Building Rural Hospital Leaders in Quality and Safety

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Building Rural Hospital Leaders in Quality and
Safety
Insights from the Office of Rural Health
Oklahoma Foundation for Medical Quality
Elanor Wallis RN, BSN Quality Improvement
Oklahoma Foundation for Medical Quality
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In the Beginning

• Office of Rural Health asked OFMQ to partner in
  2002 for a Rural Hospital Conference.
• 7th Scope-Task 2b Transition hospitals to self
  generated data collection and reporting (2003)
• quickly became assistance with public reporting
• Beginning of a true partnership

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First Oklahoma Rural Health Conference Success

• Office of Rural Health had 2 employees who did
  all the organization
• Well supported by Hospital leadership, staff and
  vendors
• Promoted second joint project Rural Hospital
  Computer Project (1e)

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Computers to Rural Hospitals

• OSU/Office of Rural Health purchasing contract
  pricing
• OFMQ provided non-government funds
• Purchased computers for 53 rural hospitals
  including CAH (2003)
• Hospital received free computer agreed to report
  quality data
• Hospital also received

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Hospitals NeededTraining Support

• OSU/ORH provided basic computer training to
  hospital staff through Career Techs throughout
  the state
• OFMQ provided technical training to individual
  hospitals
• Partnership provided regional leadership training
  and clinical education at Career Tech campuses
  throughout the state

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Ongoing Partnership

• Conference was successful-decision to continue
• Lots of ideas suggested by attendees
• Rural Hospitals crucial to Oklahomas Healthcare

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Conference Planning Committee

• Volunteers-Hospital and Vendors
• Have shifted Planning and Production
  responsibilities based on resources
• Solicit topic suggestions and evaluation
• Update National and State initiatives and
  regulations every year

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The Planning Committee Today

• Under Corie Kaisers direction- a well-run machine

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2008Oklahoma Rural Hospital Conference

• 6th Oklahoma Rural Health Conference
• Increased attendance every year
• Increased vendor support every year
• Topics of importance to rural hospitals with
  quality focus
• Considering implementing a multi-state event

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Ongoing Projects

• Continue to grow the Conference
• Rural Hospital 8th Scope
• Improving Hospital Culture of Safety
• Systems Improvement Organizational Change

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Leadership Development

• Leaders hold the key
• Leaders come from everywhere
• D.D. Bainbridge Project
• TeamSTEPPS
• AHRQ Culture of Safety Survey
• HLQAT

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Leadership-Quality Link

• Improvement in Culture of Quality Safety must
  be leadership priority.
• Board
• Administrators
• Clinical Leaders
• National, State Community Leaders

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Leadership and Quality in Critical Access
Hospitals

• Oklahoma joined a multi state project funded by
  the Rural Hospital Flexibility Program (FLEX)
• OFMQ and ORH staff have participated in
  curriculum for onsite support to hospitals

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D.D. Bainbridge Associates, Inc.

• Focus on 5 Outcomes
• Patient Satisfaction
• Patient Retention
• Patient Profitability
• New Patient Acquisition
• Market Share Domination

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Outcomes achievable when supported by

• Strong Leadership
• A clear understanding of the organizations
  mission, vision and values
• A healthy change engine founded in a strong
  quality program
• Focus on the right future defined in a
  strategic strategic plan
• A structured way to implement the plan
• A healthy balance of resources

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The Future

• Payor and Public Expect Transparency
• Quality and Safety data in the press
• CMS stated plan to Implement Value Based
  Purchasing
• CMS will pay for high quality care

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Note Requires action by Congress before hospital
value-based purchasing can be implemented. Will
not apply to CAHs.
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VBP Design Assumptions

• Would build on infrastructure of the Reporting
  Hospital Quality Data for Annual Payment Update
  Program (RHQDAPU)
• Transition from and replace RHQDAPU
• Would not include additional funding
• 2-5 withhold of base DRG funding for all
  Medicare patients (not just the core topics)
  recommended in draft report

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Health care quality is improving only modestly,
at best, said AHRQ Director Carolyn M. Clancy,
M.D. Given that health care spending is rising
much faster, these findings about quality
underscore the urgency to improve the value
Americans are getting for their health care
dollars.
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Problems with healthcare quality and safety are
commonly exposed in lay press
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(No Transcript)
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Public Reporting Evolves

• Every hospital in Oklahoma has reported data to
  the CMS Quality Data Warehouse
• Oklahoma Hospitals are required to report quality
  improvement data to comply with state regulations
  (includes CAH)
• CAH hospitals are not required to report in order
  to receive their full Medicare payment but have
  learned to use data to improve care

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Transparency

• Reported clinical measures now 30
• AMI - 8
• HF - 4
• Pneumonia - 7
• SCIP 7
• Mortality Measures - 3
• HCAHPS (Patient Survey)

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Requirements for Public Accountability

• In Oklahoma if you are a CAH or PPS hospital, you
  are required to report the CMS core quality
  measures for inpatients as a condition of
  licensure.

TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH
CHAPTER 667. HOSPITAL STANDARDS SUBCHAPTER 1.
GENERAL PROVISIONS
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Is additional reporting around the corner?

• In 2006, the Oklahoma State Legislature passed
  House Bill 2842 which amended O.S. Title 63,
  Section 1-707 of Oklahoma Statute expanding the
  authority of the Oklahoma Hospital Advisory
  Council to require hospital public reporting of
  rates of infection for adult intensive care unit
  patients to 1) ventilator-associated pneumonia,
  and 2) central line blood stream infections.
  Rules issued by the Department of Health OAC
  Title 310 Chapter 667 - specifically
  310667-1-3(h)

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Quality and Payment

• Factors driving policy related to quality
  measurement and payment incentives

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Cost and Quality

• 2.2 trillion on healthcare this year alone
• 600 billion for Medicare and Medicaid
• By 2030, at present rate of growth will consume
  50 of Federal budget
• Disconnect between payments and performance
• Paid the same regardless of quality
• Often paid more for care that results in
  avoidable complications

Volume-based Payment
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Cost and Quality

• Well documented deficiencies in the quality of
  care
• Substantial underuse of recommended care
  regardless of income, race, or age
• Substantial regional variation in the use of
  healthcare services without evidence of
  additional benefit to patients in high
  utilization regions
• Cost

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Response to the Issues of Cost, Variation, and
Quality

• Standardized measures of quality across all
  settings
• Public reporting of performance
• Payment incentives for performance
• Changes in payment policy to reward quality and
  not volume
• Withhold payment for complications

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Oklahoma Healthcare Quality Improvement Advisory
Committee

• Consistent findings of poor quality of health
  care in Oklahoma
• Robert Wood Johnson Foundation
• Commonwealth Fund
• National Healthcare Quality Report State
  Snapshots
• Convened by the Commissioner of Health
• Includes regulators, payers, provider
  organizations, business interests, and consumers

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Oklahoma Healthcare Quality Improvement Advisory
Committee

• Three committees (Home Health/Hospital,
  Outpatient care, Nursing Home care) to address
  quality measures
• Each asked to focus on
• Educational programs for providers
• Consumer engagement
• Public accountability (e.g., public reporting of
  performance)
• Payment incentives to drive better care

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Measures of Focus

• Home Health/Hospital
• Preventable hospital readmission rates are very
  high in Oklahoma
• Nursing Home
• Pressure ulcer rates, use of restraints, pain
  management
• Outpatient Setting
• Care of diabetes mellitus
• Preventive services colorectal CA screening,
  mammography, Pap smears

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Performance Model Overview

• 70 of performance score based on process
  measures
• 30 of performance score based on HCAHPS (patient
  satisfaction survey data)
• CMS currently working to incorporate the 30-day
  mortality measures, and is designing new measures
  of complications, hospital readmission, and
  efficiency

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Can you make a business case for quality??
This material was prepared by Oklahoma Foundation
for Medical Quality, the Medicare Quality
Improvement Organization for Oklahoma, under
contract with the Centers for Medicare Medicaid
Services (CMS), an agency of the U.S. Department
of Health and Human Services. The contents
presented do not necessarily reflect CMS policy.
1C-655-OK-0608