Monday, February 24, 2014

Constant improvement is a way of life in health care

Quality and safety have always been at the forefront of patient care, and now experts say hospitals are incentivized more than ever to pursue constant improvement.

Vicki Good, CoxHealth’s administrative director of patient safety, is on the front lines of monitoring where we stand on key performance measures and where we need to be in the future to serve patients and meet an increasingly complex set of requirements.

“Constant improvement is a way of life for health care. Consumers and payers want us held accountable and reimbursement is one way they do that,” Good says.

For systems like CoxHealth, staying on top of quality and safety means carefully measuring our performance, seeing how we compare with other providers and making changes to improve care and keep our patients safe. Good says hospitals are now influenced by measures tied to value-based purchasing, the cost-sharing program Medicare and Medicaid use with hospitals. Those measures include outcomes, processes of care (core measures), patient experience and efficiency of care.

It’s vital to provide high quality care all the time, but the data tracked in these categories gives hospitals a place to focus their improvement efforts.

The core measures include data on performance in areas such as heart failure, pneumonia, stroke and surgical improvement (SCIP measures). This data is all watched closely because of public reporting, and a subset of these measures affects CoxHealth’s payment structure.

Good notes that core measures look at processes: How often do you get an aspirin to a patient? How often does a patient get to the cath lab in 60 minutes?

“In order to add to the robust nature of quality, both process and outcomes must be measured,” Good says. Outcome-based measures used for value-based purchasing track how well do we do on 30-day mortality for events such as acute myocardial infarction, heart failure and pneumonia.

Under value-based purchasing, hospitals have part of their reimbursement tied to performance. Average performers don’t gain or lose money; low performers have part of their reimbursement withheld; and top decile performers stand to get money back.

“Hospitals are really focused on the measures in value-based purchasing because of the financial implications,” Good says. “All of these measures revolve around quality and safety.”

Under value-based purchasing, hospitals will be reimbursed based on a composite “patient safety index” score called a PSI 90. The composite score includes data on pressure ulcers, post-op hip fractures, post-op sepsis and a variety of other complications. Based on patient population and their risk, a prediction is made about how many complications a provider is expected to have. The PSI 90 score is a ratio of the actual number of complications compared with those predicted.

A score of 1.0 means that exactly as many complications as expected occurred. But the program is designed to encourage hospitals to beat those expectations. Currently, the median performance (required to be eligible for money back) is .62, while high performers have a score of .45.

Good says CoxHealth performed in the .28-.3 range in November and December, positioning us well for value-based purchasing. However, since all hospitals are striving to perform better than the median, everyone is chasing a moving target to remain in the group of hospitals that receive additional reimbursement.

That strict standard is producing significant improvements in hospitals nationwide. For central line infections, for example, a hospital must have fewer than .05 infections per 1,000 catheters just to reach the average, break-even level of performance.

Good says that watching these measures closely and constantly working to improve everything we do is vital to providing the best care for our patients.

“Just like with patient satisfaction, it’s not good to be 90 percent. An ‘A’ performance is below average on percentile,” Good says. “When you think you’ve caught up, others have caught up and gone further.”