MUDDLING THROUGH THE MAZE OF METRICS

Pepper Sobieski October 5, 2012

Objectives

¨  Understand the drivers of quality metrics

¨  Understand how we engage in and prioritize metrics in healthcare

So where do we begin ?

¨  Health Care is very complex

¤ Why do we want to follow specific metrics?

¤ How do work through the maze of metrics? ¤ What should our role be in following metrics? ¤ How do we prioritize?

Focus in four domains

¨  Patient Centered Focus

¨  Reimbursement Focus

¨  Who is Talking

¨  Who Is Looking

Who is looking………

Metrics of focus for those looking

¨  NDNQI Metrics

¨  Joint Commission National Patient Safety Goals

¨  CMS Evidence Based Care

¨  Value Based Purchasing Metrics – increased transparency and pay for performance

¨  ORYX Joint Commission Metrics

¨  Patient Experience

¨  Infection Prevention

Look who is talking

What are they reporting to the public………

¤ Standardized infection metrics ¤ Readmissions rates ¤ Complications rates ¤ Mortality rates ¤ Patient experience ¤ Electronic Health Record use ¤  Imaging procedures ¤ Composite safety scores ¤ Number of procedures

Through the reduction of adverse

events we reduce cost of care

Cost effectiveness is typically not the main motivator for healthcare

workers

But through the improvement of quality we will drive down cost

Reimbursement Focus

¨  Numerous studies have shown that unexplained variation in quality due to underutilization, overutilization, and inappropriate care leads to unnecessarily high mortality and morbidity rates

¨  In addition, the cost of health care in the United States exceeded $2.2 trillion in 2007, representing more than 16% of the gross domestic product.

¨  Expected to be 25% of the gross domestic product by 2025 AHRQ

Why do these metrics matter….

Why do these metrics matter….

¨  As the volume of Medicare patients increases, the Centers for Medicare & Medicaid Services (CMS) projects $110 billion in funding cuts between 2011 and 2019.

¨  The majority of these cuts will be in decreased Medicare reimbursements administered through a variety of reform programs, including the Hospital Value-Based Purchasing Program (VBP).  

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Value Based Purchasing is a Medicare Program to reward/penalize hospitals for their quality and patient experience

outcomes

Reimbursement or Pay for Performance

¨  Pay for performance requires that providers be able to prove they've improved patient outcomes in a range of areas.

¨  To do that, healthcare organizations must be able to provide detailed performance data that: ¤  Demonstrates they're offering effective care at the

most reasonable price ¤ That they're improving care over time

Value Based Purchasing: 2014 Reimbursement Evaluation Time Period: April 2012 – December 2012

Quality Measures Included under 2012 Data for 2014 Medicare Reimbursement Clinical Measures •  Cardiac Measures 4 Evidenced Based Care Measures •  Pneumonia 2 Evidenced Based Care Measures •  Surgical & Evidenced Based Care Measures

Patient Perception of Hospital Stay •  Nurse Communication •  Doctor Communication •  Hospital Staff Responsiveness •  Pain Management •  Medicine Communication •  Hospital Cleanliness & Quietness •  Discharge Information •  Overall Hospital Rating

Mortality •  Heart Attack Patient Mortality •  Heart Failure Patient Mortality •  Pneumonia Patient Mortality

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45%

30%

25%

The impact….

“Medicare fines over hospital’s readmitted patients”

September 30, 2012 Headlines

¨  But lets look at the patient centered focus

Why Do We Monitoring Metrics and Improving Quality

The Centers for Disease Control and Prevention (CDC) estimates that:

¨  At least 1.7 million healthcare-associated infections occur each year and lead to 99,000 deaths.

¨  Adverse medication events cause more than 770,000 injuries

and deaths each year

¨  The cost of treating patients who are harmed by these events is estimated to be as high as $5 billion annually.

The authors of To Err Is Human suggested

¨  That anywhere from 44,000 to 98,000 Americans die each year as a result of medical errors in hospitals

¨  The numbers were staggering and equivalent to a 747 airlines full of patients crashing every day

¨  Or that serious adverse events occur in 3.7 percent of all hospitalizations.

Setting Aims, Priorities, and Goals for Monitoring Metrics Improving Quality

What metrics are out there….

How important are they?

So how do we muddle through in the increasing number of metrics?

How do we wrap our arms around the metrics and not the other way around?

¨ And how to we focus on the patient first?

Setting Priorities

Medicare Condition of Participation 482.21

The hospital must set priorities for it’s performance improvement activities that consider:

q High risk q High volume q Incidence q Prevalence q Severity q Affect health outcomes patient safety q Affect quality of care

¨  The health service already provides some truly excellent care

¨  The strategy is about making the standard of care

even better and ensuring that best practice happens for every patient every time.

¨  Through delivering care more reliably and reducing

variation

In the event of a sudden loss of cabin pressure…

Leadership setting goals and expected outcomes and results

Engage the front line staff in understanding and monitoring metrics

Measuring the quality of health care and using those measurements to promote improvements in the

delivery of care

Nursing engagement in data

¨  Indicators against which to measure nursing practice can be selected on the basis of evidence based care or patient complaints.

¨  Indicators should be meaningful to caregivers and measure aspects

of care over which nurses have real influence.

¨  Linkage to the care they are providing is key

¨  Data collected on indicators should be presented in a way that enables staff to quickly and easily see how care provided in their unit measures against best practice.

¨  Need understanding of national benchmarking and top decile target

Beyond the numbers – Understanding

¨  Having a meaningful discussion on what drives the metric

¨  What actions will give the greatest impact that

¨  Engage in process improvement ¨  Giving nurses ownership of care indicators can motivate them to

improve their practice ¨  Review metrics as appropriate (every day/ week / month)

Make is visible

Number of Days Since Last Fall

Use of data/metrics to drive performance improvement

Quality Assessment

Determine Measures

Review and ID “Gaps”

Analyze and

Report

Collect Data

Process Improvement

Select PI Projects

Continue to Assess Data and Develop PI

Plan

Implement PI Plan

Document

Review and

Identify “Gaps”

CMS Surveyor Training part I

Using metrics to sustain the gain

¨  Avoid the Pitfall Which is …..

Losing sight of the goal And not sustaining the gain