Publishing Data to Promote Change

Massachusetts General Hospital and Partners Health Care -

experience with transparency

Elizabeth Mort, MD, MPH

Vice President Quality & Safety, MGHAssociate Chief Medical Officer, MGH

Team Leader for Uniform High Quality,Partners HealthCare Inc.

2

Outline

• Massachusetts reporting environment• System and hospital reporting

– Partners HealthCare, Inc.– Massachusetts General Hospital– Case studies

3

Massachusetts environment

4

National data sources

• US News and World Report• HEDIS reports for health plans• CMS Hospital Compare• CMS Nursing Home Compare • The Joint Commission Quality Check• Leapfrog• Health Grades

5

State-wide data sources

• MA Health care cost and quality council

• Massachusetts Health Care Partnership

• Department of Public Health

• MHA patients first

• Group Insurance Commission asks Health plans to tier physicians

• Planned: SRE (Spring 2009), BSI’s (March MA-wide rates, Hospital in the fall), others

6

MA Health Care Cost and Quality Council (HCCQC) launch November 2008

7

MA HCCQC Quality rankings

rating system based on 15/50/85th hospital percentile rankings

8

MA HCCQC “Cost” rankings

$ - $$$$ rating system applied to a hospital’s median cost (payment from health plans)

9

http://www.mhqp.org

MA Health Quality Partnership

10

MHA Patients first

11

MA Dept of HHS

12

Cost & Quality: The GIC Approach“Clinical Performance Improvement initiative”

• Measure cost efficiency via “ETG” methodology

• Measure quality via HEDIS, etc.

• Squeeze quality and cost scores from claims data

• Incent patient and physician behavior via differentials in co-payments

• Tiers 1,2 and 3• Implemented in 2006

13

Martha’s Vineyard Hospital

Nantucket Cottage Hospital

Rehab Hospital of the Cape and Islands

Faulkner Hospital

Newton-Wellesley Hospital

McLean Hospital

Massachusetts General Hospital

Spaulding Rehabilitation Hospital

Shaughnessy-Kaplan Rehabilitation Hospital

North Shore Medical Center - Union

North Shore Medical Center - Salem

Non-Acute Hospital

Acute Care HospitalH

Brigham and Women’s Hospital

Partners HealthCare Hospitals

14

15

MGH Current Campus

16

1) Tell our Quality and Safety story MGH/MGPO’s interpretation of quality and safety indicators already publicly available.

2) Highlight aspects of quality and safety that are not publicly reported but that we as the MGH/MGPO community feel should be reported to the public.

3) Educate the public about our internal quality improvement efforts by increasing the visibility of quality/safety data and our stories.

4) Target audience includes informed consumers interested in general information about hospital quality of care, payors, legislators, policy staff.

Goals for MGH/MGPO External Site

17

• MGH-People, Facilities & Services (structural measures-# of board certified, technologies, Magnet status)

• Delivering the Right Care (NHQM)

• Keeping Patients Safe (Infection control measures, Leapfrog safety goals)

• Listening to Patients (HCAHPS)

• Providing Equitable Care (HF, AMI and PNA segmented by race/language)

• Improvement stories

Categories of Measures

Click on Performance Reports to see list of categories.

25

1) Hold leadership accountable

2) Identify highest organizational priorities

3) Ongoing tracking

3) Target audience internal leadership

4) Eventually develop better IT connections between point of care, acute care documentation, data bases and measurement and reporting tools – a journey

Goals for MGH/MGPO Internal Site

26

27

28

29

30

Preservation Layer

Curation Layer

Real-Time Layer

Application Layer

Integration Layer

IODW

Query & Reporting

AppDM

Query & Reporting

QSD

Dashboard & Scorecard

Quality & Safety Performance Measurement Portal

Info

rmat

ion

Sou

rce

Hub

Clinical AnalystsPower Users

Senior ManagementStaff

Data Files and Data Feeds from Source Systems(e.g. TSI, PATCOM, NSQIP, etc.)

Integrated Outcomes Data Warehouse: building the IT infrastructure

31

MGH Quality & Safety Governance

MGH/MGPO Boards of Trustees

General Executive Committee

MGH/MGPO Board Quality Subcommittee

Quality Oversight Committee

Quality and Safety Steering Committee

Center for Quality and Safety Activities Non-CQS Quality and Safety Activities

Patient Care Assessment Committee

32

Comparing Average % of MGH BOT time spent on Q&S v. Finance per Calendar Yr

0%

5%

10%

15%

20%

25%

2002 2003 2004 2005 2006 2007

Meeting Year

Pe

rce

nt

of

Tim

e

Q&S

Finance

Linear (Q&S)

Linear (Finance)

Board engagement in Quality & Safety

33

Analysis of problem

Integration of Operations & Improvement

Performance reporting

Operations design

Executive oversight

Organizational strategy

Performance Measurement

(Signal detection)

Short term implementation

Executive incentives

Practitioner influence and

incentives

Longer term implementation

Research enterprise

Regular Operations

Improvement Efforts

Process Improvement

Design

Improvementcycle

Operations cycle

Backup

MGH/MGPO Culture

Immediate Response

34

Analysis of problem

Integration of Operations & Improvement

Performance reporting

Operations design

Executive oversight

Organizational strategy

Performance Measurement

(Signal detection)

Short term implementation

Executive incentives

Practitioner influence and

incentives

Longer term implementation

Research enterprise

Regular Operations

Improvement Efforts

Process Improvement

Design

Improvementcycle

Operations cycle

Backup

MGH/MGPO Culture

Immediate Response

MGH site: http://qualityandsafety.massgeneral.org/

36

Martha’s Vineyard Hospital

Nantucket Cottage Hospital

Rehab Hospital of the Cape and Islands

Faulkner Hospital

Newton-Wellesley Hospital

McLean Hospital

Massachusetts General Hospital

Spaulding Rehabilitation Hospital

Shaughnessy-Kaplan Rehabilitation Hospital

North Shore Medical Center - Union

North Shore Medical Center - Salem

Non-Acute Hospital

Acute Care HospitalH

Brigham and Women’s Hospital

Partners HealthCare Hospitals

37

• Partners is an integrated, academic health system founded in 1994 by Brigham and Women’s Hospital and Massachusetts General Hospital

• Partners four-part mission is patient care, teaching, research, and community service

• Partners was formed to preserve academic medicine, create a more rational system of care, and add value in the areas of access, cost, and quality

Partners HealthCare, Inc.

38

Patient Care at Partners

• 1.7 million patients receive care from Partners institutions and physicians

• 170,000 hospital inpatient discharges annually

• 4.3 million outpatient and physician visits annually

• 22% of acute hospital discharges in Eastern Massachusetts are from Partners hospitals

39

PARTNERS CORPORATE ORGANIZATION CHART

Dana Farber/Partners Two Physicians Cancer Care PARTNERS HEALTHCARE SYSTEM, INC. Appointed by Partners

Partners International Medical Services, LLC

Brigham and Women’s/ The Massachusetts Newton-Wellesley Partners Continuing Partners Community NSMC HealthCare, Inc. Faulkner Hospitals, Inc. General Hospital Hospital Care, Inc. HealthCare, Inc.

The Spaulding The Brigham and Women’s

The General Hospital Rehabilitation Hospital North Shore Medical Newton-Wellesley Hospital, Inc. Corporation Center, Inc. Physician Hospital Corporation

Organization, Inc.

Brigham and Women’s Rehabilitation Hospital Physicians Organization, Massachusetts General North Shore of the Cape and Inc. Physicians Physicians Group, Islands, Inc.

Organization, Inc. Inc.

Faulkner Hospital, Inc. Shaughnessy Kaplan McLean HealthCare, Rehabilitation

Hospital, Inc. Inc.

Partners Home The McLean Hospital Care, Inc. Corporation

The MGH Institute of FRC, Inc. Health Professions, Inc.

Martha’s Vineyard Hospital, Inc.

Nantucket Cottage Hospital

REVISED: 11/12/07 49184v6

40

1) Tell the High Performance Medicine Story: what we’re doing to provide better, safer, more cost effective care

2) Educate the viewer about the importance of a system in making the full spectrum of health care services available and in ensuring uniform care throughout the system

3) Share our performance on key quality and safety indicators

4) Highlight improvement strategies 5) Link to entity (hospitals) sites

Goals for external reporting at PHS

41

High performance medicine: Better, Safer, & more Cost-effective care

• Maximizing the use of Information Technology

• Making our care as safe as possible, free from harm & errors

• Ensuring high quality across all sites by making care reliable

• Taking expert, tailored care of specific high-risk patients

• Using drugs and imaging technologies cost-effectively

The story for the first PHS release

42

The Performance Metrics for the first PHS release

Maximizing the use of Information Technology

Implementing Computerized Order Entry

Adopting of electronic medical record by Primary Care Providers

Adopting of electronic medical records by Specialists

Prescribing medications electronically

Making our care safe, free from harm

Implementing Electronic Medication Administration Records

Bar coding patients, staff and medications

Making transitions in care safer

Ensuring uniform, reliable, high quality care

Adhering to guidelines for care of patients with Heart attacks, Congestive Heart Failure and Pneumonia

Delivering PCI within 90 minutes for eligible heart attack patients

Delivering smoking counseling to targeted populations

Preventing surgical infections

Reducing ICU Bloodstream Infections

Reducing Patient Falls with injury

Caring for High risk populations

Connecting Congestive Heart Failure patients to post-discharge services

Using resources cost-effectively

Increasing the appropriate use of Generic Drugs

http://qualityandsafety.partners.org/

44

45

46

47

48

49

50

51

Partners High Performance MedicineLeadership Structure

Executive CommitteeJames Mongan, MD, Thomas Lee, MD, Jennifer Daley, MD,Cindy Bero, John Glaser, Robin Jacoby, and Sheridan Kassirer

CMO’s/Physicians Executive Council

(Advisory on Clinical Priorities)

Operating Units(Advisory on

Resource Issues

DirectorThomas H. Lee, MD

Chief Operating OfficerSheridan Kassirer

Team 1Cynthia Bero

Team 2Tejal Gandhi, MD

Team 3Elizabeth Mort, MD

Team 4Timothy Ferris, MD

Team 5Jennifer Daley, MD

Sheridan Kassirer

PHS site: http://www.s180.com/phs_quality