Rapid Identification of Hospital Core Measure Patients Improves Hospital Bottom Line

Monday, July 25th, 2011
This post was written by Jackie Lyons

Even one miss on a hospital core measure can mean the loss of a significant amount of money for an organization, says Dr. Steven Berkowitz, MD, president SMB Health Consulting and former chief medical officer of St. David’s Healthcare System.

To become successful with core measures, hospitals need to develop an organizational culture of zero misses, explained Dr. Berkowitz during the recent webinar Healthcare Performance Improvement: Exceeding Core Measure Targets for Value-Based Reimbursement.

With the upcoming changes to Medicare reimbursement, hospitals are no longer focusing on core measures for quality, but for the financial bottom line, said Dr. Berkowitz. Therefore, it is vital to identify every core measure patient.

Most of the core measure patients come out of the emergency room (ER), said Dr. Berkowitz. This presents the opportunity to identify them as heart failure (HF), acute myocardial infarction (AMI) and pneumonia patients.

One strategy to rapidly identify core measure patients is to note every direct hospital admission to the concurrent reviewer so that the patient is on the potential core measure radar screen before they even hit the floor of the hospital.

In addition, each measure must be reviewed individually. Ownership should be assigned to different people for each measure. According to Dr. Berkowitz, everyone should know whether they are the one responsible or not. This allows for policies and procedures to be put in place that create accountability. For example, if a nurse misses a core measure, that nurse is accountable to the CEO of the hospital to explain why that measure was missed.

According to Dr. Berkowitz, it is important to check, check and recheck the core measures. When looking at each measure, such as HF, ask detailed questions like: How do we identify the patient? How do we make sure that the patients receive the packet per discharge instructions? How do we confirm these packets are matched up with the physician’s discharge?

It is necessary to break the process down into everything that needs to be done and who is responsible for following and identifying the necessary patient and making sure it is done in a timely manner, Dr. Berkowitz explained. Listen to an interview with Dr. Berkowitz.

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