In my prior blog entries, I have reflected on employment and student nondiscrimination as one of four vital measures of equality in health care that also include patient nondiscrimination, visitation, and cultural competency training. The recently released fifth annual Healthcare Equality Index (HEI), 2011 provides benchmarks of these four measures of equality within the hospital setting.
Why the HEI? PAs may think that LGBT health disparities and discrimination are a thing of the past. Yet 56% of lesbian, bisexual, and gay patients and 70% of transgender patients report some form of discrimination throughout their health care experience in a 2010 survey. This is why in 2008 I accepted an invitation to serve on the National Advisory Council for the HEI as a representative of the PA profession, and this is why I encourage my PA colleagues to familiarize themselves with the tools and resources for health care institutions and professionals, as well as current patient education for our LGBT patients.
In industry terms, health care equality issues include quality care, regulatory compliance, risk reduction, payment reform, and market share.
Quality care: The IOM defines quality care as care that is safe, timely, effective, patient-centered, efficient, and equitable. Most meaningful to improving quality care for LGBT patients are the issues of patient-centeredness (providing care that is respectful or responsive to patients needs) and equity (providing care that does not vary regardless of personal characteristics). Effective patient-provider communication and patient- and family-centered care have a positive impact on reportable measures of quality and also, most importantly, on patient outcomes. As health care providers continue to emphasize patient- and family-centered quality care, the HEI works to ensure LGBT patients and their families are part of the equation.
Regulatory compliance, risk reduction and payment reform: The HEI can help hospitals and clinics achieve compliance with recent federal regulations from the Department of Health and Human Services, which are tied to the ability to receive funding from the Centers for Medicare and Medicaid Services (CMS) as well as to the new Joint Commission’s accreditation standard. A hospital or clinic that fails to comply with these new requirements from CMS could be terminated from the program and become ineligible to receive either Medicare or Medicaid payments. Hospitals that desire accreditation by the Joint Commission will be evaluated for compliance with their new LGBT-inclusive nondiscrimination standards.
In addition, payment reform has come to CMS in the form of incentives for the provision of quality care based on performance on a set of quality measures that have been linked to improved clinical processes and patient satisfaction through its Value-Based Purchasing Program. The new CMS rule for value-based purchasing takes effect in October 2012.
For hospital administrators, the HEI is both a self-evaluated assessment tool that supports regulatory compliance and risk reduction and a technical assistance tool that provides useful resources, including model institutional policies and best practices that are explicitly inclusive of LGBT patients and their families. These model policies and practices can be utilized to achieve compliance with CMS regulations and Joint Commission standards.
Market share: The increasing public availability of quality and performance measure reports being generated as a result of health care reform is informing patient decisions about where to seek care and the quality of care received. About two-thirds of LGBT adults report that they were likely to select a product or service from a brand that has a reputation for being LGBT-friendly – even when less friendly brands offer lower prices or are more convenient. This has implications not just for hospitals but also for healthcare professionals. As census data demonstrate that more than 99% of all US counties have same-sex households, health care equality is truly a national issue.
What to tell your LGBT patients? The HEI advises your LGBT patients to plan ahead to ensure they receive nondiscriminatory hospital-based care. This includes checking out the patients’ bill of rights at their local hospital. If it doesn’t include LGBT patient protections, encourage your patients to ask why. Patients are also advised to complete advanced health care directives including authorizing a surrogate medical decision maker and making sure their surrogate knows their wishes. LGBT patients are advised to complete forms authorizing hospital visitation and to keep all forms in a safe place where they can be accessed in an emergency. Patients should also look at the hospital’s visitation policies. Again, if these policies don’t explicitly recognize LGBT patients, ask why.
A companion piece released in conjunction with the HEI provides more details on the issues I’ve outlined and serves as call to action for health care professionals. To see if your hospital is a top performer or to learn more about how your hospital can participate in the 2012 HEI, visit www.hrc.org/hei.