Response to AHCA

July 7, 2006

Lisa Rawlins, Bureau Chief
State Center for Health Statistics
Agency for Health Care Administration
2727 Mahan Drive, MS #16
Tallahassee, FL 32308

Dear Ms. Rawlins:

On behalf of All Children’s Hospital, I write to thank you and your staff for the cooperative efforts extended as we work together toward providing meaningful and understandable pediatric performance data through the AHCA Consumer Website.  During the Agency’s conference call on June 30, 2006, you agreed to a focused pediatric conference call to discuss our specific concerns, and that commitment is important in our collaborative effort to improve the information on Compare Care.

We remain committed to the state of Florida’s vision of a “more transparent health care system” in the interest of providing consumers with meaningful information to make important healthcare decisions - especially as they apply to children. We believe that progress toward that goal has been made since the initial website data release. In particular, the creation of a Pediatrics section within data reported for “Performance by Medical Condition or Procedure” is an important step toward that goal.  The data, as provided to us, illustrates that there is considerable work yet to be done if this goal is to be reached. Indeed, the data in its current form still has the potential to mislead consumers.

The attached document reflects in great detail, both concerns and recommendations, from an internal multidisciplinary task force in regard to the State’s data management methodologies, specifically as they pertain to pediatrics.  Four overall themes emerge from the detail:

  • Services Descriptors need further refinement to more accurately reflect the level of pediatric services being provided.  While our focus is specific to children, this will have an impact upon all specialty or referral providers.  Consumers interested in pediatric services may be misled by the broad-based descriptors currently listed. They may, in fact, wrongly assume that certain services are not provided at all, when in fact those services are tailored to pediatric needs.
  • Data related to readmissions must be refined (for example, to account for planned readmissions or readmissions for unrelated conditions).  This is a common occurrence n pediatrics.
  • Risk adjustment figures throughout the website are suspect due to calculations that include all-aged patient data.  These mismatches in age-specific categories skew the resulting values for both pediatric and adult patients.

Transparency needs to extend throughout the process of how these statistical values are calculated. Currently, that process is not clear and thus affects our ability to validate the data as provided. The State must hold its vendor accountable for the accuracy and transparency of this process to assure the resulting product may be validated for consumer use.

In summary, we share the most important goal of providing consumers with the means to quickly find information specific to their particular needs or concerns.  We look forward to working with you to assure that this information is simple to access, clearly defined for differing consumer concerns, and provides accurate comparative measures through appropriate filtering of relevant data.

All Children’s Hospital will continue to advocate for this important effort on our website, but also promote and seek the needed clarifications in the pediatric data, to optimize its use by Florida patients and families.  We are also committed to actively participate with the State and other pediatric healthcare providers to appropriately establish specific pediatric clinical indicators to gauge provider performance in the care of children in our State. 


Gary A. Carnes
President and CEO

cc:  Alan Levine, Secretary of AHCA