Monday, 22 June 2015 19:50

Value-Based Purchasing: The Journey Continues with Flawless Care Measure

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k geierHealthEast Care System is a community-focused, nonprofit healthcare organization that includes one long-term acute-care hospital (126 staffed beds), three short-term acute-care hospitals (500+ staffed beds), outpatient services, clinics, home care, hospice, and medical transportation. We have 7,300 employees, 1,200 volunteers, and 1,500 physicians on staff.

HealthEast is continuing its journey to address and define value-based purchasing (VBP). The past year we have been discussing a more global approach to VBP and what that might look like. We have been “trying out” the idea and methodology to report a flawless care measure to see how it would work in tandem with our VBP measures. 

To create the numerator we are using the following VBP and non-VBP measures, and we further qualified it by applying it only to the short-term acute-care hospitals:

  • CMS OFI’s: PC-01 Elective Delivery Between 37-39 Weeks Gestation Completed and IMM-2 Influenza Immunization
  • Readmissions
  • Number of falls
  • Number of reportable pressure ulcers
  • Hospital-acquired infections

The denominator is the number of short-term acute-care inpatient admissions.

After scrutinizing results and tracking them for several months, we realized that the number was only repeatable, and we struggled with making it both meaningful and actionable. We enlisted the help of one of our value-based improvement (VBI) advisors to help us try to understand the data and make it actionable. The VBI advisor broke out each measure and created control charts only to encounter measures for which the “n” was so small you couldn’t graph it (and we did not know how to react to the results). 

Identified Barriers and Issues with Current Flawless Care Measure 

  • The greatest takeaway from this was that the readmission portion of the numerator definition was numerically dominating the other measures directly impacting the flawless care result. The results were being driven by one measure rather than all five measures.
  • Another issue we battled was the timeliness of the data, particularly with the readmissions and hospital-acquired infections. There is required time that needs to lapse before the readmissions and hospital-acquired infections can be counted. For example, readmissions need to run out 30 days to capture data properly.
  • There were no national benchmarks, so we compared our data against our previous data and determined the percentage of improvement over last year, not knowing if this was meaningful.
  • Capturing of the data to create the flawless care measure was done completely manually, cobbling multiple reporting systems together to calculate a monthly number.

The identified issues led back to this question: how could this be measured at the patient level of point of care? The journey has us looking more closely at what measures we currently are capturing and reporting that would make sense to include in our flawless care measure. We now have come full circle and are asking this question: what really is “flawless care,” and how do we measure for results that are repeatable, meaningful, and actionable?

The idea of identifying one number to define flawless care has evolved into a larger group of measures that define a flawless care scorecard. This will be pretty straightforward and easy to create. The challenge lies in identifying that number and making it meaningful.

The measures included in the flawless care scorecard could drive prioritization of our work around VBP using the value-based improvement methodology discussed in my first article: Value Based Purchasing; A3 Lean Methodology Being Leveraged to Improve Results.

Next Steps

Discussions will continue to occur as we create the HealthEast flawless care measure definition – again, to identify what is not only meaningful, but actionable. 

Future articles will continue to take you on the HealthEast journey, and we will share our progress and our struggles as we work towards defining flawless care and improving our VBP results.

About the Author

Kathleen Geier is the director of clinical and regulatory performance at Health East Care System in St. Paul, Minn. She leads the strategic planning and oversight of government-required pay-for-performance and commercial payor clinical and regulatory performance measures. She is also a member of the Minnesota Statewide Quality Reporting and Measurement Committee for 2014-2016.

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Last modified on Monday, 22 June 2015 19:52

Kathleen Geier is the director of clinical and regulatory performance at HealthEast Care System in St. Paul, MN. She leads the strategic planning and oversight of government-required pay-for-performance and commercial payor clinical and regulatory performance measures. She is also a member of the Minnesota Statewide Quality Reporting and Measurement Committee for 2014-2016.