Proper planning and automation are necessary if health care leaders want to reap the results of quality reporting--improved patient care.
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| Kristine Martin Anderson | Susan Sinclair |
The focus on quality and the concept of pay for performance have fueled another movement in the health care industry--performance measures. But without proper standardization and management, much of the innovation in measuring clinical quality will backfire.
With more than 300 external reporting requirements, along with internal reporting measures at most hospitals, the burden of collecting and reporting data is enormous. It often prevents providers from doing precisely what the measures are meant to do--improve the quality of patient care. In fact, in some instances, it can take a negative toll on care.
This burden will become only greater as public reporting and pay-for-performance programs take effect and begin threatening the financial viability of health care providers. An estimate based on a sample of CareScience customers shows that it takes between 50 and 90 monthly hours to collect data for the Joint Commission on Accreditation of Healthcare Organizations’ (JCAHO’s) Core Measures for AMI, heart failure and pneumonia. It took approximately 23 hours per month to analyze the data. The cost associated with extracting, entering, submitting and analyzing this data for the same three measures reached $77,000 to $100,000 annually. And these measures represent only 16 percent of the inpatient data. Hospitals simply cannot bear the cost of measuring 100 percent of patients using the current methodology.
How can hospitals gain control over the plethora of reporting requirements as pay for performance initiatives are adopted? A successful, innovative example of managing reporting requirements is the Quality Indicator Matrix created at the Sisters of Mercy Health System in St. Louis.
At Mercy, the parent organization of 18 acute care hospitals and a variety of health care facilities and services, getting a handle on public reporting measures is part of improving quality across the health system. It’s supported by a strong organizational initiative that embraces technology to facilitate quality and safety.
For Mercy, the crucial first step was to understand the scope of public reporting requirements. Mercy created a compendium--or “quality matrix”--of all measures, identifying their governing organizations and their impact on payment, compliance, and clinical quality and safety.
The compendium, created in collaboration with quality improvement specialists at CareScience, included all current reporting measures, their definition, officiating bodies and implications in a single document.
Knowing what measures your organization must track against is not enough to efficiently manage results. An organization also needs to identify and implement best practices. At Mercy, five best practices pivotal to the success of the measures compendium quickly became clear. These practices can be adopted by any and all providers looking to create their own measure compendium, boost the results from quality measurement or both.
1. Stay up to date. Because the standardization of existing measure sets is ongoing, and because various payer organizations are increasingly using independent measures, hospitals must stay current with standards. At Mercy, updates are made to the compendium on a weekly basis. To avoid duplicative efforts, CareScience maintains an up-to-date compendium for public use. The compendium is available online for free at www.carescience.com/compendium .
2. Prioritize measures. While each measure set is valuable, not every one is equally relevant to every organization. Furthermore, not every measure set has an impact on public reporting or financial performance.
At Mercy, measures were categorized into high, medium and low importance. Priority measures were dictated by clinical and safety initiatives, regulatory requirements and public reporting requirements. A second tier consists of measures that will be required within 24 months and/or measures that national organizations are starting to focus on. The final tier includes measurements of low-volume or low-risk populations and measurements that are not likely to be publicly reported in the next two years.
3. Executive leaders should have a stake in improving quality of care. Research conducted by Eugene Kroch, Ph.D., vice president of research for CareScience, and Thomas E. Vaughn, Ph.D., at the University of Iowa, established that better quality outcomes are strongly related to the involvement of the hospital board in quality improvement. They also noted in their report, “Relating Clinical Performance to Hospital Leadership and Governance,” that incentives for executives and physician leaders are tied to higher marks in measured quality.
An executive team focused on improved clinical quality and patient safety will instill that focus throughout the organization. Executive team support will also allow for allocation of resources toward measurement and reporting programs to improve performance against those measures. This in turn will drive measurable improvement against key quality-of-care benchmarks.
At Mercy, tying several quality measures to CEO compensation has aligned the organization’s strategic objectives to quality of care improvement activities.
4. Secure buy-in from internal stakeholders. Key leaders within the organization must support the organization’s goals. These leaders, including nurses, physicians and administrative and executive staff, will drive improvement of priority measures.
With the support of key stakeholders, quality directors can speak with authority to negotiate measures and reporting standards with payers and other audiences that are consistent with the organization’s existing measurement programs and in accordance with organizational priorities. This will save valuable resources and ensure timely payment as pay-for-performance models are adopted.
At Mercy, representatives from constituencies within the organization were included in the measures prioritization process at the outset of the compendium development effort. Physicians, executives, nurses and staff from specialty departments were able to bring a commitment to the compendium process back to their own departments.
5. Avoid additional measure sets. Many payers want to create their own measure sets for providers. These additional measures weaken public reporting and clinical quality measurement, as more resources are poured into reporting and fewer are available for quality improvement action. Providers can work with payers to suggest comparable measures already in use. As measure sets are standardized, providers can focus on improvement rather than on reporting.
As a result of the inclusive compendium process, stakeholders at Mercy who were involved in the process are now able to speak with payers to negotiate for Mercy’s own measure sets in lieu of the payers’ sets.
At Mercy, the greatest return on investment in the compendium project is expected when the organization incorporates electronic medical records so applicable patient data can be uploaded directly into measure systems. This will greatly reduce the need to review charts manually. In addition, the value of the compendium is enhanced when it is used for large-scale internal department or specialty performance improvement initiatives, such as medication bar coding, which is in use across Mercy.
It is up to providers to take action to ensure that clinical quality reporting is improving the quality of care and lowering costs. Managing and prioritizing your organization’s measurement reporting is the first step in making quality reporting productive for your organization.
Kristine Martin Anderson, M.B.A., is principal at Booz Allen Hamilton in McLean, Va. Susan Sinclair, R.N., L.C.S.W., C.C.M., is director of quality management at the Sisters of Mercy Health System in Chesterfield, Mo.
In addition to this Inpatient Care Compendium, Mercy and CareScience consultants are developing an Ambulatory Care Compendium, which will also be made available for public use once it is completed.
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This article 1st appeared on August 15, 2006 in HHN Magazine online site.
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