TROJAN HORSE. A growing number of states – led by Pennsylvania and California – as well as the federal government and several private companies now publish hospital "report cards" that showcase clinical outcomes and charges/pricing. The initial philosophy behind this was to promote consumer-directed healthcare and provide enough data for people to shop around for the "best" service. Noble and useful, yes. However, CMS now is using this data as a means to adjust reimbursement rates (which loyal readers saw predicted in a previous Fast Foreward). Of course, CMS touts its tactic as a strategy to "encourage" operational improvements and reward good behavior, but it’s hard not to see it as a penalizing maneuver – and justifiably so. After all, people should be able to shop around for high-quality service, which hospitals should be delivering anyway. This emerging "era of transparency," however, represents a quagmire for healthcare facilities. With outcomes and pricing as the public face of their operations, hospitals and other healthcare facilities no longer can charge as much as they can to offset clinical challenges, cost-related black holes and inefficient processes. Not only do they now have to know what their true costs are but they have to worry about turning off potential customers if they charge too much to cover poor clinical and business practices. What a conundrum, exacerbated when insurance companies and private payers jump into the fray. When all is said and done, this surely will redefine how hospitals and physicians operate in the years to come. But can’t we hold the insurance companies and private payers to the same standards?

BYTE ME. The Government Accountability Office (and the name alone sparks riotous guffaws) reported that it found 47 weaknesses in the computer system that the Centers for Medicare & Medicaid Services uses to send and receive bills and communicate with providers. In an unrelated story, CMS has noted a spike in the number of claims it has rejected for seemingly medically unnecessary colonoscopies filed by hundreds of people who’s only apparent link is their GAO employment.

CHOP PHOOEY. The Medicare Payment Advisory Commission recommended to the CMS that it should adopt the Medicare Severity Diagnosis-Related Groups payment system, otherwise known as MS-DRG. Remove the DR, as in doctor, from the process acronym leaves you with MSG, a preservative that tends to give you a headache. The moral of the story? Messing with doctors in the payment process will make your head hurt.

DANCING DOLLARS. Annual salary surveys can be a curious exercise, whether they explore healthcare materials management, or say, media/press people. Some follow the tabulated results religiously, taking the figures seriously enough to evaluate their own self-worth. Others doubt their reliability because of perceived inherent errors, data inconsistencies and overall variability in the survey process. Whatever the case, they remain popular features – almost like tabloid fodder for the trade press set! When Healthcare Purchasing News found in its 2007 materials management salary survey that average salaries may be marginally higher and pay hike rates stable but many feel secure in their jobs, we scratched our heads. Then HPN Art Director Tracy Arendt cleared the fog for us: Let’s see… they’re not making that much more money and pay raises have slowed. Of course they have job security! Priceless.

Celebrate success, readers.