New Financial And Performance Metrics For Healthcare Industry From Brian Walker
GhA Ceo Webinar 12 2009 Final
1. Helping Georgia Hospitals Prepare for Meaningful Use and Improved Quality Kent Giles, MPPMEric Bartholet December 9, 2009
2. Agenda Welcome and Introductions Review Meaningful Use Requirements Review “where we are” in GHA Facilities Keys to Success Q&A
3. Introductions Kent Giles, MPPM, Partner, CSC Healthcare 25 years of Hospital Administration, Physician Practice, Payor and Consulting GHA Account Partner and Advisor to C-Level Executives across the SE US Subject Matter expertise in strategy, planning, IT and Margin/Operations Improvement Eric Bartholet, Partner, CSC Healthcare IT Strategy & Planning Over 25 years working with healthcare systems Subject Matter Expertise in It Strategy, Systems Implementation and Architecture
4. Adoption of Clinical IT in Hospitals is Low and Even Lower Among Physicians Background Transforming the health system will require hospitals and physicians to dramatically increase their use of HIT The latest data from HIMSS Analytics suggests that just over 40 percent of hospitals have basic clinical (nursing) documentation but less than2 percent have physician documentation(HIMSS Analytics, 2009) The level of current EMR adoption will be a major factor in how much investment will be necessary to satisfy the Meaningful Use requirements
5. EHR Meaningful Use Timetable Meaningful Use and HIT-Enabled Health Reform Targets The “meaningful use” criteria to be phased in, with the criteria building from year to year. 2015 2011 2009 2013 HIT-Enabled Health Reform HITECH Policies Capture & Share Data Advanced Care Processes with Clinical Decision Support Improved Outcomes Source: Meaningful Use Work Group Presentation at the HIT Policy Committee Meeting on June 16, 2009
12. What CEO’s Want to Know Meaningful Use Can my application vendor make my hospital ARRA compliant? Can we just accept the penalties and not achieve meaningful use? Isn’t this an issue that I should delegate to my CIO? 4. How do we achieve MU and keep our medical staff and clinicians happy? What is the financial impact on my organization? What are the major CEO risks that I face?
13. HITECH Framework HITECH Scorecard: Results Of 17 GHA Hospitals Overall readiness can be determined by totaling the scores of all the categories, 80 is “likely to achieve MU”. To have a good probability of readiness, a hospital needs to score 80 percent or better in a given category. Dimensions of Healthcare Delivery
35. Left against medical adviceAcute myocardial infarction (AMI) patients without beta-blocker contraindications who received a beta blocker within 24 hr after hospital arrival REG/ADT FACE SHEET (4 data elements) EDDOCUMENTATION (6 data elements MD DOCUMENTATION (7 data elements) RNDOCUMENTATION(1 data element) DISCHARGE SUMMARY (8 data elements) UB-04 (3 data elements) SOURCES OF DATA ELEMENTS
46. ARRA Costs vs. Incentives (350 bed facility w. limited CIS) ARRA costs (capital vs operating) Capital: $ 2.75 million License and Installation – $1,550,000 Project Management - $450,000 Training - $150,000 Clinical Adoption - $450,000 Order Sets (250), Reports (50), Interfaces - $150,000 Operating: $3.24 million / year Hosting and Application Management - $850,000/year Help Desk - $90,000 Additional FTEs in IT, Departments- $1,500,000/year Back Up and Recovery - $ 800,000 ARRA Revenues Incentive Payments of $6,200,000 Impact Analysis Initial need to fund $2,750,000 with cash or financing Additional Operating Budget of $3.24 million / ongoing $3,670,000 in annual penalties if MU not achieved
47. Recommendations for Hospitals and Participating Providers Recommendations Educate - Your Leadership Understand the regulations, rewards, risks and costs. Proforma incentives and ongoing deductions. Form - Steering Committee Chaired by a C-Level Executive (CEO preferred) MU is a major impact on clinical, business office, IT and medical staff Include key clinical, IT, operational and financial leaders (Big Team) Maximize quality improvement, patient safety and cost reduction opportunities Reduce the number of initiatives across the Hospital to provide focus on MU Assess - Current State Assessment w. Road Map (GHA offers one) Determine where you are currently using HITECH Framework Develop overall timelines, major milestones, operational and capital budget Develop measures and accountabilities with responsible parties Implement – CIS and Revise Clinical Processes and Work Flow System Selection based upon criteria not vendor demos Build a detailed project plan with PMO Be honest about your internal capabilities and needs Engage partners (application vendor (s), consulting resources, internal hires) Focus on clinical adoption and implementation in a combined methodology with PMO Focus on best practices and maximize opportunities for improvement Improve – Improve Performance Receive Stimulus Dollars Constant improvement of quality, service and process improvement / cost reduction
48. Elements of Meaningful Use of EHRs Meaningful Use RIGHTOUTCOME RIGHTADOPTION RIGHT IMPLEMENTATION RIGHT PRODUCT
Quality measures are actually quite complicated and include:Inclusion criteria - define what patients to include in the population for this condition.Exclusion criteria - define which patients should be excluded from this particular measureOutcome - is what tells us if the recommended care happened—e.g. did the patient receive beta-blocker within 24 hr of arrival at the hospital?Most of the data elements for complex quality measures like core measures are for exclusion criteria. This is the price we pay for clinical appropriateness. In the case of this measure………Note that there are a number of different sources to check for this information. Also there are more sources than data elements because some have multiple possible sources.