Benchmarking and IT Meet Pay For Performance Demands Donna Isgett, RN, MSN Vice President of...

Benchmarking and IT Meet Pay For Performance Demands

Donna Isgett, RN, MSNVice President of Clinical EffectivenessMcLeod Health, Florence, SC

Gail E. Latimer, RN, MSNVice President and Chief Nursing OfficerSiemens Medical Solutions, Malvern, PA

Learning Objectives

Identify strategies to promote Pay for Performance

Describe the process and methodologies McLeod has employed to build it’s culture of quality evidence-based practice and transparency

Understand the role of physician and executive leadership in developing this culture

Identify CMS outcomes achieved to date as a result of the Medicare demonstration project

Quality - Quality Everywhere

1997• Dana Farber Cancer Institute Event

2000• To Err is Human, IOM Report

• Healthgrades.com

• Business Roundtable: Leapfrog Group

• Crossing the Quality Chasm, IOM Report

• JCAHO Sentinel Event Alerts

2002• Robert Wood Johnson - Pursuing Perfection Grant

• CMS 7 Scopes of Work

2004• Premier/CMS Demonstration Project

Milliken Award for Quality

CMS/Premier Demonstration Project “Top Performer”

Publication Features: Modern HealthcareUS News and World ReportUSA Today

McLeod Quality

CMS/Premier Hospital Quality Incentive

AMI, CABG, HF, CAP, Hip and Knee278 participating hospitals

Quality - Pay for Performance

The first national project to measure hospital performance and offer additional Medicare payment for top quality care (October, 2003)

Widely accepted quality measures(34)

27 indicators from the National Quality Forum

Public reporting

Quality - Results that Make a Difference

McLeod Regional Medical CenterOctober 2003 - September 2004

Composite Quality Score

Clinical Focus Area National Top Decile MRMC Decile

AMI 95.8% 98.0% 1

CABG 95.6% 95.6% 1

HF 85.2% 85.0% 2

CAP 83.5% 85.8% 1

Hip/Knee 94.8% 95.1% 1

McLeod Health at a Glance

HSMR Hospital Standardized Mortality Index for McLeod

0.8

0.9

1

1.1

1.2

1.3

1.4

1.5

1.6

1997 1998 1999 2000 2001 2002 2003 2004 Jan-05 Feb-05 Mar-05 Apr-05

*Each point reflects the 12 month (annual) rate ending at the point's date

ReliabilityTheory

Quality Core Value

Physician & Executive Engagement

Improvement Methodology

PrioritizationCore

Success Factors

Change Theory

Core Success Factors

Quality Core Value

CoreSuccess Factors

Clinical Effectiveness: Promoting Change

Core Values

Value of Person

Value of Integrity

Value of Caring

Value of Quality

Quality of Service

Culture of“No Blame”

Leadership Support

Physician Leadership

Quality of Safety

Quality of Science

Quality Pyramid

Quality Core Value

CoreSuccess Factors

Prioritization


Cost

LOS Complications

Readmissions

Prioritization: Benchmarking Assessment

Mortality

Opportunity

Prioritization: National Benchmarking

Purchased Databases

Premier Perspective

Vermont Oxford

STS (Society of Thoracic Surgeons)

Public Data

Medicare website

CMS 7 scopes of work

Leapfrog Group

Healthgrades.com

Quality Core Value


PrioritizationCore

Success Factors


Methodology:

GE’s Total Quality Management (TQM)

Problem Solving Process (PSP)

Results Oriented ProcessImplemented - 1994

1. Identify & Select Problem

5. ImplementSolution

4. Select/PlanSolution

3. GeneratePotential Solutions

2. Analyzefor Cause

ProblemSolvingProcess

6. EvaluateSolution

Performance Improvement

Quality Core Value


PrioritizationCore

Success Factors

Change Theory


Kotter’s Theory of Change

1. Establishing a Sense of Urgency

2. Forming a Powerful Guiding Coalition

3. Creating a Vision

4. Communicating the Vision

5. Empowering Others to Act on the Vision

6. Planning for and Creating Short-Term Wins

7. Consolidating Improvements and Producing Still More Change

8. Institutionalizing New Approaches

John Kotter, Leading Change

Quality Core Value


PrioritizationCore

Success Factors

Change Theory



Clinical Effectiveness: Quality of the Science

Design Principles:

Physician Leadership

Evidence Based

Data Driven

Senior Leadership Key:

Priority of Work

Dedicated Staff

Implementation of Ideas

ReliabilityTheory

Quality Core Value



PrioritizationCore

Success Factors

Change Theory


Intent, Vigilance and Hard Work: 101 Performance

Level 1 (Designing basic failure prevention)

Common equipment, standard orders sheets

Personal check lists

Working harder next time

Feedback of information on compliance

Awareness and training

© Institute for Healthcare Improvement

Level 1 Changes at McLeod

Pre-printed order sets

Data feedback to physicians and hospital staff

Education to physicians and hospital staff

Pre-printed Rx scripts

Disease specific discharge sheets to include detailed instructions/meds


Human Factors and Reliability Science: 102 Performance

Level 2

Decision aids and reminders built into the system

Desired action the default (based on evidence)

Redundancy

Scheduling

Taking advantage of habits and patterns

Standardization of process



Decision aids and reminders built into the system:

Antibiotics in Pyxis in ER and reminder on Pyxis "Blood cultures needed? Check with physician”

Decision aids and reminders built into the system:

List of all positive troponins for intervention

Desired action the default (based on evidence):

House-wide pneumonia vaccination standing order

Desired action the default (based on evidence):

Automatic printing of smoking cessation information for patients

Redundancy:

Medication check against allergies



Taking advantage of habits and patterns

All operative antibiotics given as leaving holding area

Radiologist to contact ED physician if chest XRay positive for pneumonia

Standardization of process

All patients screened for smoking at admission and counseled on discharge


ReliabilityTheory

Quality Core Value



PrioritizationCore

Success Factors

Change Theory


Key Ways IT Can Support Pay for Performance

Reliability

Hand-off communication

Patients “in the know”

Workflow EngineThe Right Information, to the Right Person, at the Right Time…

Workflow EngineListening, Monitoring, and Escalating…

Increase Accuracy and Reliability of Clinical ProcessesComputerized Physician Order Entry

Increase Accuracy and Reliability of Clinical Processes Evidence-based Content

Increase Accuracy and Reliability of Clinical ProcessesHand-off Communication

Personal Health CardsSMART Card

A secure SMART Card contains your critical healthcare information

Allows medical providers the ability to track patients through a course of treatment that crosses multiple organizations

Authenticates the patient and provides for improved insurance processing

Delivers a scalable, portable health record – and control of patient medical data

Healthcare Technology Utilized

PHR- Personal health record/SMART cards Schedule appointments Reminders Medication history Personal spending account Monitoring

HomePhysician’s

Office Hospital InsuranceProvider


HomePhysician’s

Office Hospital InsuranceProvider

Interoperability Electronic patient records Referring physicians Trends/ benchmarking Billing

InsuranceProvider


HomePhysician’s

Office Hospital

Clinical Information System Point of care information Evidence-based practice CPOE Workflow engine PACS/results Trends/benchmarking


InsuranceProviderHome

Physician’sOffice Hospital

Clinical information

Billing codes

Payment

Trends/benchmarking

Benchmarking and IT Meet Pay For Performance Demands Donna Isgett, RN, MSN Vice President of...

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