Clinical transparency is rapidly diffusing through health care, driven by the determination of powerful public and private payers alike to hold providers accountable for results. Medicare, for example, is set to implement a formal hospital pay-for-performance program in 2008. The number of such programs nearly quadrupled during the past five years, going from just 39 in 2003 to an estimated 155 in 2007, according to an annual survey by the Leapfrog Group and Med-Vantage. An independent study by the Commonwealth Fund found that a majority of state Medicaid programs already employ financial incentives to reward high-quality care – even more noteworthy is the fact that an overwhelming 85 percent of programs plan to do so within a five year span. Put differently, grades – quality scores – are increasingly being linked or will be linked to "greenbacks" – reimbursement for the providers.

Most hospital executives are aware of this trend, however just 30 percent are collecting the quality and performance data needed to meet the demands of pay for performance, according to the 2007 HIMSS Analytics Report. At the same time, the number of outside performance indicators in use is soaring, whether from regulators, coalitions of providers (e.g., the Hospital Quality Alliance), or private companies such as HealthGrades. Hospital executives and clinicians who point with pride to their scores on some of these report cards one year may realize with gritted teeth that they have fallen off the pinnacle for no apparent reason on subsequent report cards.

This HFMA audio webcast is an introduction to the murky world of transparency.