Quality

1
Quality Finance

• Indun Whetsell
• March 6, 2015

2
Quality Finance
Contributed Potential Gain/At Risk
VBP 408,893 1,054,593
RRP 817,786 817,786
HAC 272,595 272,595
BCBS 1.2 million
TOTAL 1,499,274 3,344,974
potential gain at risk
Recoupment
VBP 285,678
RRP 681,489
HAC 0
BCBS 716,457
TOTAL 1,683,624
NOTE BCBS increase on compounded dollars
35 loss of CMS monies contributed BCBS models
CMS programs however, no penalties associated
only gain
3
FFY15 Total Loss- 1.7 million
4
FFY15 Loss greater than 50,000 by Measure
5
Associated Infection Control Loss- 700,000 (41
of total)
6
Patient Experience of Care Loss
Loss
Hospital Staff Response 53,873
Overall Hospital Rating 53,873
Doctor Communication 22,146
Medicine Communication 25,310
Nurse Communication 25,310
Pain management 22,146
D/C information 57,037
Cleanliness Quietness 44,382
TOTAL LOSS 304,077
7
Hospital Acquired Conditions (HAC)
FFY15 (ended 12/13) FFY16 (1/13 12/14) FFY17 (1/14 12/15) Comments
PSI 90 (aggregate) 95.408 95.408 68144
WEIGHT 35 35 25
PSI 3 Pressure Ulcer 11,926 11,926 8518
PSI 6 Iatrogenic pneumothorax 11,926 11,926 8518
PSI 7 CLABSI 11,926 11,926 8518 Based on coded data (not aligned with NHSN)
PSI 8 Post op hip fracture 11,926 11,926 8518
PSI 12 Periop PE or DVT 11,926 11,926 8518
PSI 13 Postop sepsis 11,926 11,926 8518
PSI 14 Postop wound dehiscence 11,926 11,926 8518
PSI 15 Accidental laceration 11,926 11,926 8518
8
HAC
FFY15 (ended 12/13) FFY16 (1/13 12/14) FFY17 (1/14 12/15) Comments
CDC NHSN 177,186 177,186 204,446
WEIGHT 65 65 75
CLABSI 88,593 44,296 51,111
CAUTI 88,593 44,296 51,111
SSI Colon 44,296 51,111
SSI Ab Hysterectomy 44,296 51,111
TOTAL DOLLARS AT RISK 272,595 272,595 272,595
9
TAKE AWAY

• Numbers here only account for rewards not
  savings in cost (antibiotics, LOS, lives, etc)
• Lot of people in the chart silo approach
• Data not concurrent
• Worst with infection (10 of 10)
• Need focus on Prevention infection
• CLABSI (improvement in 2014)
• CAUTI
• SSI
• c. Diff and MRSA
• Pneumonia
• Prevent Readmissions
• Decrease mortality
• Need focus on nursing homes
• Superior results with PSI related to surgery
• Heavier weights to outcomes going forward
• BCBS did well FFY15 n FFY17 measures not
  available
• FFY 16 already done

10
Recommendations

• Physician driven
• Concurrent coding
• Mortality reviews
• Daily tracking board
• Unexpected deaths RCA
• Need to increase RCAs
• Infection Control monitoring lines daily
• HAC rate by doc unit
• Integrate nursing care with plan
• 24/7 operation
• MD mandatory madness
• Antibiotic stewardship
• TeamsTEPPS
• Restructure HRO Infection Control CQO
  leadership
• Pressure ulcer prevention
• Nursing home alignment
• Palliative Care
• Continued focus on surgical prevention of
  complications
• Focus on ZERO harm

11
Data transparency monitoring
12
FUNCTIONAL (not org) CHART
CEO
Care Planning
Medical School Affiliation
CQO
HLC
D/C Clinic
Medical Staff Services
Director of Quality
Pt. Exp

• VBP
• Core Measures
• HAC
• RRP
• BCBS

Data Analysts inclusive of CDI Core Measures
(War Room)
Peer Review, FPPE, OPPE, credentialing
LEAN

• SERVICE LINES
• Medicine (LOS, Readmit, Cost, Antibiotic
  Stewardship, Palliative Care, NH Liason)
• Surgery (Trauma), NSQIP, CC, SCIP, Bariatric)
• Specialty Medicine (Stroke)
• Radiology
• Maternal Child (Early delivery, Infant MM, CS)
• ED

Safety

• DACS
• Sepsis
• Readmit
• Asp PN
• PC

IC
RM