In recent years we have all been distressed by reports in the popular press of inaccurate hospital mortality data. We have been concerned when quality assurance programs attempt to compare infection rates among surgeons without adjusting for the differences in underlying illnesses of their patients. A similar concern arises when infection rates are compared among hospitals. And university hospital administrators have been concerned by the inadequate reimbursement given to referral hospitals compared with community hospitals.

Congress has mandated that the Health Care Financing Administration (HCFA) adopt a severity adjuster for DRGs (Diagnosis Related Groups), the basis of Medicare's prospective payment system. A number of states are close to mandating the use of severity adjusters. These states include New Jersey, Colorado, Pennsylvania, Iowa and Washington. Finally, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is developing severity-adjusted clinical indicators to assess the quality of care.

Dr. William Scheckler, when he was the president of the Society of Hospital Epidemiologists of America (SHEA), had the foresight to set up a task force so that SHEA could develop a position on the severity of illness indicators. The findings of the task force have been published previously in this journal (see volume 9, number 7, pp 309–316).