Are there just way too many quality metrics in health care, enough to leave a new doctor's head spinning? Why can't hospitals just have a simple, agreed upon set of quality measures, similar to the Generally Accepted Accounting Principals?
That was one of the topics that came up recently when I interviewed Joe Fifer, the new head of the Healthcare Financial Management Association, in Westchester, Ill. Our interview appears in this month's issue of H&HN, but I thought I'd share some of the leftover bits that never made it off the cutting room floor.
Fifer hails from Michigan, and he's spent more than 20 years in hospital finance, most recently as vice president of hospital finance at Spectrum Health. Besides the health care stuff, I gathered that he's big on sports (especially the Detroit Tigers), family (his mom is his biggest influence in life), and books on the two world wars.
In financial reporting, one hospital can have thousands of different accounts and possibly thousand of different cost centers, with data spread every which way. But the cascading reporting process allows all those disparate parts to be dumped into sortable buckets, Fifer notes. They're reported with a standard set of rules, GAAP, and thus there's some consistency and it's easy to compare from entity to entity.
Why, Fifer wonders, can't the same be done with quality data on the clinical side? At first he thought there should be less measures. But on the flipside, maybe health care needs thousands of quality metrics, just like those cost centers, that are gathered and analyzed in a cascading manner down to a common set of metrics used to compare organization to organization.
"You can't draw total conclusions, but at least it's a framework that is consistently generated and consistently reported that gives the industry an ability to have a comparable comparative starting point," he said. "I don't know if it's possible or not, but I do know it's like the wild, wild west in terms of all of the quality reporting, and you cannot compare one entity to another because there's not a systematic way to gather the data, and there's not an agreed upon, summarized data set that would be representative of quality across one organization to another."
Fifer does think that health care will get to this ideal state eventually, but it's just a matter of time and effort. Along the way, he thinks its essential for hospitals and health systems to consider the patient's perspective when compiling this master list of quality metrics.
"We're not stamping sheet metal here. We're working on people. We're working with people's lives and their health, he said, later adding, "So, my point in comparing it to manufacturing is not to draw too much of a correlation, other than, is this is a human business. So, since it's a human business, the patient has got to be right at the center of that. Because it's the patient's functional outcome that ultimately really matters here. Much of the other data that we're looking at today would be more input, and it's important. It's quality processes, but the true outcomes are going to be functional outcomes, and by definition, the patient is at the center of that."
Despite the recent election and Supreme Court decision on health reform, there's still uncertainty in the industry. CEOs are worried what might happen to their hospital if the country falls off the fiscal cliff, and leaders don't really have a true sense of how insurance exchanges are going to shake out in the next couple of years. Fifer is telling HFMA members to try some new things, and be ready for whatever curveball might fly at their hospital in the near future.
"We are encouraging them to get ready for whatever happens," he said. "We are encouraging them to focus on the business-intelligence needs. We're encouraging them to understand and get more disciplined on performance improvement methodologies. We're encouraging them to experiment and jump in, not in a huge way, but jump into a different risk model or a bundle-payment scheme because the learning environment is rich when there's an actual contract at hand or an actual situation. And I'm not talking about clinical learning here; I'm talking about the business models. There's' no better learning environment than if you experiment."