Quality improvement, by the numbers

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Organization-wide quality improvement is a top priority of savvy, resident-centric long-term care operators – and its value and importance has become even more magnified in light of the Centers for Medicare and Medicaid Services' soon-to-be-implemented quality measures for MDS 3.0.

No question, being quality-focused has significant advantages. In addition to improved clinical outcomes, operators also benefit from fewer professional liability claims, potentially lower insurance premiums, and improved resident satisfaction. What's more, well-performing facilities also benefit from fewer fines and survey deficiencies, higher occupancy rates and increased reimbursement – not to mention, a more positive public perception. Demonstrating quality are requirements for success in many of the Patient protection and Affordable Care Act (PPACA) initiatives.

Staying abreast of clinical performance data requires ongoing effort and steadfast dedication. Operators must have a reliable, effective means of aggregating, analyzing and utilizing clinical data in a way that detects trends, challenges and risks, and promotes widespread quality improvement at an organization and individual facility level. Unfortunately, this critical task is not one that can be easily tackled by operators on their own. Many are time- and resource-constrained, and lack the ability to gather, decipher and disseminate data in a meaningful way, yet alone on an ongoing basis. Relying on information gleaned from their MDS software or electronic health record provider likely won't be enough, either. While operators may attain the CMS quality measures from their MDS software provider or the federal government, they won't have access to root-cause analysis tools that can identify risks and help drive consistent, ongoing performance improvement.  As well, case-mix adjustment of these raw rates, and appropriate benchmarking require additional skills.

"It's that root-cause analysis that not only tells a facility how they're doing, but then also gives them insight into how best to make changes and improvements," said Steven Littlehale, EVP and chief clinical officer at PointRight Inc. "A lot of programs out there can tell a facility about its problems. The better approach, though, is to identify those problems and then identify potential risks and areas of opportunity so the facility or organization can proactively make improvements to overcome those problems."

A suite solution

PointRight's Performance Portfolio was developed to help operators make the most of their data, identify and mitigate risks, and drive continuous quality improvement. This suite of real-time online reports provides risk-adjusted insights into a facility's clinical performance – comprehensive analyses that can be presented at virtually every management level within the organization.

Three key components comprise Performance Portfolio: a QM reporting tool that gives operators access to both retrospective and real-time data to determine their clinical performance and also benchmark their QM performance against other facilities across the nation; the RADAR Report, a resident-based descriptive and predictive tool that illustrates levels of acuity and dependence (along with a resident's risk in developing negative outcomes) and ensures data integrity for MDS submissions; and the Medicare PPS Report, which illustrates changes in a facility's Medicare processes over time using current Resource Utilization Group (RUG) categories and payment criteria. Performance Portfolio customers also benefit from a dedicated account management team that proactively combs through the client's data to ensure that the tools and aggregated data are being used correctly and to their fullest potential. 

Even though CMS' quality measures component of MDS 3.0 hasn't yet taken effect – and CMS hasn't articulated which quality measures will be used for the Five Star Quality Rating System until later this year – experts warn that long-term care operators don't have the luxury of waiting to monitor their performance measures, track trends, identify risks and determine the best approach to ongoing quality improvement.

"Any facility that has treated this blackout period with the quality measures like a get-out-of-jail free card and hasn't been tracking their own measures or trying to maintain or improve their quality over this past year is going to be in for a real awakening," said Sue LaBelle, MSN, RN, RAC-CT, healthcare management consultant for PointRight. "When those new measures go up, you'd better be ready. And the only way to be ready and in a good place with the 2012 measures is to be tracking and trending your clinical data on a regular and ongoing basis."

Success story

It's a message that resonates with Opis Management Resources LLC, a company that manages and operates skilled nursing facilities throughout Florida. Through the use of PointRight's Performance Portfolio, Opis has been able to monitor and track its quality measures over the course of the blackout period and then use the reports to benchmark clinical performance against other PointRight customer data.

"The data analysis that PointRight sends in its reports is [generated] from what we're actually putting in the MDS – and that's the information that CMS will be using for the [Five Star Quality Rating]. The data integrity component of Performance Portfolio helps us proactively determine coding or documentation issues or inconsistencies so we can be sure our MDS is accurate before we actually submit to CMS," said Suzanne Foxcroft, RN, vice president of clinical and risk for Opis Management Resources. "Data accuracy is important from a reimbursement standpoint, but even more importantly from a quality of care standpoint. We can use the PointRight reports to look at trends, compare ourselves with other facilities and determine ways to improve processes that impact resident care."

PointRight has tracked and trended 24 clinical measures throughout the blackout period and then used that data to provide customers with a monthly report based on their unique data. In addition, Opis focuses on five internal quality indicators: how it's responding to Opis team members' needs; how it's caring for residents; its overall approach to care quality; how it's addressing the financial aspects of business; and how it's managing growth.

"Quality really does drive everything. We know that if we take care of the first three [of our internal quality indicators], the other two fall into place," added Foxcroft.

Although benchmarking comparisons are specific to those in PointRight's own client database – and represents a smaller pool than the national comparisons that will be generated by CMS once the 2012 quality measures take effect – PointRight's client database is nonetheless large enough to be statistically significant, assured LaBelle.

It's certainly given Opis the assurance it needs, particularly with the 2012 quality measures on the horizon. "Because of PointRight's reports, we've been able to use all our MDS and quality data in a proactive way and stay one step ahead," Foxcroft added.

Quality at the core

Using Performance Portfolio to its fullest provides benefits beyond risk identification, QM performance improvement and data integrity assurance, however. As Littlehale explained, the suite's Medicare PPS Report component also helps operators proactively monitor their financial health. The report offers drill-in capabilities that simplify compliance monitoring, while real-time Medicare reporting makes it easy to monitor prospective payment daily and predict monthly revenue – all without waiting for month-end close.

"Performance Portfolio helps you look at performance with a broader lens – from a clinical, risk and financial perspective – and then [leverage] the data and reports in a way that allows you to drill down and investigate the root cause of all performance issues," he said.

Above all, though, it's about putting operators in control of their own operational data to drive ongoing success. Put simply, those who stay focused on quality and consistently use their data proactively to improve care quality will effectively rise above challenges, according to LaBelle.

"Quality measures and other requirements may change, but quality care will still be quality care. And a good performer will continue to be a good performer."

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