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

Documentation Quality: Time to Line up the Ducks

The Joint Commission’s (TJC) current “Quick Safety” article, intended to advise healthcare organizations about safety and quality issues, is about the potential risks when technology and human workflow practices do not ensure patient documentation is accurate, complete, and understandable. Although the title of the article is, “Transcription translates to patient risk,” the gist of the article is that documentation being captured via dictation and transcription, speech recognition technology, direct entry into templates, straight typing by providers, or any other method, needs to be reviewed with utmost care to protect patients from injury and death. Continue reading

Budget Neutral Payment for Pharmaceuticals – Tying Value to Outcomes

We believe there are two core principles that should be adhered to when implementing payment reform initiatives. First, that measurement of performance change should be directly quantifiable in dollars where possible; and second, that performance change should directly translate into improved patient outcomes. We adhere to these principles by encouraging payment incentives tied to potentially preventable events – rate-based outcomes performance measures with clearly quantifiable costs. Continue reading

A Tale of Two Hospitals…Ethics in Reporting Quality Outcomes

Pardon the bad play on words, but “it was the best of hospitals, it was the worst of hospitals.” Within the past week I interacted with two healthcare organizations and had the chance to discuss not only how they report, but improve their quality outcomes. In order to protect both the guilty and the innocent, I will only state that both are large academic medical centers with similar services, physician leadership and quality organizational structures. In comparing the two organizations, the gargantuan differences in reporting frustrate me, and the ethics of the leaders involved in quality at one institution frankly disgust me. How can we accurately measure, and ultimately improve, quality outcomes if all are not “playing” honestly? And yes, I acknowledge that “gaming” in quality scores has been occurring for decades. But does that make it right?
Continue reading

Population Health Management and the Annual Physical Exam

Population Health Management (PHM) is the application of specific interventions and approaches within a healthcare delivery system designed to improve and maintain the health of a population. PHM strategies should be effective (lead to better outcomes), as well as efficient (achieve the best outcome at the lowest cost). As the U.S. healthcare system continues to promote value-based care and PHM, it’s critical that health systems address the most important issues that lead to the best outcomes. Continue reading

Present and Accounted For…Potentially Preventable Complications

We all know the phrase “First do no harm,” a philosophy that is a driving force in health care. In other words, if we do not do anything to improve the health of our patients during their stay, at least let’s not allow anything bad to happen to them on our watch. Continue reading

To Readmit or Not Readmit…Is That the Question?

As many of us in health care realize, sometimes it is just not possible to keep patients out of the hospital! All of our best strategies are in some cases not used, or in others, did not work. So how do we keep patients out of the hospital? Per chance we are putting the cart before the horse. Let me explain. Continue reading

How Can You Predict a Patient’s Risk for Heart Failure? Ask Them.

A critical task in population health management is identifying individuals at risk for bad outcomes and providing intervention to reduce that risk. Claims-based algorithms identify prospective risk,¹ but people without a claims history present a problem as payment continues to move toward value-based purchasing. Rather than waiting for claims, we can ask people questions that unmask significant risk. Patient-reported data tells us, in real time, a person’s risks and hands clinicians an opportunity to address those risks and change outcomes. Continue reading

Top Issues Facing Payers on the Journey to Value

We recently held our biannual payer client conference in Orlando, FL, and it was another very productive meeting. Several plans shared their respective progress and challenges as they each journey forward on the path to value. Based on the feedback, my colleague, James Lawson, Vice President, Client Experience, Payment and Population Solutions, shared some key takeaways from the meeting: Continue reading

What’s Getting Between People and Better Outcomes?

Patient reported outcome measures matter. The subject is capturing an increasing amount of attention as clinicians strive to reduce suffering by trying to figure out what matters to people (see the New York Times article, “Doctors Strive to Do Less Harm by Inattentive Care”).

Helping people with chronic conditions achieve better outcomes is a foundational principle of population health management and value-based contracting. Continue reading

The Need for Case Mix Adjusted Payments: Lessons from Louisiana’s PCMH Program

The title says a lot: “Patient-Centered Medical Homes In Louisiana Had Minimal Impact On Medicaid Population’s Use Of Acute Care And Costs.”¹

Health plans and other payers want to improve total cost of care and quality by aligning payment and measurement models with better health care delivery. They ask “How will we know better care delivery when we see it?” The National Committee for Quality Assurance’s PCMH (patient-centered medical home) recognition program is one way. Continue reading