There has never been a time of greater emphasis on performance and quality in healthcare than there is today. The Affordable Care Act (ACA) of 2010 and various insurance payers have created “pay-for-performance” strategies that are intended to put financial pressure on medical providers to ensure quality clinical outcomes and/or potentially reduce reimbursement.
The mandated requirements of the ACA are limited primarily to hospitals reporting certain data to CMS for use in evaluating quality of patient care. These data that are intended to reflect the hospital’s level of performance (i.e., quality) are used by CMS to adjust reimbursement either favorably or unfavorably based on how the hospital’s performance compares to regulatory performance standards.
Understanding these performance requirements and knowing how to achieve standards and avoid penalty is essential to hospitals for maximizing financial reimbursement.
Unfortunately, some people feel helpless and view data reporting and reduced reimbursement as a necessary evil of ACA as well as other regulatory performance initiatives including core measures, satisfaction requirements of HCAHPS, and PQRS that can reduce reimbursement. Understanding these performance requirements and knowing how to achieve standards and avoid penalty is essential to hospitals for maximizing financial reimbursement.
Each regulatory initiative has a slightly different focus in terms of the part of patient care and the provider of care each is directed at. Many hospitals have responded to each requirement by creating a new organizational unit for each. The result is typically separate and independent units with each forming a new layer of organization.
But all performance outcomes, whether financial or quality, are a product of the underlying patient care policies, processes, and procedures. (We refer to these collectively as “3P”). And effective design and compliance with 3P always determines the revenue and cost of the service as well as quality. If you focus your efforts on effective and efficient design of 3P, and measure to ensure compliance, you naturally and concurrently dictate the level of performance of all of the regulatory, financial, and quality dimensions.
HospitalMD views performance as systemic, continuous, ongoing, and intrinsic to all patient care.
views performance as systemic, continuous, ongoing, and intrinsic to all patient care. And since performance outcomes are always a product of the underlying 3P of patient care, and all of these regulatory initiatives exist for the singular purpose of improving performance, HospitalMD
believes that the management of improvement should employ the same underlying analytic improvement methodology.
We employ an improvement methodology based on the PDCA methodology for Performance Management used by W. Edwards Deming to assist commercial businesses to achieve superior global prominence in quality and cost. It is based on four components: P
oing (or putting solutions into action), C
hecking (progress), and A
cting (on results). Since these four components of our improvement methodology are the same components required to actually deliver patient care, it is easy to see that performance (and its improvement) is intrinsically part of how “work” is done. This systematic approach allows us to truly impact performance improvement in the Emergency Department (ED) and maximize all aspects of our clients’ services, especially financial reimbursement and operational efficiency! We use this methodology and commit to assist our clients to adopt and implement our methodology.
How Does It Work?
The first component of the methodology is the “Plan
”. Development of the Plan
begins before we implement our services with a site assessment to meet with key staff and confirm or revise information we collected during development of our proposal. Our start up team works with hospital administration and staff to identify and understand current 3P and begin to discuss areas of emergency medicine for which the hospital knows improvement is needed. We collect additional data if necessary to understand history as a baseline for improvement and begin to form a collaborative relationship. We establish goals and objectives (benchmarks or standards of excellence) that allow us to monitor progress as we move forward. This information is incorporated within our site-specific training manual.
component begins with provider orientation and continues as we provide patient care every hour of every day. Each provider participates in orientation prior to his/her first shift using our training program. The hospital staff participates in our orientation allowing everyone to be involved in the process. This fosters an alignment between the hospital and our physicians with respect to the Plan
that has been outlined, the measurement tools that will be used, and what the expected outcomes are.
is the third component in the methodology. Data collected on previously established performance measures enables us to check our progress through our reporting system. And because the ”Plan”
was collaborative, both HospitalMD
and the hospital can objectively measure the progress together.
Acting on the results can often be the most difficult step in the process because it often requires difficult decisions.
Once we have checked progress, we are able to “Act”
on the results. If the plan resulted in the intended outcomes, we will continue to monitor the plan and results and continue to look for incremental improvement. If the results are short of expectations, we begin the process of analyzing 3P to look for causes of variation and develop significant design options. Acting on the results can often be the most difficult step in the process because it often requires difficult decisions. But it’s critical for continued growth and success in the emergency medicine service!
This methodology used with each of our clients has been effective in reducing overall average lengths of stay , standardized practice protocols, streamlined medical screening to comply with EMTALA and reduce bad debt, create admission and transfer hotlines, implement best practices for medical outcomes and customer service, and achieve consistent medical necessity decisions and compliant clinical documentation!
Creating an environment that allows our physicians to work with your hospital and staff to implement a Performance Management model that systematically approaches all elements of quality and performance has allowed HospitalMD
to help our clients deliver quality clinical outcomes while maximizing their revenue.
Contact us today
to learn more!