Hm306 week 8

1. © 2016© 2016
A Practical Approach to Analyzing
Healthcare Data
Chapter 9 – Benchmarking and
Analyzing Externally Reported
Data

2. © 2016
The Benchmarking Process
• Benchmarking – comparing performance to a
standard
• Internal benchmarking – comparison to
internal goals or year-over-year
• External benchmarking – comparison to
external norms or competitors
• Benefits
– Identify strong or weak areas
– Part of quality improvement culture

3. © 2016
Benchmarking Steps
1. Identify the issue to benchmark
2. Locate internal data related to the issue
3. Analyze internal data
4. Identify external data available for benchmarking
5. Collect public domain data or purchase data, if appropriate
6. Compare internal and external data
7. Determine whether a performance gap exists
8. Communicate benchmarking findings
9. Establish performance-level targets and action plans for
achievement
10. Implement plans; monitor and communicate progress
11. Recalibrate benchmarks as necessary
12. Repeat the process

4. © 2016
Hospital Value Based Purchasing
Programs (HVBP)
• CMS HVBP is example of a formal benchmarking
program
• HVBP includes four domains
– Process of care
– Outcomes
– Patient experience
– Efficiency of care
• Generates Total Performance Score (TPS) that is
used to determine an incentive payment added to
Medicare inpatient payments for participating
hospitals

5. © 2016
Dashboards and Scorecards
• Method to represent performance in terms of key
performance indicators (KPI)
• Guide management decisions
• Include a combination of indicators measured on a
‘per unit’ basis for comparability across time
• Categories may include:
– Clinical
– Operational
– Financial

6. © 2016
AHRQ Dashboard

7. © 2016
AHRQ HCUP Data
• HCUPnet – online querying tool to select
regional/national statistics based on claims data
• Collects data from state organizations
• Creates a probability sample from the state databases
and additional sample data from selected hospitals
• Updated annually
• Used by many researchers and practitioners for
benchmarking
• Only publicly available source of all payer claims data

8. © 2016
AHRQ HCUP Data
• National Inpatient Sample (NIS)
– All payer inpatient data
• Kids’ Inpatient Database (KID)
– Pediatric inpatient data
• Nationwide Emergency Department Sample (NEDS)
– All payer emergency department data
• State Inpatient Surgery Database (SASD)
– All payer ambulatory surgery data for selected states
– Primarily hospital based clinics
• State Emergency Department Databases (SEDD)
– All payer data for selected states

9. © 2016
AHRQ Quality Measures
• Types of care
– Preventive measures
– Acute care measures
– Chronic care measures
• Settings of care
– Hospital care measures
– Ambulatory care measures
– Home health care measures
• Care by clinical area
– Cancer measures
– Diabetes measures
– Heart disease measures
– Maternal and child health measures
– Respiratory diseases measures

10. © 2016
National Quality Forum (NQF)
• Provides a framework for endorsing healthcare quality measures by:
– Convenes working groups to foster quality improvement in both public-
and private-sectors;
– Endorses consensus standards for performance measurement;
– Ensures that consistent, high-quality performance information is publicly
available; and
– Seeks real time feedback to ensure measures are meaningful and
accurate.
• Endorsement of a quality measure requires the following steps:
1. Measure is proposed and supported with scientific evidence
2. Validity and reliability of the measure is established
3. Feasibility is tested typically via pilot testing; includes cost and
potential administrative burden for data collection
4. Usability is assessed; does the measure provide enough feedback so
that users can improve performance
5. Assessment of related or competing measures

11. © 2016
Medicare Quality Measures
• Data.medicare.gov
– Hospital Compare
– Nursing Home Compare
– Physician Compare
– Home Health Compare
– Dialysis Facility Compare
• Data provided in online query and
comparison format as well as a bulk
download of national statistics

12. © 2016
Hospital Compare
Example

13. © 2016
Risk adjustment
• Quality measurement should include an adjustment for the risk of an
adverse outcome
• Patient level adjustment
– Age/gender
– Comorbidities
• Provider level adjustment
– Teaching status
– Location (urban/rural)
– Socio-economic attributes of patient mix
– Payer mix
• Used to compare actual performance to expected performance based
on the risk factors
– SIR – standardized infection rate (observed infection rate divided by the expected
infection rate)
– SRR – standardized readmission rate
– SMR – standardized mortality rate
• For all standardized rates, a value of greater than one is interpreted that
a facility’s rate is higher than expected given the risk attributed to their
patient mix

14. © 2016
Leapfrog Group
• Data collected via hospital survey
• Areas of measurement
– Prevention of medication errors
– Appropriate ICU staffing with professionals
specially trained in critical care
– Steps to avoid harm
– Reduction of pressure ulcers
– Reduction of in-hospital injuries
– Managing serious errors
• May compare again Leapfrog Group criteria

15. © 2016
Bridges to Excellence
• Not-for-profit organization
• Developed by employers, physicians, and
industry experts
• Pay-for-performance program
• Providers submit data
• Standard data exchange
• Standard performance measurement
• May be implemented by state governments,
health plans or employers

16. © 2016
HealthGrades
• Data licensed from CMS and selected states
• 31 procedures and diagnoses
– State/geographic area via website
– More detail may be purchased
• Hospitals receive a 1 to 5 star rating based
on performance
– Patient safety
– Clinical performance
– Patient experience

17. © 2016
HEDIS
• Healthcare effectiveness data and
information set
• Administered by the National Committee
for Quality Assurance (NCQA)
• Data tracks the performance of health
plans
• Data is validated