Archive for the ‘Healthcare Quality Ratings’ Category

7 Quality of Care Investments That Earned Marshfield Clinic $15.83 Million in Shared Savings

August 9th, 2011 by Patricia Donovan

Marshfield Clinic, one of 10 participants in the CMS Physician Group Practice Demonstration, invested in seven key areas to improve quality of care delivered to patients. Marshfield Clinic was one of four participants to generate significant savings under the terms of the demonstration that resulted in a $15.83 million performance payment.

The key quality of care investment areas are:

  • A well-developed electronic health record (EHR). All clinic physicians have access to patient records from all clinic centers through the EHR, which helps to eliminate duplication of services, like lab tests and imaging. The EHR helps plan visits, addresses care at the time of the visit, and assures that appropriate monitoring of chronic conditions is performed.
  • 24-7 telephone nurse line for advice and triage for patients who have their primary care provider within the Marshfield Clinic system;
  • Anticoagulation clinic;
  • Congestive heart failure clinic programs;
  • Cholesterol management programs;
  • Well-established telemedicine initiative;

Marshfield Clinic was one of four to generate significant savings under the terms of the demonstration that resulted in a performance payment. Marshfield Clinic is one of only two out of the 10 large physician group practices to achieve shared savings in each of the five performance years.

The Marshfield Clinic system provides patient care, research and education with 54 locations in northern, central and western Wisconsin, making it one of the largest comprehensive medical systems in the United States.

5 Steps to Reduce 30-Day Readmissions for Heart Attack, Heart Failure and Pneumonia

August 3rd, 2011 by Patricia Donovan

How to reduce rehospitalizations for the “big 3″ to improve core measure ratings? “Hit them hard and hit them big time,” says Dr. Steve Berkowitz, president at SMB Health Consulting and former chief medical officer for the central and west Texas division of HCA at St. David’s HealthCare.

Dr. Berkowitz shared five of St. David’s strategies for reducing 30-day readmissions during the Q&A of a recent webinar on Healthcare Performance Improvement: Exceeding Core Measure Targets for Value-Based Reimbursement.

“We have seen in our pilots enormous improvement in rehospitalization rates. We were cruising along before our program at about 18 to 20 percent on heart failure and pneumonia, which is around the national average. Our pilots have gotten it down to 2 or 3 percent. So, there is no question that we can do this. We can hit it hard and we can hit it big time.

“What it really amounts to is the whole idea of the continuity of care. The patient goes to a nursing home. Make sure that the nursing home gets the medications. Make sure that there is good communication between the physicians. Make sure that patient is getting daily weights and all the things that they need to do this. If the patient is going home, provide individual patient education. Establish good communication with the attending physician. All these steps have dramatically reduced readmissions.”

There is a flip side, however:

“I’ll tell you where the rub is right now. though. Presently, readmissions generate a lot of revenue so that our hospital administration wants us to reduce them. But maybe not to reduce them too much, and maybe to not reduce them too fast. That is one of our challenges.”

Rapid Identification of Hospital Core Measure Patients Improves Hospital Bottom Line

July 25th, 2011 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.

One Third of Medical Homes Will Join an ACO

July 18th, 2011 by Cheryl Miller

New market research shows that one third of medical homes will join an ACO in the next 12 months. And more than half of those interviewed by the Healthcare Intelligence Network for our fifth annual survey on patient-centered medical homes said they had already established a medical home for their population. The PCMH is a favored model of integrated care delivery and a cornerstone of accountable care — two core elements of healthcare reform. More in this issue.

About $216 million nationally is spent each year managing drug
shortages in the hospital setting, with three drugs in particular
affecting over 80 percent of health systems, says a new study
released by the American Society of Health-System Pharmacists
(ASHP). The problem is not only increasing hospital costs but
harming patient care: nearly a third of the 353 pharmacy directors
surveyed said they had to pull clinical staff to manage the crisis.

More than $300 billion each year is spent on care for dual-eligibles,
the 9 million Americans currently receiving both Medicare and
Medicaid benefits. HHS hopes to lower these costs — and improve
care — with three new initiatives: financial models to better align
finances between the agencies; a quality care program for nursing
home residents, and a resource center program.

Telemedicine continues to serve the underserved. A new remote
monitoring pilot project from the University of Utah seeks to help the
chronically ill who are unable to reach traditional care facilities easily
on a regular basis. The project will feature a centralized care
coordinator, four clinics monitoring 15 to 20 patients each and two
locations using kiosks to monitor another 30 patients each. Read more in this week’s Healthcare Business Weekly Update.

Disney’s Building a Culture of Healthcare Excellence Program

July 18th, 2011 by Cheryl Miller

Forget fish tanks and Muzak; ever think your patients might appreciate watching a simulated space shuttle flight while waiting for their physical?

Or how about a FASTPASS® card, good for one free pass to the front of the line for a flu shot?

Or some fairy tale characters to keep the kids busy?

Disney believes it can teach hospital and healthcare executives how to meet and exceed their patients’ expectations. The mega theme park is introducing a new program, called “Building a Culture of Healthcare Excellence,” and it incorporates Disney’s 5 leading philosophies:

• Leadership excellence
• People management
• Quality service
• Brand loyalty
• Creativity/innovation

The program, created and presented by the Disney Institute, is designed to help healthcare administrators, physicians, nurses and other manager-level personnel.

The timing of the program is designed to coincide with the HCAHPS’s nationally standardized survey that allows consumers to compare hospitals based on how effectively they satisfy patient expectations. Starting this month, hospitals are required to publicly report the results of these surveys, which are published by the CMS on its Hospital Compare website.

In line with this, the Disney Institute’s program looks beyond the clinical and technical and focuses instead on the entire patient experience, including interactions with hospital staff at all levels, and amenities that can help the patient feel more comfortable, such as private rooms and on-demand dining services.

It’s an area that many healthcare executives admit they need to improve. According to the results from our recent Improving Patient Experience and Satisfaction survey, nearly 85 percent of respondents said they were not happy with their organization’s patient satisfaction scores as currently posted on the CMS Hospital Compare site. Communication and quality of care were the areas that they felt were most important to their patients and members. But more than half of them said communication was where they felt they needed the most improvement in, with access and waiting times coming in second.

So maybe we can learn a thing or two from the company that makes thousands of people happy every day.

And wishing on a star might not hurt either.

Release of Medicare Claims Data Reshapes Quality Measurement Landscape

June 13th, 2011 by Cheryl Miller

HIN Content Editor Cheryl Miller

In a move that could redefine the quality measurement landscape and increase transparency for stakeholders, CMS has proposed rules that will grant qualified organizations access to patient-protected Medicare data for use in provider performance reports. These vetted companies will combine Medicare claims data from CMS with private sector claims data to help consumers more easily identify hospitals and doctors providing the highest quality, cost-effective care.

We also report this week on a project that could transform patients’ perceptions of cellphone use — a new mobile application to encourage simple lifestyle changes through personalized expert guidance for individuals with diabetes and pre-diabetes. The mobile device is transformed into a virtual coach that personally guides users to better health through healthier nutrition, fitness, weight loss and tips on self-management. It’s part of an emerging mHealth technology that has important implications for healthcare not just here, but in the developing world as well. You can read more about it in this week’s issue, and in a separate post.

And to get employees away from their phones, we’ve published the results of our third annual Health and Wellness Incentives Use e-survey, which shows that benefits-based incentives, like offering to reduce employees’ health premiums, will encourage them to adopt healthier behaviors. And a gift card to Starbucks wouldn’t hurt, either.

Lastly, if you’ve been waiting to make any move at all toward applying for CMS’ Pioneer ACO Model, procrastinators take note: you get a few more weeks to file your applications. CMS has extended its deadlines, so you now have an additional month — until August 19th — to submit your applications.

Beginning this week, Cheryl Miller takes the reins of the Healthcare Business Weekly Update.

CMS Seeks ACO Pioneers for Summer Launch

May 23rd, 2011 by Patricia Donovan

Do you have what it takes to be a pioneer? CMS is seeking up to 30 vanguard healthcare companies for its Pioneer ACO program set to launch this summer ahead of the January 2012 Medicare Shared Savings Program. Only those practiced in care coordination and willing to accept financial accountability and performance incentives need apply. This week’s Healthcare Business Weekly Update contains more details as well as a link to the application, which must be submitted by July 18.

For the rest of the industry, healthcare consultant Greg Mertz spells out a few prerequisites for creating an accountable care organization.

Patient satisfaction is among the many metrics by which patient-centered delivery systems such as the ACO and medical home will be judged and compensated. We invite you to take our Patient Experience and Satisfaction survey and share how your organization is reshaping the healthcare experience for your population. You’ll be e-mailed a summary of the responses.

Patient Satisfaction: What’s It Worth to Your Organization?

May 23rd, 2011 by Patricia Donovan

There’s a lot of heated debate about whether patient satisfaction ratings should figure into healthcare quality and reimbursement models. The fact is, CMS already posts patient satisfaction ratings in 10 key areas on its Hospital Compare site. It’s only a matter of time before the Physician Compare site follows suit.

We’ve just launched a new survey on Improving Patient Experience and Satisfaction. Please tell us how your organization is working to improve patients’ and members’ experience and satisfaction with their care by June 20. We’ll e-mail you a free summary of survey results once it is compiled in mid-July. We’ll be sharing some of the most impressive strategies in future blog posts and publications.

In the meantime, we’ve heard about a hospital that claims to be the first in the nation to solicit and publish patient reviews. Hill Country Memorial in central Texas integrates online rating and review tools into its Web site. Patients can rate the Patient Experience, Quality of Care, or any of a number of hospital departments. The published reviews capture the good, the bad and the ugly…and Mark Peterson, the hospital’s director of customer experience, responds to many of them.

In an April 2011 post on patient satisfaction, a blogger for Better In Emergency Medicine describes how he has come to view that there is value in pursuing a goal of more satisfied patients:

Needless to say, as I mature in my practice, I have come to realize that there is a lot of truth to the statement, “They don’t care how much you know until they know how much you care.” With that in mind, I want to share some key points from a nice review of customer satisfaction that I stumbled upon from the Emergency Medicine Clinics of North America.

So why pursue a goal of having more satisfied patients?

There are multiple demonstrating benefits from hospitals which perform better:

  • Staff morale improves (Turnover decreases, work is more enjoyable)

  • Malpractice risk decreases (Happy patients sue less frequently)
  • Patients respond better to treatment (Patients follow instructions when they believe that they received good care)
  • Hospital finances improve (Patients recommend the facility and will come back)

We came across this brief video from HcPro on improving patient satisfaction. While geared to hospitals, the six tips contained herein can be adapted for physician practices as well as health plans.

Incenting Physicians to Improve the Patient Experience

May 17th, 2011 by Jessica Papay

Practices that exceed patient satisfaction metrics will be rewarded at bonus time, explains Bruce Nash, MD, MBA, senior VP of medical affairs and CMO for Capital District Physicians’ Health Plan Inc. (CDPHP).

Our bonus model is $50,000, and we based it on the Institute for Healthcare Improvement (IHI) Triple Aim. We are looking for improved satisfaction, and we want improvements in value, quality and cost.

We approach satisfaction by dealing with it as a threshold measure. If the practice drops below a certain level, they are not eligible for the bonus at all. It is an important safeguard if one is going to move to a mostly capitated type of payment, because every payment model has its own perverse incentives. We want to make sure the patients are receiving an appropriate experience.

As a health plan, when it came to creating the approach for the quality and cost pieces, in order for this to be sustainable and scaled, we needed to be sure that measurements in those areas that we were rewarded on resulted in savings to the plan, because otherwise we wouldn’t achieve our goals. Therefore, we created this idea that by hitting your quality metrics, you created the bonus opportunity. However, you didn’t earn it unless you hit the efficiency metrics. We chose 18 specific Healthcare Effectiveness Data and Information Set (HEDIS®) measures along the line. We are not trying to say these are the ‘be all and end all,’ but we do have a scoring methodology. These 18 measures get scored on a grid. It is weighted, and depending on how they do compared to last year, they end up with an overall score. Our overall score at a particular practice hit 66.9 percent of the $50,000. Each physician created an opportunity for $33,448 of bonus payments.

As we look at efficiency, we are an Ingenix® client. Our efficiency model is based on a customized version of an efficiency score. We are comparing everybody to the overall network. It is a relative model that we are using. Any practices in the top 10th percentile would be eligible to earn the full $50,000, if they created that opportunity with their quality. If they are in the bottom 10th percentile, they are not eligible for a bonus. In between, we multiply the efficiency score times the bonus and add this in as a kicker for improvement year to year.

ACO Rule Gets Thumbs Down from Industry Influencers

May 16th, 2011 by Patricia Donovan

Late last week, 10 healthcare heavy hitters rejected CMS’s proposal for ACOs on the grounds that it would prove too costly for many providers to implement. One pricy example cited by Geisinger Health System, Dartmouth-Hitchcock and the eight other co-signers: the investment required to report on the 65 quality measures specified in the ACO rule. It will be interesting how the feedback from this group influences CMS, which has given the industry until June 6 to comment on its guidelines for accountable care organizations.

In the meantime, two Texas health systems are going ahead with plans to collaborate in a multi-provider ACO. This week’s Healthcare Business Weekly Update provides the details.

Today is the last day to respond to our fifth annual Patient-Centered Medical Home Survey. Join the more than 110 organizations that have already described their medical home’s health IT tools, patient education, team members, metrics, ROI and more. Besides receiving a free e-summary of the survey results, you’ll also be eligible to win a copy of our newest medical home resource, Guide to Physician Performance-Based Reimbursement, excerpted in this week’s issue.