Quality and Business Intelligence in Healthcare

Transcription

1 Quality and Business Intelligence in Healthcare John Neider Siemens Healthcare Solutions

2 Agenda Overview of Quality and Financial Impact. What is the Hospital Impact? Where is Quality Headed? How can Finance and Clinical work together? 2

3 Organizations Driving Quality CMS Joint Commission Center for Disease Control Leapfrog National Quality Forum Nursing National Database for Nursing Indicators Magnet Accreditation Physician Quality Reporting Initiative (272 measures) National Health Safety Network HFMA 3

4 What is your Mantra? Without margin there is no mission Without mission there is no margin. Sally Jewel CEO of REI 4

5 Cost Accounting for HCO S. Finkle and D. Ward; Dollars from Waste in Healthcare Sp;ending Rober Wood Johnson Foundation; Cost of hospital services for premature newborns by birth weight cln_66p1773/

6 Public Reporting on Quality Payers create financial incentives for quality. 90% of top 10 U.S. hospitals list quality as a priority. 1 Patients choose healthcare providers based on quality using hospital compare ( 1 Based on U.S. News and World Report of the Best American Hospitals 2008 Rankings 6

7 Financial Impact CMS Quality Initiatives Inpatient Quality Reporting Requirement (IQR, formerly RHQDAPU) (8 AMI, 4 HF, 7PN, 11 SCIP) Value Based Purchasing 1% 1.25% 1.5% 1.75% 2% Readmissions 1% 2% 3% 3% 3% Hospital Acquired Conditions 1% 1% 1% Meaningful Use 1% 1% 1% 7

8 Trends and Challenges in Healthcare Quality Over 77,000 people die each year as a result of preventable medical errors. 1 There are currently over 400,000 preventable drug-related injuries in hospitals amounting to more than $3.5 billion in medical costs per year. 2 Approximately 20 to 30 percent of health care treatments are unnecessary. 3 Medication errors injure 1.5 million people and cost billions of dollars annually Medication Errors Injure 1.5 Million People and Cost Billions of Dollars Annually, The National Academies News, July Based on U.S. News and World Report of the Best American Hospitals 2008 Rankings 8

9 Hospital Acquired Infections - Cost Implications Analysis in one Midwestern hospital identified that the average cost to treat a catheter related blood stream infection (CRBSI) was $91,000, whereas the average reimbursement was about $67,000 an operational loss of $24,000. The CDC estimates 250,000 central line-associated infections occur in the United States annually. 9

10 Recent Centers for Disease Control and Prevention* Estimated annual number of deaths attributed to C. diff increased to 14,000 in , up from 3,000 deaths annually in % of C. diff cases in 2010 were related to health care delivery. 25% of those infections occurred in hospitalized patients, 75% occurred in nursing home patients, outpatients, or recently discharged patients. The infection in hospitals accounts for an additional $1 billion annually in U.S. health care costs, CDC said. *CDC Vital Signs March,

11 You Cannot Manage What You Do Not Measure No DRG complication status assigned if the following Hospital Acquired Conditions occur: Object left in during surgery Blood incompatibility Air embolism DVT/PE following Hip or Knee Replacement Catheter Associated Urinary Tract Infection Pressure Ulcers Stage III or IV Vascular Catheter Associated Infection Surgical Site Infection Mediastinitis after CABG Falls and Trauma Poor Glycemic Control Staphylococcus Aureus Septicemia Ventilator Associated Pneumonia (VAP) Deep Vein Thrombosis (DVT) Pulmonary Embolism (PE) Methicillin Resistant Staphylococcus Aureus (MRSA) Clostridium Difficile Associated Disease Wrong Surgery 11

12 All Cause Readmission for Heart Failure, AMI and Pneumonia 12

13 Value Based Purchasing FY2013 Clinical Process of Care Measures Acute myocardial infarction: Heart Failure: AMI 2 Aspirin Prescribed at Discharge. AMI 7a Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival. AMI 8a Primary PCI Received in 90 Minutes of Hospital Arrival. HF 1 Discharge Instructions. HF 2 Evaluation of LVS Function. HF 3 ACEI or ARB for LVSD. Healthcare-associated infections: SCIP Inf-1 Prophylactic Antibiotic Within One Hour Prior to Surgical Incision. SCIP Inf-2 Prophylactic Antibiotic Selection for Surgical Patients. SCIP Inf-3 Prophylactic Antibiotics D/C Within 24 Hours After Surgery Ends. SCIP Inf-4 Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose. 13

14 Value Based Purchasing FY2013 Clinical Process of Care Measures Pneumonia: PN 2 Pneumococcal Vaccination. PN 3b Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in Hospital. PN 6 Initial Antibiotic Selection for CAP in Immunocompetent Patient. PN 7 Influenza Vaccination. Surgeries: SCIP Card-2 Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the Perioperative Period. SCIP VTE 1 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered. SCIP VTE 2 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery. Survey Measures HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems Survey 14

15 Value Based Purchasing FY2014 FY2013 measures + Outcome Measures Outcome Measures Mortality MORT-30-AMI Acute Myocardial Infarction (AMI) 30-Day Mortality Rate. MORT-30-HF Heart Failure (HF) 30-Day Mortality Rate. MORT-30-PN Pneumonia (PN) 30-Day Mortality Rate. Hospital Acquired Condition measures: Foreign Object Retained After Surgery Air Embolism Blood Incompatibility Pressure Ulcer Stages III & IV Falls and Trauma: (Includes: Fracture, Dislocation, Intracranial Injury, Crushing Injury, Burn, Electric Shock) Vascular Catheter-Associated Infections Catheter-Associated Urinary Tract Infection (UTI) Manifestations of Poor Glycemic Control 15

16 Value Based Purchasing FY2014 AHRQ Patient Safety Indicators (PSIs), Inpatient Quality Indicators (IQIs), and Composite Measures: PSI 06 Iatrogenic pneumothorax adult PSI 11 Post Operative Respiratory Failure PSI 12 Post Operative PE or DVT PSI 14 Postoperative wound dehiscence PSI 15 Accidental puncture or laceration IQI 11 Abdominal aortic aneurysm (AAA) repair mortality rate (with or without volume) IQI 19 Hip fracture mortality rate Complication/patient safety for selected indicators (composite) Mortality for selected medical conditions (composite) 16

17 ARRA Requirement July 2010 Final Ruling - Reporting Automated Measure Calculation: Automated Measure Calculation for 14 meaningful use objectives with a percentage-based measure Yes/No Attestation for 9 Measures Electronically record the numerator and denominator and generate a report including the numerator, denominator, and resulting percentage associated with each applicable meaningful use measure. Clinical Quality Measures: Electronically calculate the 15 clinical quality measures specified by CMS Electronically submit calculated clinical quality measures in accordance with the standard and implementation specifications provide aggregate numerator and denominator through attestation electronically submit quality measures 18

18 Hospital Requirements for MU Change Initially, the Meaningful Use rule from Aug 2009 described a set of metrics that could be accomplished accessing data from structured tables. The final rule, July 2010, added quality measures that require chart abstractions e.g. Data located in ancillary systems (OR, ED) and from unstructured data sources Resulting in: Hospitals must be able to access information in both structured databases and unstructured free text reports such as Cardiologist Report, History and Physical Hospitals must be able to respond to changing guidelines for calculation of metrics Hospitals must be able to submit numerator and denominator data for each metric 19

19 STAGE 1 MEANINGFUL USE One Example: More than 80% of all unique patients seen have at least one entry or an indication that no problems are known for the patient recorded as structured data One Example: Measure # ID (VTE-1) VTE Prophylaxis within 24 hours of arrival One Example: Perform at least one test of certified EHR technology s capacity to electronically exchange key clinical information 20

20 Automated Measure Calculation Stage 1 More than 80% of all unique patients seen have at least one entry or an indication that no problems are known for the patient recorded as structured data More than 80% of all unique patients seen have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data More than 80% of all unique patients seen have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data More than 50% of all unique patients seen have demographics recorded as structured data More than 30% of unique patients with at least one medication in their medication list have at least one medication order entered using CPOE For more than 50% of all unique patients age 2 and over, height, weight and blood pressure are recorded as structured data More than 50% of all unique patients 13 years old or older have smoking status recorded as structured data More than 50% of all patients who request an electronic copy of their health information are provided it within 3 business days More than 50% of all patients who are discharged from an eligible hospital or CAH s inpatient department or emergency department and who request an electronic copy of their discharge instructions are provided it The EP, eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital s or CAH s inpatient or emergency department The EP, eligible hospital or CAH who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals More than 10% of all unique patients seen are provided patient-specific education resources More than 50% of all unique patients 65 years old or older admitted to the eligible hospital have an indication of an advance directive status recorded More than 40% of all clinical lab tests results ordered for patients admitted to its inpatient or emergency department during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified HER Core / Menu Core Core Core Core Core Core Core Core Core Menu Menu Menu Menu Menu 21

21 Measures Requiring Yes/No Attestation Stage 1 The EP/eligible hospital/cah has enabled this functionality for the entire EHR reporting period (drug-drug and drug-allergy interaction checks) Conduct or review a security risk analysis per 45 CFR (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process Implement one clinical decision support rule Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP, eligible hospital or CA Performed at least one test of certified EHR technology capacity s to provide electronic submission of reportable lab results to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful The EP/eligible hospital/cah has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period Generate at least one report listing patients of the EP, eligible hospital or CAH with a specific condition Core / Menu Core Core Core Core Menu Menu Menu Menu Menu 22

22 Stage 1 Clinical Quality Measures Measure Number ID Emergency Department ED-1 ED-2 Stage 1 Measures Emergency Department Throughput admitted patients Median time from ED arrival to ED departure for admitted patients Emergency Department Throughput admitted patients Admission decision time to ED departure time for admitted patients Stroke-2 Ischemic stroke Discharge on anti-thrombotics Stroke-3 Ischemic stroke Anticoagulation for A-fib/flutter Stroke-4 Ischemic stroke Thrombolytic therapy for patients arriving within 2 hours of symptom onset Stroke-5 Ischemic or hemorrhagic stroke Antithrombotic therapy by day 2 Stroke-6 Ischemic stroke Discharge on statins Stroke-8 Ischemic or hemorrhagic stroke Stroke education Stroke-10 Ischemic or hemorrhagic stroke Rehabilitation assessment Venous Thromboembolism VTE-1 VTE-2 VTE-3 VTE-4 VTE-5 VTE-6 VTE prophylaxis within 24 hours of arrival Intensive Care Unit VTE prophylaxis Anticoagulation overlap therapy Platelet monitoring on unfractionated heparin VTE discharge instructions Incidence of potentially preventable VTE 23

23 Healthcare Intelligence Population Management Data Time and Attendance Data Revenue Cycle Materials Management Professional Billing Patient Satisfaction Data Dashboard KPIs Reports OLAP Cubes Ad-Hoc Queries Predictive Modeling Enterprise Wide Healthcare Intelligence Cost Accounting Budgeting Contract Modeling Machine Learning Data Mining Patient Management Orders, Results, Clinical Observations General Ledger Patient Registries Operating Room DB Human Resources

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27 Clinical Quality Measures VTE 28

28 Clinical Quality Measures Stroke 29

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30 Manual versus Automated Manual Manual chart abstraction for finding relevant evidence Manual data entry (clinical and financial) into a calculation box Automated Abstraction Automated chart abstraction Automated quality measure calculation Manual report creations Manual implementation of quarterly guideline updates Automated report presentation Ongoing updates for quarterly guideline changes "insurance 31

31 Unstructured Free Text Abstraction 32

32 Where Are We Headed 33

33 HHS National Quality Strategy The National Quality Strategy was released by Department of Health and Human Services (HHS) on March The strategy drives the development and selection of quality measures for CMS programs. Six measure domains used in Stage II MU are based on this national quality strategy. Source: HHS National Quality Strategy 34

34 HHS Alignment of Goals HHS National Quality Strategy Clinical Process/Effectiveness Patient Safety Care Coordination Efficient Use of Healthcare Resources Patient & Family Engagement Population & Public Health Five Pillars of Meaningful Use Engaging patients and families Improving safety, quality, efficiency, and health disparities Improving care coordination Improving population health Ensuring adequate privacy and security protections. 35

35 Stage 2 Clinical Quality Measures - Final Measure Group Stage 2 Measures Venous Thromboembolism 6 Acute Myocardial Infarction 4 Pneumonia 1 Surgery Care Improvement Project 3 Stroke 7 ED Throughput 3 Maternal/Newborn 4 Asthma 1 36

36 Clinical Quality Measures: Eligible Hospitals and CAHs Pool of 29 Clinical Quality Measures Domains: 1. Patient and Family Engagement. 2. Patient Safety. 3. Care Coordination. 4. Population and Public Health. 5. Efficient Use of Healthcare Resources. 6. Clinical Process/Effectiveness. Select 16 measures from at least 3 quality domains FY 2014 The 29 clinical quality measures will apply for all eligible hospitals and CAHs, regardless of whether they are in Stage 1 or Stage 2 of meaningful use. Proposed measures listed in Table 9, pg

37 Clinical Quality Measures: Eligible Providers Pool of 64 Clinical Quality Measures Domains: 1. Patient and Family Engagement 2. Patient Safety 3. Care Coordination 4. Population and Public Health 5. Efficient Use of Healthcare Resources 6. Clinical Process/Effectiveness. Option 1: EPs would report 9 clinical quality measures, from at least 3 different domains. Option 2: EPs would report under the PQRS s EHR Reporting Option Proposed measures listed in Table 8 p

38 Healthcare Intelligence Enterprise wide data warehouse Graphical view of key performance indicators Automated data abstraction for clinical reporting and analysis Cost and Contract modeling Predictive analytics for populations at risk Sophisticated natural language data mining Populations Health Management 39

39 What are Hospitals Doing? Using automated data collection, MedCentral Hospital improved their quality abstraction time: Over 66% for Heart Failure (HF), 63% Acute Myocardial Infarction (AMI) 52% for Surgical Care Improvement Project (SCIP) 40

40 What are Hospitals Doing? Denver Health created an integrated data warehouse of structured and unstructured data to produce patient progress reports for disease populations such as diabetes, hypertension, colorectal cancer. 41

41 Patient Progress Report 42

42 Which is Your Headline? Medical Errors Cost U.S. $8.8 Billion, result in 238,337 potentially preventable deaths, according to HealthGrades Study OR Mortality Rate 71% Lower at Nation s Top-Rated Hospitals: HealthGrades 11th Annual Hospital Quality Study 43

43 Questions 44