Q&A: With Hospital Core Measures, 90% Doesn’t Cut It

Thursday, December 22nd, 2011
This post was written by Jessica Fornarotto

Good core measure performance is good patient care, explains 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. Prior to his presentation on Healthcare Performance Improvement: Exceeding Core Measure Targets for Value-Based Reimbursement, Dr. Berkowitz discussed the most challenging clinical measures to improve, tools for collecting core measure data and physician incentives to improve performance.

HIN: St. David’s healthcare system has specifically improved care related to heart attacks, heart failure, pneumonia and surgical care. What was the most challenging clinical measure among those to improve and what process changes sparked the improvement?

(Dr. Steve Berkowitz): Every one of those measures has unique challenges that we needed to handle. Frankly, a general challenge that we had was developing these protocols over eight hospitals in two different markets. Having said that, the most challenging measures are the surgical care improvement program (SCIP) measures because they are resource-intensive as well as require physician buy-in and input to make sure they get done appropriately. One thing I want the audience to come away with is a sense of enthusiasm that your organization can get it done. You can achieve virtual 100 percent performance with some hard work, checking and rechecking, and dedication of your physicians, nursing, pharmacy and administration. But most important, the establishment of good core measure performance is good patient care.

HIN: Can a hospital or health system that does not have an electronic health record share this type of data efficiently?

(Dr. Steve Berkowitz): Absolutely. When we first started this, we had very little of an electronic record at St. David, and that’s improving fast. What we were able to do was just develop internal processes to track those patients very early, have concurrent review of those patients, and get the data widely disseminated and available. Not only can we track our performance now, but we can use that data to identify outliers, whether they be physicians, nursing, pharmacists, etc., so that we can specifically target approaches to go for our goal of zero misses.

HIN: In the absence of the EHR, did you use registries at all to either collect the data or disseminate the data?

(Dr. Steve Berkowitz): We had some internal processes that we developed. But it really was a function of downloading all of the data from our system and then individually tracking and monitoring. I want to emphasize that to be excellent in core measures, it’s very labor intensive. You have to check, check and recheck, and there needs to be redundancies built into the system because we need zero misses. Ninety percent doesn’t cut it anymore, 95 percent doesn’t cut it anymore, and even 99.6 percent performance leaves a lot of dollars on the table.

HIN: What physician incentives were in place, or are in place, at St. David to encourage performance improvement?

(Dr. Steve Berkowitz): We have very little physician incentive there, although there is an incentive plan for the hospital lists because they are the driver of these measures, particularly with heart attacks, pneumonia and heart failure, and maybe less so with SCIP. But we instituted an incentive program for our hospital lists and they led the charge. They got us to outstanding performance quickly in those three categories.

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