Category Archives: Quality Outcomes

Quality of care; pay for performance; quality-based reimbursement; case mix index; quality scores; quality report cards; data analytics; value-based purchasing; performance ratings; mortality rates; hospital report cards; POA; present-on-admission; HACs; hospital-acquired conditions; PPRs; potentially preventable readmissions; SOI; severity of illness; ROM; risk of mortality; healthcare reform; HealthGrades; P4P; potentially preventable complications; PPCs; state initiatives; federal funding

Risk Adjustment and Socioeconomic Status – The NQF Task Force Report

I was fortunate to serve on the NQF Task Force on Risk Adjustment for Socioeconomic Status or other Sociodemographic Factors (SDF)i. This report generated more comments than any other NQF Task Force Report – ever. Of the 700 comments received in reaction to the draft report, the vast majority (more than 98%) were in favor. CMS was one of a very small number of institutions opposed to the initial report. While the final report contains significant modifications to the initial report, much of the spirit and substance remains. Continue reading

Oh what a tangled web we weave…The impact of CDI and Coding part II

I previously discussed how selection of principal diagnosis may impact quality. This ripple effect (like a pebble on a pond) may occur when one works in a silo, ignoring other departments such as quality. If only the ripple effect was the lone “offender” in which CDI and coding may impact quality outcomes. Consider a spider web: intricately designed and seeming impervious. However, as strands get broken, the web collapses.

In review, CDI professionals and coders are tasked with obtaining and capturing a complete picture of the patient’s encounter for appropriate reimbursement, accurate reflection of severity of illness (SOI) and risk of mortality (ROM) and outcomes of care. Historical models of CDI programs and coding processes focused predominately on the first two tasks, without acknowledgement of how this may affect quality outcomes (potentially fracturing the spider web). Continue reading

Medical Homes: It’s not “Do they work?” but “How do they work?”

Earlier this year, The Journal of the American Medical Association (JAMA) published a widely publicized but limited article on medical homes in Pennsylvania that found little improvements in quality and no improvements in costs or utilization associated with medical homes. The authors concluded medical homes may generally “need further refinement” — a phrase that was taken by many in the press to mean that medical homes “don’t work.”

Subsequently, there has been much debate and little clarity around the promise of medical homes. Continue reading

CQI and Performance Evaluation: The Debrief

Continuous quality improvement is well known to us and integral to the culture of 3M. We often think of this as process improvement, employing Six Sigma and Lean methodologies. There is a distinctly human aspect to evaluation of individual and critical team performance because of opportunities for personal growth and refinements to team dynamics, respectively. Tremendous value is achieved when individuals bring absolute honesty and integrity to the process. Continue reading

What Will Patients Do When They See Your Prices?

Two trends are forcing greater consumerism and price sensitivity in health care. One is that Medicare, Medicaid, and some commercial insurance carriers, are starting to show patients and employers the prices facilities charge for common procedures. Another factor is that patients with high-deductible health and account-based plans have an incentive to consider cost when choosing services and providers.

How consumer-savvy are patients? They can search for providers by quality measures on a number of websites including HealthGrades.com and QualityCheck.org. But it’s not as easy to find out what providers charge for, say, an MRI or sinus surgery and compare prices to quality measures. Continue reading

Toss Those Pebbles Carefully…The Ripple Effect of CDI and Coding on Quality Outcomes

I have never been able to skip a stone, but I do enjoy watching the ripples expand until they disappear. Or do they?

Clinical documentation improvement (CDI) has been around for quite a while and the function has changed throughout the years. Initially, the focus was on appropriate financial reimbursement for resources provided to patients. As quality of care became more transparent, the scope expanded into accurate reflection of severity of illness and risk of mortality. Today, the role of clinical documentation has grown far beyond these two functions. Continue reading

Three Reasons Not to Model Health Care after Trader Joe’s

The AHIP conference in Seattle this month includes three consumer retail executives on the agenda. In leading up to the event, the media cited one of the speakers, the former president of Trader Joe’s, and suggested that health care should take some cues from the retail grocer.

Stop right there. Health care should not imitate the business model of Trader Joe’s, known for its folksy story-telling and unique selection of private label foodstuffs. The healthcare market is significantly different from grocery stores in ways that make it difficult to be consumer friendly: Continue reading

Health Equity: Data and Analytics Are The Great Equalizer

Those in public health believe that everyone is entitled to breathe the same clean air, drink the same safe water, and eat the same uncontaminated food. Public health protects and promotes health for everyone — regardless of race, sex, age, socioeconomic status, whether among rural or urban dwellers, whether the employed or unemployed. The basis for charting progress has been measuring and monitoring health indicators using epidemiologic tools and methodologies that account for variations in the population, such as identifying risk factors for certain conditions and geographic considerations.

But what about equity in access to health care, health information and health security? Continue reading

What Every Hospital Ought to Know About Measuring Patient Quality, Cost, and Experience

Every hospital in the U.S. is being pushed to improve patient experience, health outcomes, and total costs. Not every hospital has a data analyst –let alone a team of analysts—dedicated to measuring the progress. Fortunately, the 3M Client Experience Summit provided plenty of opportunities to learn from presenters and trend-setting hospitals.

This year, for the first time, several sessions at the Summit focused on population health. Amirav Davy, senior clinical analyst at Allina Health, talked about how to “provide information that matters” in improving transitions of care.

Following his presentation, 3M met with Amirav to learn more about how Allina uses analytics to improve the delivery of healthcare. Here are some excerpts from the conversation: Continue reading

…Ah yes, the patient!

Quality and integrity were the final syntheses at the end of the journey for enlightenment in Zen and the Art of Motorcycle Maintenance. As is true of many things in life, we can often learn vicariously from reading about the discoveries of others, and author Robert Pirsig’s philosophical reflections of 40 years ago still have relevance today. Quality and integrity are the foundation of all that is good in health care. Caregivers strive to maintain these goals, even in the face of “flavor of the month” initiatives that often superficially address the perceived ills and flaws of healthcare processes and systems.

One need only observe the spreading trend of hospitals advertising care “Navigators” to assist patients in their course of care. Care navigators are viewed as increasingly necessary for certain patients who need advocates to scrutinize and question every aspect of care delivered – from dietary choices to medication type and doses, to the indication and diagnostic yield of scheduled tests, to the relevant experience of surgeons proposing operations. Continue reading