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Allied Hospital Association Leadership for Quality - 2011

Mon, 25 Jul 2011 00:00:00 CST

Early Learnings from the Bundled Payment Acute Care Episode Demonstration Project

Fri, 01 Jul 2011 00:00:00 CST

The federal health reform legislation includes several demonstration projects that will be held in the coming years to test new models for care delivery and payment. Hospitals and health systems are encouraged to carefully study the provisions of these upcoming projects and clearly understand their requirements. Early Learnings from the Bundled Payment Acute Care Episode Demonstration Project provides an overview and summary of lessons learned to date from a current CMS pilot project, the CMS Acute Care Episode (ACE) Demonstration Project, which is testing the effect of bundling Part A and B payments for episodes of care on the coordination, quality, and efficiency of care.

The report offers the following lessons learned to date:

Constructing a framework before the beginning is helpful.
Getting more patient volume isn't as important as getting market share with the vendors.
Bringing physicians on board early in the process is vital.
Understanding that money is not a driving incentive for patients is important.
Hiring a full time case manager is necessary.
Having prior health plan experience is a plus.

It also explores several questions yet to be answered:

How can the ACE Demo be expanded into a post-hospital setting' What would a post-acute payment bundle that goes 30-60 days post-discharge look like'
What will the provider incentives look like as the project enters future years of the demo, especially if it is harder to find savings as the "low-hanging fruit" is all picked'
How does the project work if there are multiple, competitive hospitals doing the same thing in the same market' How do vendors react if all hospitals in one market are working in this type of program'
How can this be expanded to non-surgical MS-DRGs' Would this program work well for cancer patients, for example'
How do you create better beneficiary incentives' Are the i

Striving for Top Box: Hospitals Increasing Quality and Efficiency

Fri, 01 Apr 2011 00:00:00 CST

Striving for Top Box: Hospitals Increasing Quality and Efficiency is part of the HPOE Signature Leadership Series, created to share best practices and key lessons from innovative organizations on a variety of topics including care coordination, health and wellness, equity of care, and new payment and care delivery models.

Striving for Top Box showcases three organizations working towards improving both quality and efficiency: Novant Health in North Carolina, Piedmont Health in Georgia, and Banner Health in Arizona. During site visits to these organizations, we conducted interviews with key leaders who provided us with a variety of strategies they are implementing to meet their Top Box goals. This guide summarizes our discussions with each organization and provides a series of cultural characteristics, key strategies and successful practices common across each of these health systems that any organization can consider implementing.

Overall, Top Box organizations are implementing strategies to improve both efficiency and quality of care by:

Standardizing processes
Increasing IT infrastructure and data reporting
Reducing variation in cost
Creating accountability for performance improvement
Identifying and implementing best practices across the organization
Engaging clinicians and physicians

Improving Health Equity Through Data Collection AND Use: A Guide for Hospital Leaders

Tue, 01 Mar 2011 00:00:00 CST

Improving Health Equity Through Data Collection AND Use: A Guide for Hospital Leaders

Racial and socioeconomic inequity persists in health care quality. An exploratory interview with three hospitals substantiated by a review of the literature reveals that hospitals are collecting race, ethnicity, and primary language data about their patients. Leading hospitals are now moving beyond data collection to analyzing and using the data to develop targeted interventions for improving access to care for underserved populations. All hospitals are encouraged to follow their lead and, in an era of greater emphasis on community health improvement, devote the necessary resources and infrastructure to use their data in efforts to overcome disparities in care.

The exploratory interviews did identify key strategies that hospitals have adopted to streamline the data collection process:

Key Strategies for Collecting Patient Race, Ethnicity, and Language Data

Engage senior leadership
Define goals for data collection
Combine disparities data collection with existing reporting requirements
Track and report progress on an organization-wide basis
Build data collection into quality improvement initiatives
Utilize national, regional, and state resources available
Review, revise, and refine process and categories constantly

A review of literature highlighted several approaches for using the patient data collected by hospitals:

Leading Practices for Using Patient Race, Ethnicity, and Language Data

Use an equity scorecard or dashboard to report organizational performance
Inform and customize the language translation services you provide
Review performance indicators such as length of stay, admissions, and avoidable readmissions
Review process of care measures
Review outcomes of care
Analyze provision of certain preve

Health Care Leader Action Guide: Understanding and Managing Variation

Tue, 01 Feb 2011 00:00:00 CST

Health Care Leader Action Guide: Understanding and Managing Variation builds upon the report of the American Hospital Association's Task Force on Variation in Health Care Spending (January 2011). The purpose of this guide is to provide hospitals with a resource to help reduce inappropriate variation within their own organizations and in conjunction with care partners. The guide includes practical steps to understanding and managing variation and a list of best practices and case studies as examples and resources for hospital leaders to use for implementing key interventions.

Variation arises from many interrelated factors, some within and some beyond the control of the health care system. Not all variation is undesirable or inappropriate. Distinguishing among the types of variation to determine what is acceptable and what is not is critical to arriving at a reasonable set of recommendations for action. Hospitals and health systems can take these action steps alone or in collaboration with others to reduce inappropriate variation within their organizations.

There are six steps to understanding and managing variation:

Determine your strategic focus to reducing variation
Set measurable goals
Acquire and analyze data
Understand your data
Identify areas of focus
Implement improvements

Research has shown that some of the greatest potential areas of focus include:

Intensity
End-of-life care
Outpatient/ambulatory services
Obstetrics
Imaging use
Emergency services

To address these focus areas, there are a variety of improvements to implement, including:

Providing feedback of performance data at the provider level
Standardizing processes of care by using chec

Hand Hygiene Project: Best Practices from Hospitals Participating in the Joint Commission Center for Transforming Healthcare Project

Mon, 01 Nov 2010 00:00:00 CST

Hand Hygiene Project: Best Practices from Hospitals Participating in the Joint Commission Center for Transforming Healthcare Projects. Hand hygiene was chosen by eight leading hospitals for the first Robust Process Improvement (RPI) project by the Joint Commission Center for Transforming Healthcare. The Joint Commission had surveyed the hospitals and asked, â€œWhat is the number one patient safety challenge'â€ Hospitals prioritized the challenges, and hand hygiene ranked first on the survey.

Many health care-associated infections (HAIs) are transmitted by health care personnel, and hand hygiene is a primary means to reduce these infections. In 2002, the estimated number of HAIs in U.S. hospitals was approximately 1.7 million, with more than 98,000 deaths annually, according to the CDC.

The Eight Participating Hospitals
Mark Chassin, MD, Joint Commission president, chose the eight hospitals to participate in the hand hygiene project. These hospitals all had â€œwell-established RPI infrastructure at their hospital,â€ said Melody Dickerson, RPI black belt, the Joint Commission. All eight hospitals use Lean Six Sigma methodologies, and it was a requirement that the eight hospitals follow the same methodology throughout the project.

The Joint Commission standard for hand hygiene has changed as a result of the hand hygiene project. Previously the standard called for hospitals to demonstrate hand hygiene compliance at a rate greater than 90 percent. A hospital that failed to comply would receive a Requirement for Improvement (RFI) and have 90 days to show improvement to 90 percent. â€œBecause of this project, we now know how difficult it is to reach 80 percent, let alone 90 percent,â€ said Dickerson. â€œNow the standard says the hospital needs to work to improve compliance,â€ she explained.

The eight hospitals are:

Cedars-Sinai Medica

Designing A 21st Century Approach to Primary Care

Wed, 13 Oct 2010 00:00:00 CST

When it comes to primary care, neither patients nor practitioners are satisfied with current trends. A new vision of primary care—one built on a clinically and economically sound foundation—offers substantial benefits to both physicians and their patients.

Although primary care is expected to be safe, effective, patient-centered, timely, efficient, and equitable, it often is not. Research indicates that patients’ overall satisfaction with primary care is limited and that substantial numbers of primary care practitioners report dissatisfaction with their field and concerns about its future. Today’s primary care system is also troubled financially.

A paper by John Griffith, Kyle Grazier, and Scott Ransom proposes to remedy these problems with a new vision of primary care. They reference successful business models as a way to revolutionize primary care via improvements in marketing (both to patients and caregivers), logistic support functions, clinical practice functions, and financial management. The authors believe that, to achieve success, the new primary care system must:

be responsive to patient needs so that patient-customers return when appropriate and recommend the provider to others;
create a desirable “product” by providing benchmark level care against IOM goals and seeking continuous improvement in treatment quality and effectiveness;
retain and attract caregivers by “delighting” practitioners in the areas of personal and professional satisfaction with their careers;
provide care that maximizes value and effectively manages referrals for patients who need specialty care;
use financial incentives to reward providers and patients for constructive behavior.
be implemented without substantially disrupting current patient care or a physician’s practice.

The authors’ plan for primary care offers patients an expa

Practical Issues in the Design and Implementation of Pay-for-Quality Programs

Wed, 13 Oct 2010 00:00:00 CST

A recent wave of pay-for-performance programs focus—in some cases exclusively—on quality of care. Factors underlying this renewed interest in the “pay-for-quality” (P4Q) concept include growing concern about the quality of health care in the United States, evidence that medical errors are occurring more frequently than many experts predicted, and steadily rising health care expenditures. Payers are also hoping that P4Q will support the business case for quality healthier—in other words, that healthier patients will translate into long-term cost savings.

Although the motivation for P4Q programs is clear, the best strategies for designing and implementing programs are not. Using the results of their on-going research, Drs. Young and Conrad identify and discuss some practical issues that should addressed when developing and conducting P4Q programs.

Quality Measures

Research indicates that, when selecting quality measures, payers struggle with three key decisions. The first is the type of clinical conditions on which to focus. Most programs focus on preventive care and primary care of chronic conditions, reflecting the high health payoffs of preventive care and the high concentration of expenditures among persons with chronic conditions. Thus, an optimal quality incentive program would be based on a broad range of measures that capture a representative set of the preventive, diagnostic, and treatment processes typically managed by the physician.

Another key decision is whether to focus on clinical processes or outcomes. Although outcome measures have an obvious “bottom-line” appeal, process measures are more feasible for most P4Q programs because, from a provider standpoint, they are the most controllable aspects of quality.

A third decision is whether to select quality measures based on national standards or those derived from local priorities and customs. Most P4Q pr

Organizational and Clinical Factors Influencing Use of Clinical Practice Guidelines

Fri, 08 Oct 2010 00:00:00 CST

Implementing clinical practice guidelines can improve the quality of patient care and positively impact a health care system’s bottom line. To increase the chances of successful implementation, a study by Dr. Stone and her colleagues examines ways that guidelines can be tailored to better meet physicians’ needs and also suggests strategies that encourage guideline acceptance.

The first phase of the study surveyed almost 500 physicians from four health systems when two guidelines (one for acute myocardial infarction and the other for pediatric asthma) were implemented. Researchers asked physicians exactly where they preferred that the guidelines be placed and what specific learning strategies best encouraged them to use the guidelines. They also asked about the content areas, formats, and types of medical evidence that physicians found most useful as they treated patients.

Survey results revealed that, overall, physicians preferred that guidelines be placed on the front of the patient chart, on their personal palm pilots, or in the progress notes. Discussions with colleagues and continuing medical education were identified as most effective in encouraging guideline implementation. During patient treatment, physicians considered guidelines that included immediate treatment flows and strategies aimed at minimizing and encouraging self-management to be the most useful. Clinical guidelines presented in the form of flowcharts, algorithms, and pre-printed orders were also judged more convenient to use when treating patients, and randomized controlled trials were the most persuasive medical evidence that could be included in a guideline.

The following are some of the negative physician viewpoints uncovered by Dr. Sands and her colleagues:

Physicians judged departmental memos and electronic newsletters as ineffective tools for educating or encouraging them in the use of new guidelines.
Disease- or illness-specific pamphlets

Making and Enacting Strategic Decisions in Hospitals and Health Care Delivery Systems: Orchestrating Standardization

Fri, 08 Oct 2010 00:00:00 CST

As the costs associated with materials and the broader hospital and system supply chain continue to escalate, pressures to achieve savings through standardization have intensified. In a study focusing on implantable items in the specialties of cardiology (pacemakers) and orthopedics (hip implants), researchers investigated the factors associated with successful materials standardization efforts, including the role played by physician trust. After conducting interviews with key members of five different systems and with representatives of two major group purchasing organizations, researchers found that hospitals and systems that achieved consensus on standardization had much in common.

Success was frequently related to physicians recognizing that the institution brought value to their practice and that they could contribute to the organization by consistently working to serve their mutual interests. These physicians appeared to trust that their involvement in product evaluation would lead to good-faith behavior on the part of management when purchasing materials. A number of organizations also reported a specific incident, such as a clinical service being placed at risk, that helped bind physicians to participation in the product selection process and made them appreciate the contribution of product not only to the success of the organization but to their own practice.
Successful hospitals and systems acknowledged that their physicians had strong preferences based on long-standing experience with brand-name products and on service provided by manufacturer representatives and the broader sales force. These organizations managed such relationships through formal, clearly stated policies and procedures specifying which contracted and non-contracted materials were permissible and describing the conditions for payment for non-contracted goods. Informants also reported success when vend