Measuring and improving healthcare quality, safety and performance remain constants
Andy Weissberg, SVP, Marketing and Education, Quantros
Many skilled nursing and long-term care providers face uncertainty stemming from the heated debates over repeal of the Affordable Care Act and the fate of the Better Care Reconciliation Act.
Regardless of any legislative outcome, one thing remains a constant: Payments and reimbursement throughout the healthcare ecosystem are increasingly and decisively linked to the quality of care that is delivered, documented and measured.
The Improving Medicare Post-Acute Care Transformation Act, for instance, requires the submission of standardized data by long-term care hospitals, skilled nursing facilities, home health agencies and inpatient rehabilitation facilities.
The Act also requires CMS to develop and implement quality measures from five domains using standardized assessment data, as well as the development and reporting of measures pertaining to resource use, hospitalization and discharge to the community ― all with the aim of facilitating coordinated care and improving outcomes and overall quality comparisons.
The goals of this legislation are clear: Make care safer, better engage patients and family, promote effective communication and coordination of care, enhance preventive practices, promote best practices and make quality care more affordable for patients and payers alike.
In this landscape, as more hospital systems acquire skilled nursing facilities and expand their post-acute care networks, they are assuming financial responsibilities for re-admissions and other performance-centered risks and incentive. Therefore, it will become increasingly critical for these organizations to create a high-performing post-acute care network to meet increasingly high standards of care, safety and performance.
For most long-term care providers, unwarranted variation in care is a significant source of suboptimal outcomes and unnecessarily high costs that apply to all patients across their case mix and payer mix. Apart from the penalties linked to excess readmissions and hospital-acquired conditions in federal programs, emerging value mandates from both private purchasers and commercial payers narrow the margin for error, and provide even stronger incentives to pinpoint and address the most sensitive areas of undesirable variation in care.
Measuring quality and safety
While hospitals recognize the need to become laser-focused on providing care quality and keeping their patients safe, not all hospitals do this effectively. More than 250,000 Americans die each year from medical errors, making medical error the third leading cause of death in the United States. However, with increased sophistication of health IT systems, it may now be easier to achieve optimal patient safety and quality goals.
When “Total Safety Management” in a healthcare environment is supported by appropriate IT infrastructure, healthcare facilities create a viable framework for reaching these objectives. It is based upon the idea that a healthcare organization can build long-term success by having all its employees, from low-level workers to its highest ranking executives, focus on safety and quality improvement. By finding the real causes of medical errors and determining the issues, it is possible to measure safety and quality, and ultimately provide safe, quality healthcare to the patients in a way that is financially viable and legally compliant in today's complex healthcare environment.
This requires a strategy to accurately measure quality and manage evolving quality reporting and reimbursement requirements. It relies upon the adoption of sophisticated tools designed to foster operational efficiency that leads to safer, higher quality care.
Better performance: A holistic view brings assets together
Taking a holistic approach to these IT tools is critical, and it involves not only integrating new systems, but also viewing them as a single entity. Healthcare organizations need everyone working together to support the new technology so that, in turn, it can support them.
Just as a holistic approach to medicine treats each patient as an integrated system and considers how the mind affects the body, a holistic approach to technology focuses on the interdependence of system components.
By focusing on change management and aligning the people, organization and systems to the business processes, this new holistic approach can pull together all the organizational assets necessary to increase performance, and improve quality and patient safety.
Providing the best possible care
Having a clear-cut IT strategy is key to providing the best possible care, and can be the difference between success and failure. TSM requires organizations to focus on continuous process improvement over the long term, rather than simply emphasizing short-term goals.
Continuous improvement should center on the use of strategy, data and effective communication to instill a discipline of care quality and safety into the healthcare organization's culture and processes.
TSM puts emphasis on the processes and calls for organizations to define those processes, continuously monitor and measure their performance, and use that performance data to drive improvements. It's critically important that all employees – from the top down -- be part of this process. The objectives are to eliminate waste and increase efficiencies by ensuring that services are performed correctly the first time.
TSM's holistic approaches include:
Systems thinking: A holistic approach to analysis that focuses on the way that a system's constituent parts interrelate, how systems function over time and how they function within the context of even larger systems.
Enterprise risk management: A holistic approach to planning, organizing, leading, and controlling a healthcare organization's activities to minimize the effects of medical error.
Long-term care facilities should seek new enterprise performance management solutions that provide a line of sight into risk-adjusted measures of quality, including patient safety, patient satisfaction, complications, excess all-site readmissions and others linked to value-based payments and reimbursement across a hospital and health system's payer mix.
21st century thinking in healthcare
Other industries have provided a number of documented reasons why their information IT initiatives failed. Long-term care facilities should begin to learn these lessons and overcome the inability to adapt to change that has left it functioning in an outdated and inefficient way ―often to the detriment of patient care and safety.
Healthcare stakeholders within the organization must also overcome misconceptions of what IT is and how it is used. Not doing so has led executives and healthcare professionals to adopt varied, and often opposing, ideas about what IT's true role is when it comes to quality and safety measures.
IT innovation should be viewed as an indispensable tool that must be aligned with an organization's goals and priorities. Because IT represents change and change affects people, organizations must understand the different ways that IT impacts every aspect of the operations. TSM's holistic approach aligns goals to ensure that IT is embraced by the people within the healthcare organization so that it can truly be effective and potentially save lives.
Whether patients are insured, underinsured or uninsured, under any newly proposed or future healthcare reforms, improving patient care outcomes remains the key to achieving clinical and financial success and survival. This means finding an innovative and reliable resource for measuring value and improving performance in the emerging value-based healthcare economy.
Andy Weissberg is the SVP in Marketing Communications at Quantros.