Hospital Performance and Quality Reporting

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Hospital Performance and Quality Reporting

• Critical Access Hospital Conference
• Austin, Texas
• June 25, 2009
• Kevin Warren, SVP, Operations
• Becky Heinsohn, RN, CPHQ, Director, Patient
  Safety
• TMF Health Quality Institute

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Disclaimer

• Kevin Warren, Becky Heinsohn and TMF Health
  Quality Institute do not have relevant financial
  relationships to disclose.

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Objectives

• Describe the national hospital quality
  improvement efforts and initiatives
• Describe the central role quality plays in the
  efforts to improve healthcare
• Recognize benefits of voluntary quality data
  reporting
• Identify and discuss other factors for
  consideration

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Knowledge is of two kinds. We know a subject
ourselves, or we know where we can find
information upon it. Samuel
Johnson, 1775
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The Means to an End

• Collecting Information on Quality
• Selective Contracting with High-Quality Providers
• Partnering with Providers on Plans for
  Improvement
• Educating Employees on Quality Issues
• Rewarding High Quality and Penalizing Poor
  Quality
• Value-Based Purchasing A Review of the
  Literature,
• Vittorio Maio, Neil I. Goldfarb, Chureen Carter
  et al.,
• The Commonwealth Fund, May 2003

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Setting the Stage

• Medicare Modernization Act (MMA) 2003
• 0.4 holdback for non-voluntarily reporting
• 10 Initial Measures
• Deficit Reduction Act (DRA) 2005
• 2.0 holdback for not reporting
• Expansion of Publicly Reported Measure Set
• Report to Congress for VBP program (FY 2009)
• Present on Admission (Hospital Acquired
  Conditions)
• Tax Relief and Health Care Act of 2006
• Incorporate hospital outpatient measures
• Physician Quality Reporting Initiative (PQRI)
• Gainsharing Demonstrations
• American Recovery and Reinvestment Act of 2009
• Reimbursement incentives for successful
  meaningful use
• Regional Extension Centers to provide assistance
  and education with HIT adoption

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Next????
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Quality
Cost
Tension for Change
Access
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Uninsured to Pay 30 Billion on Own, Study
Says. Wall Street Journal. Monday, August 25,
2008.
Health-care spending accounted for 16.3 of
gross domestic product in 2007, or about 2.2
trillion, and that amount could nearly double in
10 years, according to federal figures. More of
the cost is expected to shift to the government,
even as it seeks to shrink large deficits.
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• Improve Quality
• Quality improvement opportunity
• Wennbergs Dartmouth Atlas on variation in care
• McGlynns NEJM findings on lack of evidence-based
  care
• IOMs Crossing the Quality Chasm findings
• Avoid Unnecessary Costs
• Medicare fee schedules and prospective payment
  systems are based on resource consumption and
  quantity of care, NOT quality or unnecessary
  costs avoided
• Tom Valluck, MD, CMS Presentation
• CMS Progress Toward Implementing Value-Based
  Purchasing
• September 13, 2007

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Why Does the System fall short in Providing High
Quality Care?

• Current improvement methods are highly dependent
  on vigilance and hard work
• Focus on clinical outcomes gives clinicians a
  false sense of security
• Permissive clinical autonomy allows wide
  performance margins
• Deliberate design for reliability rarely occurs

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Whats wrong with being right 99.9 of the time???

• 12 Babies a day given to the wrong family!

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Great people need great systems to help them
deliver great care.
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Intent, Vigilance, and Hard Work, or Redesign?

• Standardization
• Pre-printed orders, checklists, feedback on
  compliance, training, education
• Human factors and reliability science
• Decision aids and reminders built into the
  system, redundancy in the system, forcing
  functions, or desired actions are the default
  (requires opt out to fail)
• Redesign of the reliable system constantly
  learning from failures and redesigning the system
  to account for human factors and failures

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Voluntary Reporting

• Why?
• Why not?

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Quality Data Reporting Initiatives

• Improved performance on clinical measures
• Acute myocardial infarction
• Heart failure
• Pneumonia
• Surgical care

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Who Reports?

• Over the past 2 years, 33-35 Critical Access
  Hospitals in Texas have been reporting data
  consistently
• So What??

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Success is Achievable
Critical Access Hospital Performance
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TMFs Role in the Data Reporting Support

• Support data submission to the clinical data
  warehouse
• Validation of data submitted by providers
• Analysis of data and education
• Access to comparative performance
• Training on technical manual changes regional
  workgroups

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Approach

• Supportive Management Structure
• Structures to fool proof change
• Transparency and Feedback
• Patient focused culture
• Formal Development programs
• Know your sources for resources

Use your size to your advantage!
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Board Engagement
Jiang, Joanna H.,et al (2008).Board Engagement
in Quality Findings of a Survey of Hospital
and System Leaders. Journal of Healthcare
Management. 53(2) 121-134
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Sources for Resources

• Your Peers
• Texas Organization for Rural and Community
  Hospitals (TORCH)
• TMF Health Quality Institute
• Office of Rural and Community Affairs (ORCA)
• Institute for Healthcare Improvement (IHI)
• National Quality Forum (NQF)
• Centers for Medicare Medicaid Services (CMS)
• And so on.

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• To do things differently, we must see things
  differently. When we see things we havent
  noticed before, we can ask questions we didnt
  know to ask before
• John Kelsch, Xerox

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What can you do when you get back to work?

• Get goals
• Get bold
• Get together
• Get the facts
• Get to the floor
• Get a clock
• Get your numbers
• Get the stories

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Call the Question

• How do your clinical scores compare to your
  competitors?
• Are you proud of your performance?
• Does your organization relate financial
  performance to quality of care performance?
• Does improving quality really matter in your
  organization?
• Are you prepared for quality driven
  reimbursement?
• How are quality initiatives prioritized within
  your organization?
• Developed from AHA Get w/ the Guidelines program
  (Houston, 2005)

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• What endures is your effect on other people and
  the kind of world, organization and culture that
  you've helped to create.
• Jeffrey Pfeffer
• Stanford University

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Contact Information

• Sherri Gagner
• Hospital Data Reporting Consultant
• 512-334-1717
• sgagner_at_txqio.sdps.org
• Christine Pencak
• Hospital Data Reporting Consultant
• 512-334-1803
• cpencak_at_txqio.sdps.org