospitalization.
- Beginning October 1, 2007 for both PPS and non-PPS hospitals:
- Prophylactic antibiotics discontinued within fortyeight (48) hours for post-operative cardiac patients as measured from surgery end time.
- Cardiac surgery patients with a controlled 6 a.m. postoperative serum glucose.
- Beginning July 1, 2008 for both PPS and non-PPS hospitals:
- Central vascular access catheter related bloodstream infection rates in designated critical care units.
- Patients diagnosed with postoperative ventilator acquired pneumonia during index hospitalization as set forth in SCIP.
Compliance and Impact on Hospitals
The July 1st deadlines are fast approaching and the public already must be notifi ed of their right to request nurse staffi ng data, therefore hospitals must begin to act quickly to comply with the fi nal rules of the Hospital Report Card Act. Even without these new rules, hospitals have signifi cant reporting obligations; therefore, a review of current operations and data reporting processes should be the fi rst step towards compliance. This may be the perfect opportunity for hospitals to establish a centralized data reporting offi ce that can gather data and comply with these new obligations, as well as existing obligations. Centralizing the data reporting process will most certainly make the collection and reporting of required data more effi cient and accurate. Further, these reporting obligations can and should involve all areas of the hospital, such as the human resources department, infection control, the clinical units, nursing leadership and the medical staff leadership.
Whether the disclosure of this information will infl uence a patient’s choice of a health care facility remains to be seen. Unlike other consumer goods, the choice of a health care facility is infl uenced not only by quality measures, but also insurance coverage, personal preference, location and physician loyalty.
The nurse staffi ng, vacancy and turnover rate information, however, will certainly make potential nurse employees better consumers, thus affecting their choice of a hospital for employment. Additionally, the nurse staffi ng and infection control measurement information can be used to bargain with third party payors for improved reimbursement rates. Higher quality care, as evidenced by lower postoperative complications and a stable, well-staffed facility, can be a useful bargaining tool for hospitals seeking improved reimbursement rates. There is no doubt that these additional reporting obligations are a burden on hospital operations; however, the reports have the potential to improve hospital operations and fi nances, which just may be the silver lining of this regulatory cloud.