Can I Get a Witness? The Limits of Evidence in Healthcare Quality Evaluation Systems in American Hospitals

Abstract

“I got verbals, but verbals don't hold up in court….I need it in black and white.” After Sheila submits hospital quality data to the Center for Medicaid and Medicare Services (CMS), reports indicate that her data hasn't been received. She makes countless calls to the CMS Help Desk to get answers. They reassure her numerous times that they have her data, yet Sheila is insistent that she needs to see the change explicitly stated in the report. Sheila makes it her personal crusade to obtain material evidence because only written testimony will prove that her data has been submitted successfully and protect her facility from CMS penalties. At a time when we are becoming increasingly reliant on data and technology as the ultimate bearers of truth, Sheila exemplifies how people become stewards of evidence in service to these technical systems. As she moves her facilities’ data through CMS’ error‐ridden reporting system, the burden of proof is on her to provide the type of evidence acceptable to demonstrate her facilities’ compliance with federal quality of care standards. Throughout our paper, we explore the different practices that hospital employees and vendors take to demonstrate their facility's quality of care to CMS, identifying key elements of materiality, evidence and moral obligation. By weaving together their narratives of a responsibility to prove their truth to a capricious, data‐driven system, with theoretical concepts of “bearing witness” and governmentality, we reveal the ways in which digital data falls short of being sufficient evidence and the dangers inherent in shifting blame from a body of government onto the body of an individual.