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

The seven habits of highly successful care programs—and six examples

Last month, David Blumenthal, MD, director of The Commonwealth Fund, addressed a 3M conference in New York City on value-based care. He mentioned soon-to-be-released recommendations from his organization on effective models for healthcare improvement.

What he didn’t say was that the recommendations would be accompanied by a media crusade. In the past several weeks, The Commonwealth Fund has released a range of multi-media content advocating new models of care. Continue reading

Good news and bad news: The cost of (partial) Patient-Centered Medical Home implementation

Magill and colleagues published a nice analysis of the staffing costs of a Patient-Centered Medical Home (PCMH). Compared to a regular practice that already has an electronic medical record, they looked at the incremental costs associated with meeting NCQA standards for Patient-Centered Medical Home recognition.

The investigators reported incremental costs in three ways: Continue reading

“What did you have for dinner last night?” Nutrition and the healthcare system

While we often hear about the role of good nutrition in promoting health, it is not typically discussed in the context of the Triple Aim – better outcomes, lower cost and improved patient satisfaction. What are the opportunities in health care to promote good nutrition and improve healthcare outcomes? Continue reading

Getting it “right”: Risk-adjusted rates for potentially preventable readmissions

Ever wonder how states (or CMS) set thresholds for readmission rates? Much has been said about and written on the subject, but there a few things I think are highly overlooked.

1. Organizations actually set readmission rates themselves

Now before you fire off an email to me, let me clarify. Documentation (or lack thereof) on a patient’s health status is gathered by government agencies via claims data and analyzed.   In determining readmission rates, what else is at their disposal on a detailed claim besides diagnoses and health status? As a whole, lack of complete documentation for many years gave data to CMS and state agencies that may not have told the whole story on the health of a populations. And remember, CMS and states are typically utilizing a three-year rolling period of data. So not only did our documentation probably not accurately reflect the health of our populations three or even five years ago, we probably aren’t doing it correctly now either. Continue reading

Strong patient-provider relationships drive healthier outcomes

Maybe there is a way to measure quality so that metrics better represent outcomes that matter.

Harvard Medical School’s Center for Primary Care has been studying exemplars in primary care through a series of case studies in the past two years. Their article in Harvard Business Review describes the finding that good outcomes are related to the strength of relationship between the primary care provider and patient. This finding is strong and consistent across all primary care exemplars in their study.i Continue reading

What you don’t know might hurt you…the potential negative impact of CDI programs on quality outcomes data

We’ve all heard the phrase…”what you don’t know won’t hurt you.” That might be true in some settings, but in the world of documentation improvement this is definitely not the case.

Let’s look at a few commonly queried diagnoses and their impact on quality profiles. The first one is acute blood loss anemia (ABLA). Certainly this can be a diagnosis present on admission (POA), but many times it is a diagnosis clarified in the postoperative setting. And heaven forbid the provider document dilutional anemia even though it might actually be the case! On the plus side, this may increase reimbursement or impact severity of illness. On the negative side, ABLA not present on admission is a potentially preventable complication (PPC). Continue reading

Care coordination and the community health worker (CHW) – The time has come

Improving care coordination for the sickest, most vulnerable and highest cost patient segments remains an important component of population health management and achieving the goals of the Triple Aim – better outcomes, lower costs and improved patient satisfaction. Yet, even as we acknowledge the importance of care coordination and devote considerable resources to this effort, the next question is whether these resources are being diverted to the right places to make a meaningful difference in health outcomes, cost and patient satisfaction. Continue reading

Working 22.6 hours a day: Alert fatigue, guidelines and “left of boom” opportunities in health care

Where do alerts fit in a physician’s 22.6 hour day?

When I’m travelling around the country interacting with healthcare leaders and health systems, I mostly see valiant efforts to improve outcomes through improved management of diseases. While improving disease management through guideline adherence is certainly a good thing, this is a problematic strategy given the current reality of our tools, the design of our workflow and our ability to recognize and address the multiple non-disease factors that weigh heavily on outcomes. Continue reading

Is the accountable care community the next evolution of the ACO?

The move to accountable care is ultimately about achieving better health outcomes at lower cost while creating a better experience for the patient. This is the Triple Aim. A narrow view of health focuses on health care, which is understandable in the United States, since a wide range of health-related expenditures are funneled through the medical system. The United States has long been the leader among industrialized countries in healthcare spending, while other nations have led in health outcomes, such as lower infant mortality rates, lower mortality amenable to health care and longer life expectancy. Continue reading

WIFM? Engaging physicians in quality outcomes improvement

WIFM (what’s in it for me) is a common question in health care. With too many patients and not enough hours in the day, compounded by requests for additional documentation regarding medical necessity/continued need for inpatient admission, quality outcomes data can quickly fall down to the bottom of the provider’s to-do list.

Let me be clear on one thing. Providers do care about quality data and how their care is perceived, some more than others. Asking any surgeon to comment on a potential complication is fairly easy. But providers need better, more detailed information about how quality beyond operative complications impacts them and their practice of medicine. What follows is a partial list of WIFMs for providers from a quality perspective: Continue reading