Accuracy Responsibilities for the Subs

Metrics define a majority of federal and state healthcare reimbursement. Metrics also help to define federal and state regulations. Metrics determine how much a provider may get reimbursed, and this affects how many providers want to participate in any given program. Metrics determine whether or not a hospital can be built in a community. Metrics determine how much a public health department is allocated. Metrics determine relief assistance and even determine scope of practice or international education flexibility. 

However, metrics are not accounted for when legislators enact health legislation. 

Scientific progress embraces a metrics-driven approach, so metrics-driven process improvement is a natural and serendipitous pivot for the healthcare world. Even so, analytics is a resource-intensive accountability. Analytics are now embedded in healthcare; this cost allocation will continue. 

Analytics are not embedded into legislator work consistently. Metrics, and the tools used for validity and reliability of data, are unclear when legislators enact health legislation. The source of the data, consistency of sources, and the credentials of data aggregators are not always accounted for; even when accounted for, reliability is unchecked.  

Responsibility in representing a public requires a commitment to data integrity through metrics accountability. Legislation titles, dates, committee assignment and legislator names are attached to legislation. There should be a standard that requires disclosure of data sources and processes. 

• If the argument that data source disclosure would be unnecessary for legislation seeking to fill specific population gaps, such as a Native American Act, the response should be that the gap is accountable to a metric. 
• If the argument that data source disclosure is unnecessary for legislation seeking to budget, the response should be that areas such as medical research remain entirely unclear in funding streams. Data disclosure helps to assist future clarity, bench-marking and legislation evaluation.  
• If the argument that data source disclosure is unnecessary because the experts in charge of health-related programs determine their own needs, the response should be that tax-funding should account for how the data is analyzed consistently. It matters that a tobacco grant in one federal program, a tobacco grant in another federal program and a tobacco grant in a state program funded in part with federal dollars are all speaking the same data analytics language. 

Establishing requirements for metrics accountability for our House and Senate in the United States Congress is not difficult to do, and this process should start small. As it stands, the Subcommittees for Health all disclose their current health-related legislation differently to the public. The Subcommittees all present the legislation differently as well. And, there appears to be no legislation evaluation process that our Congresspersons are accountable to. Metrics accountability, while now ingrained in healthcare operations processes, would be an entirely new concept to our United States Congressional operations. We can start small and develop. 
Opportunities with Congressional requirements of metrics disclosure include: 

• Capability to analyze the data and tools used for consistency, validity, reliability 
• Potential for legislation evaluation processes to become objective
• Capacity for health legislation to match health regulation 
• Capacity for the public to sort legislation for tracking, understand legislation and prioritize advocacy
• Potential for the US Congress to establish credibility in the eyes of the healthcare industry and the public it serves
• Capability to redirect Congressional attention toward the public's health and slightly lessen attention to health lobbyist interest 

With seven formal subcommittees assigned healthcare legislation responsibilities, and other subcommittees assigned informal health-related legislation, there is opportunity to align through metrics. The Senate’s: 1) Committee on Finance, Subcommittee on Healthcare, 2) Committee on Health, Education, Labor & Pensions, 3) Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education and Related Agencies and the House of Representative’s 1) Committee on Ways and Means, Subcommittee on Health, 2) Committee on Energy and Commerce, Subcommittee on Health, 3) Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education in Relation Agencies, 4) Committee on the Budget [1] should all be excited at the prospect of these opportunities.

One great first gameplan might center on budgeting and reimbursement, a primary legislative focus. Current data on readmissions and surgical outcomes are popular metrics in the reimbursement world. Perhaps an examination of readmissions or surgical outcomes could require disclosure of data sources in the legislation's public outline. 

• In example, if readmission reimbursement is reconfigured, based on complexities of patient population, legislation could disclose the data source. The use of the Nationwide Readmission Database for studies on spinal surgery in cerebral palsy patients [2] or the use of the NRD in postpartum readmission [3] may or may not be relevant when compared to collective readmission studies by campus. An adenocarcinoma readmission study [4] or a care fragmentation study that identifies travel and transportation issues with readmission [5] may lead to alternative care interventions. In today’s Congressional climate, each of these could be cited as a rationale for readmission reimbursement legislation changes, with no rhyme or reason to the citing. Instead, accounting for data sources and enduring validity and reliability could help with legislation accountability. 
• In a second example, legislation that seeks to address patient outcomes could be accountable to metrics or methodology disclosure. Reliance on the National Surgical Quality Improvement Program (NSQIP), for example, remains intensive in healthcare. Some data shows that NSQIP risk calculation findings may not match the patients affected, and this data may be twisted - or utilized for improvement - in legislative reviews[6]. It matters that the data, methodology and studies cited in legislation are readily available and easily presented for public consumption. Should studies continue to find that NSQIP patient outcomes are not changed when costs are increased [7], legislative moves may pivot. Instead of back room conversations and votes on the subject, without regard to the data, let the metrics be attached. Legislation should be transparent on which tools were used with decisions on cost and reimbursement for the US population's surgeries.

Metrics accountability, while now ingrained in healthcare operations processes, would be an entirely new concept to our United States Congressional operations. We can start small, with analytical transparency and accuracy a responsibility of the Subcommittees. We can start, confident that metrics, data methodology and tools used will not only help with legislator accountability; metrics disclosure will help our public become more data-driven, and less vulnerable to manipulation. 

After all, when you’re tasked to lead the public, a first priority is to protect the public from vulnerabilities and manipulation.

How exciting this all is, to know that Congressional legislative operations can be tasked with trail-blazing performance improvement expectations on behalf of a healthier, secure public.

Sources

[1] https://www.mgma.com/advocacy/make-change-happen/take-action/key-congressional-committees-in-healthcare

[2] Nathan J. Lee, MD, Michael Fields, MD, Venkat Boddapati, MD, Justin Mathew, MD, Daniel Hong, MD, Zeeshan M. Sardar, MD, Paulo R. Selber, MD, Benjamin Roye, MD, Michael G. Vitale, MD, Lawrence G. Lenke, MD. Spinal Deformity Surgery in Pediatric Patients With Cerebral Palsy: A National-Level Analysis of Inpatient and Postdischarge Outcomes. Global Spinal Journal, 2020.

[3] Jason L.Salemi, Syed Ahsan Razac, SanjuktaModak, Jo Anna R.Fields-Gilmore, Maria C.Mejia de Grubb, Roger J. Zoorob. The association between use of opiates, cocaine, and amphetamines during pregnancy and maternal postpartum readmission in the United States: A retrospective analysis of the Nationwide Readmissions Database. Drug and Alcohol Dependence (vol 210; 1), 2020

[4]  Javier Valero-Elizondo, Yuhree Kim, Jason D. Prescott, Georgios A. Margonis, Thuy B. Tran, Lauren M. Postlewait, Shishir K. Maithel, Tracy S. Wang, Jason A. Glenn, Ioannis Hatzaras, Rivfka Shenoy, John E. Phay, Kara Keplinger, Ryan C. Fields, Linda X. Jin, Sharon M. Weber, Ahmed Salem, Jason K. Sicklick, Shady Gad, Adam C. Yopp, John C. Mansour, Quan-Yang Duh, Natalie Seiser, Carmen C. Solorzano, Colleen M. Kiernan, Konstantinos I. Votanopoulos, Edward A. Levine, George A. Poultsides & Timothy M. Pawlik. Incidence and Risk Factors Associated with Readmission After Surgical Treatment for Adrenocortical Carcinoma. Journal of Gastrointestinal Surgery (vol 19) 2015.

[5] David G Brauer MD, MPH, Ningying Wu, PhD, Matthew R Keller, MS, Sarah A Humble, MS, Ryan C Fields, MD FACS, Chet W Hammill MD, MCR, FACS, Willam G. Hawkins MD, FACS, Graha, A Colditz MD, DrPH, Dominic E Sandford MD MPH. Care Fragmentation and Mortality in Readmission After Surgery for Hepatipancreatobiliary and Gastric Cancer: A Patient-Level and Hospital-Level Analysis of the Healthcare Cost and Utilization Project Administrative Database. Journal of the American College of Surgeons (vol 232, 6) 2021

[6] R. Fields, E.W. Beal, J. Kearney, E. Lyon, A.G. Lopez-Aquiar, G. Poultsides, E. Makris, F.G. Rocha, Z. Kanji, S. Ronnekleiv-Kelly, V.R. Rendell, B.A. Krasnick, K. Idrees, P. Marincola Smith, H. Nathan, M. Beems, S.K. Maithel, C.R. Schmidt, M. Dillhoff. Evaluating the ACS-NSQIP risk calculator in primary pancreatic neuroendocrine tumor: results from the united states neuroendocrine tumor study group. HBP (vol 20, 1) 2018

[7] David G. Brauer,William G. Hawkins,Steven M. Strasberg,L. Michael Brunt,David P. Jaques,Nicholas R. Mercurio,Bruce L. Hall,Ryan C. Fields. Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: implications for standardization and improved resource utilization HPB,  2015