The unsustainable rising cost of medical care is creating financial pressures that will critically alter the way that health care is both paid for and delivered. Limited resources dictate that we become more efficient at providing high quality care. In an effort to provide financial incentive for delivering quality care the Federal government instituted Value Based Purchasing (VBP) and Bundled Payments. In order to maximize reimbursement under these programs, providers of health care must follow to the basic tenants of the quality principles.
Lorraine Hutzler, Associate Director of the Center for Quality and Patient Safety at NYU Hospital for Joint Diseases at the NYU Langone Medical Center, will discuss:
• How to build a quality infrastructure for your orthopedic program
• What quality metrics to measure and how to engage surgeons using them
• Lean and Six Sigma principles to use to accelerate improvement
About the Speaker:
Lorraine100Lorraine Hutzler is the Associate Director of the Center for Quality and Patient Safety at NYU Hospital for Joint Diseases at the NYU Langone Medical Center and a Principal of Labrador Healthcare Consulting. She designed, built and maintains a robust quality infrastructure for the Department of Orthopaedic Surgery. Lorraine has extensive expertise in quality metrics management and reporting as well as Lean and Six Sigma Certification.
Managing Total Joint Replacement Bundled Payment Models: Keys to SuccessWellbe
Speaker: Andrew Duncan, Executive Director for Orthopaedics and Rehabilitation at University of Florida Health
This webinar will describe bundled payments and episode of care based patient management strategies. Attendees can learn to successfully manage total joint replacement bundled payment programs and what clinical service delivery strategies to use to be positioned for success. The importance of collecting and using data to understand costs for the episode of care and to negotiate will also be a focus.
About the Speaker:
Andrew Duncan has been a licensed physical therapist since 1991, when he graduated from the State University of New York at Buffalo with his Bachelor of Science in Physical Therapy. Upon completion of entry-level training, he worked as a physical therapist for two years and then completed his post professional Master’s degree in Human Movement Science and became certified in Athletic Training at the University of North Carolina at Chapel Hill. He then underwent board certification by the American Board of Physical Therapy Specialties and became a Sports Certified Specialist in 2002. While working as a manager at rehabilitation corporations and later at an academic health care center, he developed a passion for the business of health care and went on to complete his MBA from the Simon School of Business at the University of Rochester and has also earned his DPT from Boston University. Since 2012, Duncan serves as the Executive Director for Orthopaedics and Rehabilitation at the University of Florida College of Medicine, Co-Director of the UF Health Orthopaedic and Sports Medicine Institute, and also serves as the Executive Director for Rehabilitation and Radiology Services at UF Health Shands Hospitals. He holds an adjunct clinical lecturer appointment in the University of Florida Department of Physical Therapy providing instruction in the Patient and Families First and Professional Issues courses of the DPT curriculum.
Clinical Quality Measures: Measuring and monitoring clinical quality measures...Practice Fusion
Learn about:
1. CMS quality measures.
2. How to capture the data in Practice Fusion.
3. How this data can be used to earn incentive payments through quality reporting programs, including Meaningful Use and PQRS.
Managing Total Joint Replacement Bundled Payment Models: Keys to SuccessWellbe
Speaker: Andrew Duncan, Executive Director for Orthopaedics and Rehabilitation at University of Florida Health
This webinar will describe bundled payments and episode of care based patient management strategies. Attendees can learn to successfully manage total joint replacement bundled payment programs and what clinical service delivery strategies to use to be positioned for success. The importance of collecting and using data to understand costs for the episode of care and to negotiate will also be a focus.
About the Speaker:
Andrew Duncan has been a licensed physical therapist since 1991, when he graduated from the State University of New York at Buffalo with his Bachelor of Science in Physical Therapy. Upon completion of entry-level training, he worked as a physical therapist for two years and then completed his post professional Master’s degree in Human Movement Science and became certified in Athletic Training at the University of North Carolina at Chapel Hill. He then underwent board certification by the American Board of Physical Therapy Specialties and became a Sports Certified Specialist in 2002. While working as a manager at rehabilitation corporations and later at an academic health care center, he developed a passion for the business of health care and went on to complete his MBA from the Simon School of Business at the University of Rochester and has also earned his DPT from Boston University. Since 2012, Duncan serves as the Executive Director for Orthopaedics and Rehabilitation at the University of Florida College of Medicine, Co-Director of the UF Health Orthopaedic and Sports Medicine Institute, and also serves as the Executive Director for Rehabilitation and Radiology Services at UF Health Shands Hospitals. He holds an adjunct clinical lecturer appointment in the University of Florida Department of Physical Therapy providing instruction in the Patient and Families First and Professional Issues courses of the DPT curriculum.
Clinical Quality Measures: Measuring and monitoring clinical quality measures...Practice Fusion
Learn about:
1. CMS quality measures.
2. How to capture the data in Practice Fusion.
3. How this data can be used to earn incentive payments through quality reporting programs, including Meaningful Use and PQRS.
Clinical Audit is a method of confirming the quality of clinical services and identify the need for improvement. A skill hospital administrator should learn and practice.
CRITICAL PATHWAY FOR NURSING ADMINISTRATION.VIKRANT KULTHE
Respected,
all Administration and Nursing Management student its very helpful for a critical planing and critical care plan for the patients those who are hospitalize. The critical pathway means a plan of care to the patients or plan for project. I hope its helpful for all student.
thanking you!!!!!!!
Population Health in 2016: Know How to Move Forwardathenahealth
Accountable care organizations (ACOs) present a significant opportunity to reduce health care expenditures and ensure quality care. Successfully managing the transition to an ACO is one of the most difficult challenges facing health organizations today. The key is to focus on the risk contract and approach population health management in a staged, incremental way.
Improving Trust Between Physicians and AdministrationWellbe
MidMichigan Health is a four hospital health system located in the Central portion of the Lower Peninsula. I am responsible for operations of both Neuroscience and Surgical Services. As such, I am accountable for the overall contribution of the service lines to the organization. Prior to taking on my current role, I was a Physician Liaison for the Gamma Knife center, which is one of three within the entire State. I was able to increase the referrals from 9 per month to 20 per month. I spent 15 years in the Pharmaceutical Industry in various roles. My entire career has been one requiring the ability to communicate well with physicians as well as with administration. Within our health system, it has been a challenge to move the Neuro and Surgical Service programs forward. This is due to a clear disconnect between Administration and the Providers. Recently, I have begun a process of working with both sides of this equation with some great success. My goal is to share with everyone the ideas that have worked to bring both sides to common ground and ultimately grow the programs.
At the end of this presentation, participants will be able to:
• Identify the key issues that need to be addressed from Administration as well as from the Providers
• Develop a communication strategy that will open discussion
• Begin to build trust through example
• Understand the difference between a “smoke screen” and a true issue
• Become the conduit to facilitate change within the system.
The Patient Experience Trifecta: Ignite the Passion, Change the Experience, T...Wellbe
Word of mouth (WOM) is a healthcare provider’s most strategic marketing weapon. In its simplest form, word of mouth is nothing more than offering incredible experiences (the WOW) that people talk about. There is a lot of talk about commitment to patient experience, yet translating that to action is sporadic and typically not sustained. And when it happens it typically is in silos.
In this session, we will first make the association between word of mouth and patient experiences. Research showing the tie between top-performing hospitals and employees who are engaged in the mission will be shared along with a systemic approach to patient experience management.
As you start to realize what is at stake by getting experience management wrong, you build the case for the need for a Chief Experience Officer (CXO) to get it right. Three roles for that position will then be covered.
Once you start to change experiences, you will want to tell your story. How to tell your story and then spread it through five strategies that mainstream companies like Starbucks use to identify and deploy customer ambassadors / crusaders will be shared with both offline and online strategies.
Learning Objectives:
1. Define word of mouth marketing and its tie to patient experience.
2. Learn why patient experience approaches have failed to date.
3. Consider a new approach to experience management that is systemic and holistic.
4. Define the roles and the reasons for a Chief Experience Officer.
5. Use and apply “crusader” marketer characteristics to tell your story and spread your story.
About the Presenter:
Anthony Cirillo, FACHE, ABC, is an international consultant and thought leader that helps leaders connect the dots that spark healthcare movements. President of Fast Forward Consulting, which specializes in patient experience management and strategic marketing, he is a Fellow of the American College of Healthcare Executives and an Accredited Business Communicator of the International Association of Business Communicators.
His article, The Chief Experience Officer was one impetus behind the Cleveland Clinic’s initiative to start an office of patient experience. He works with hospitals and organizations across the aging continuum helping them to authentically create exceptional experiences for their staff and patients and then crafting the marketing strategy that helps them tell their story.
Clinical Audit is a method of confirming the quality of clinical services and identify the need for improvement. A skill hospital administrator should learn and practice.
CRITICAL PATHWAY FOR NURSING ADMINISTRATION.VIKRANT KULTHE
Respected,
all Administration and Nursing Management student its very helpful for a critical planing and critical care plan for the patients those who are hospitalize. The critical pathway means a plan of care to the patients or plan for project. I hope its helpful for all student.
thanking you!!!!!!!
Population Health in 2016: Know How to Move Forwardathenahealth
Accountable care organizations (ACOs) present a significant opportunity to reduce health care expenditures and ensure quality care. Successfully managing the transition to an ACO is one of the most difficult challenges facing health organizations today. The key is to focus on the risk contract and approach population health management in a staged, incremental way.
Improving Trust Between Physicians and AdministrationWellbe
MidMichigan Health is a four hospital health system located in the Central portion of the Lower Peninsula. I am responsible for operations of both Neuroscience and Surgical Services. As such, I am accountable for the overall contribution of the service lines to the organization. Prior to taking on my current role, I was a Physician Liaison for the Gamma Knife center, which is one of three within the entire State. I was able to increase the referrals from 9 per month to 20 per month. I spent 15 years in the Pharmaceutical Industry in various roles. My entire career has been one requiring the ability to communicate well with physicians as well as with administration. Within our health system, it has been a challenge to move the Neuro and Surgical Service programs forward. This is due to a clear disconnect between Administration and the Providers. Recently, I have begun a process of working with both sides of this equation with some great success. My goal is to share with everyone the ideas that have worked to bring both sides to common ground and ultimately grow the programs.
At the end of this presentation, participants will be able to:
• Identify the key issues that need to be addressed from Administration as well as from the Providers
• Develop a communication strategy that will open discussion
• Begin to build trust through example
• Understand the difference between a “smoke screen” and a true issue
• Become the conduit to facilitate change within the system.
The Patient Experience Trifecta: Ignite the Passion, Change the Experience, T...Wellbe
Word of mouth (WOM) is a healthcare provider’s most strategic marketing weapon. In its simplest form, word of mouth is nothing more than offering incredible experiences (the WOW) that people talk about. There is a lot of talk about commitment to patient experience, yet translating that to action is sporadic and typically not sustained. And when it happens it typically is in silos.
In this session, we will first make the association between word of mouth and patient experiences. Research showing the tie between top-performing hospitals and employees who are engaged in the mission will be shared along with a systemic approach to patient experience management.
As you start to realize what is at stake by getting experience management wrong, you build the case for the need for a Chief Experience Officer (CXO) to get it right. Three roles for that position will then be covered.
Once you start to change experiences, you will want to tell your story. How to tell your story and then spread it through five strategies that mainstream companies like Starbucks use to identify and deploy customer ambassadors / crusaders will be shared with both offline and online strategies.
Learning Objectives:
1. Define word of mouth marketing and its tie to patient experience.
2. Learn why patient experience approaches have failed to date.
3. Consider a new approach to experience management that is systemic and holistic.
4. Define the roles and the reasons for a Chief Experience Officer.
5. Use and apply “crusader” marketer characteristics to tell your story and spread your story.
About the Presenter:
Anthony Cirillo, FACHE, ABC, is an international consultant and thought leader that helps leaders connect the dots that spark healthcare movements. President of Fast Forward Consulting, which specializes in patient experience management and strategic marketing, he is a Fellow of the American College of Healthcare Executives and an Accredited Business Communicator of the International Association of Business Communicators.
His article, The Chief Experience Officer was one impetus behind the Cleveland Clinic’s initiative to start an office of patient experience. He works with hospitals and organizations across the aging continuum helping them to authentically create exceptional experiences for their staff and patients and then crafting the marketing strategy that helps them tell their story.
Total Joint Replacement- Improving Day of Surgery Efficiency and ThroughputWellbe
Organic growth of total joint replacement volume is growing at 3-4% per year as the number of physicians entering orthopedic residency programs is in decline. Cuts in Medicare reimbursement for total joints is forecast every year producing stressors for the surgeon to perform more surgery just to tread water financially. Increasing surgical volume without increasing time in the day requires a team approach to process improvements. By taking a fresh look at operating room processes, it’s possible to accomplish this goal.
Discussion points include:
• Pre-op patient preparedness
• Resolving inherent conflicts
• Surgical case order
• Tracking case efficiency
• Surgical tray streamlining
About the Speaker:
Sandy Nettrour has specialized in orthopedics for 30 years. She is the Neurosurgery and Orthopedic Service Line Coordinator for Butler Health System, providing oversight of the business aspects of Neurosurgery and Orthopedics, while continuing to first assist in the operating room and provide patient care at the bedside.
Sandy graduated from Alderson Broaddus College in 1980 with a Physician Assistant degree. She has been awarded the Distinguished Fellow Recognition by the American Academy of Physician Assistants, the Hu C. Myers Award for lifetime professional achievement and community service, and the Pennsylvania Society of Physician Assistants Humanitarian of the Year 2013. She was a Round Table Participant in Orthopedics Today June 2012′s “Effective and Efficient Joint Replacement Programs Need Constant Review and Renewal of Processes.”
3 Strategies for Maximizing Service Line Efficiency, Quality and ProfitabilityWellbe
Maximizing service line efficiency, quality and profitability is a hot topic, particularly with rising patient care demands, changing reimbursement models, and estimated physician shortfalls. This webinar takes a look at three solutions beginning in the operating room and expanding to the entire patient care journey.
1st solution: A unique clinical and operational service model focused on the specialization of qualified, reimbursable clinical labor to optimize surgeon involvement and reduce OR costs.
2nd solution: Taking a holistic view of the service line through the patient care journey to produce a value stream map to understand the current state. Assisting staff with comparing this current state to the ideal future state, comparing national benchmarks and clinical best practices helps your staff innovate and co-create an individualized plan to get your service line to a higher level.
3rd solution: Utilizing dashboard metrics of the critical to success factors, to sustain and improve your service line.
As a participant, you will be able to:
• Identify key operational and clinical indicators of orthopedic service line efficiency
• Describe how Surgical First Assists can add value in the OR
• List the steps in developing and/or evaluating or building an orthopedic service line
• Describe how metrics/dashboards assist in sustaining change and improvement of orthopedic service line
About the Speaker:
Miki Patterson, PHD ONP, Senior Director of Orthopedics in Intelligent CareDesign at Intralign
Dr. Patterson is a certified orthopedic nurse practitioner and brings over 25 years of clinical experience in healthcare, consulting, direct advanced orthopedic patient care, teaching, NIH level, qualitative and quantitative research and publishing. She is a past president of the National Association of Orthopedic Nurses (NAON) and continues to be nationally recognized for leadership and advancing orthopedic care.
5 Clinician-Patient Communication Gaps Compromising Your Hospital’s Outcomes,...Wellbe
Stephen Wilkins, MPH, is a thought leader, researcher, entrepreneur and blogger at Mind the Gap whose areas of expertise include patient engagement and physician-patient communications. He has over 20+ years experience as a hospital marketing executive, consumer health behavior and patient-centered communications expertise.
Wilkins shared with attendees a definition of patient-centered communications, provided practical examples of patient-centered communication skills in a hospital setting, contrasted a patient-centered style of communications with the more traditional physician-directed or paternalistic communication style and shared evidence demonstrating the benefits of clinician adoption of a patient-centered communication style and skills.
Wilkins identified the top 5 clinician-patient communication gaps found in most hospitals, including examples along with how these clinician-patient communication gaps impact the patients, clinicians and the organization. The webinar also provided strategies for closing the identified clinician-patient communication gaps.
Patient Navigation: A Program to Enhance the Patient Experience and the Botto...Wellbe
In the eyes of a patient, especially one with a chronic or complex illness, the healthcare system can feel overwhelming. Compound the inherent complexities of the system with a variety of barriers patients can face – transportation, language, and many others – and patients can have difficulty following the care plan developed by their team of providers.
Founded and pioneered in 1990 by Dr. Harold P. Freeman, patient navigation originally focused on the critical window of opportunity to save lives from cancer by eliminating barriers to timely care between the point of suspicious finding and resolution by diagnosis and treatment. Since its inception as a community-based intervention program, patient navigation has expanded and transformed into a nationally recognized model that extends well beyond cancer care to include the timely movement of an individual across the entire healthcare continuum.
While patients clearly benefit from the guidance of a patient navigator, a growing body of evidence suggests that patient navigation increases both patient satisfaction and hospital revenue. Nationally, patient navigation is becoming well-recognized for being a cost-effective strategy to address several healthcare priorities. An attractive career choice for those looking to make a difference in healthcare, patient navigation also provides economic development opportunities in communities throughout the United States.
About the Speaker:
Carol Santalucia, Vice President, of CHAMPS Patient Experience, LLC is a seasoned healthcare leader with a passion and commitment to enhancing the patient experience. After 28 years in various service excellence and leadership roles at Cleveland Clinic, where she played a pivotal role in the design, creation and implementation of Cleveland Clinic’s service recovery model Respond with H.E.A.R.T., and the development of their patient navigation program and Service Excellence and Patient Advocacy Department, Carol began her own healthcare consulting practice, Santalucia Group, LLC.
NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
Riding the Rapids of Payment Reform: Downstream Effects of Quality Reporting ...Bill Presley
In this presentation, we highlighted how quality measurement programs impact reimbursement affecting your revenue. The revenue at risk in your organization. We focused on quality programs like Value-Based Purchasing (VBP), Merit-Based Incentive Program (MIPS) and Alternative Payment Models (APM) and their impact on Part A and Part B reimbursements.
It’s no surprise that reimbursement tied to quality performance is quickly becoming a reality for hospitals and physicians. CMS’ aggressive goals aimed at increasing the percentage of Medicare payments associated with quality versus quantity can be achieved through such programs as Value-based Purchasing and MACRA. This session will cover scoring methodologies, reporting requirements, reimbursement impact, infrastructure (and other resource needs), EMR tools and tactics, and workflow modifications.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
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CMS Innovation Center
http://innovation.cms.gov
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Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
quality assurance slides include components, models, approaches, cycle of quality assurance is included in the slides.
the slide gives a brief ides regarding all the points and gives a comprehensive picture of the topic.
4508 Final Quality Project Part 2 Clinical Quality Measur.docxblondellchancy
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the overall quality by making health care more patient‐centered,
reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the health of the U.S. population by
supporting proven interventions to address behavioral, social, and environmental
determinants of health in addition to delivering higher‐quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families,
employers, and government.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
4508 Final Quality Project Part 2 Clinical Quality Measurromeliadoan
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the overall quality by making health care more patient‐centered,
reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the health of the U.S. population by
supporting proven interventions to address behavioral, social, and environmental
determinants of health in addition to delivering higher‐quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families,
employers, and government.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
Health IT Summit Houston 2014 - Case Study "EHR Optimization for Organizational Value in a Changing Healthcare Environment"
Luis Saldana, MD, MBA, FACEP
CMIO
Texas Health Resources
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
Led the development of a comprehensive Dialysis Healthcare Analytics Dashboard in Power BI,
providing valuable insights into critical KPIs in the dialysis care sector.
• Achieved a significant improvement in operational efficiency by optimizing resource allocation
based on Dialysis Stations Stats, resulting in a 20% reduction in patient wait times and
increased patient access to services.
• Utilized a diverse Tech stack including Power BI, SQL for data integration, and data
visualization, enabling data-driven decision-making for improving patient outcomes and
financial performance.
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
Every hospital and health care system is significantly impacted by readmission policies mandated by new regulations.
And every facility must implement strategies to reduce the number of costly and unnecessary readmissions.
During this presentation you will discover how to decrease your readmission rates and take advantage of incentives, rather than suffer penalties that can significantly impact your bottom line.
Using Enhanced Recovery After Surgery (ERAS) to Enhance Postoperative OutcomesWellbe
Speaker: Francesco Carli, MD, MPhil, senior staff anesthesiologist at the McGill University Health Centre
Cost: Complimentary, sponsored by Wellbe
There is strong evidence that many of aspects of surgical care have little evidence, and therefore the Enhanced Recovery After Surgery (ERAS) program has been set up to accelerate the recovery process and decrease the rate of postoperative complications. There is an opportunity to improve outcomes by using team approach and revision of the standard procedures.
Learn about:
– The elements of ERAS protocols
– How to structure the Team approach
– The role of the patient in ERAS
– How to perform an audit of your program
About the Speaker:
Francesco Carli, MD, MPhil, is Professor of Anesthesia at McGill University and Associate Professor in the School of Dietetics and Human Nutrition at McGill University and a senior staff anesthesiologist at the McGill University Health Centre. He is currently an Elected Member of the American Academy of Anesthesia and a Board Member of the Enhanced Recovery After Surgery (ERAS) Society. Dr. Carli completed his medical training and anesthesia training in Turin, Italy, Paris, France, and London, England. He completed a Master’s Degree in surgical metabolism at the University of London, England.
His research interests are: metabolic changes associated with surgery and the impact of perioperative interventions (regional analgesia, nutrition, hormones, exercise) on postoperative recovery; evaluation of functional outcome measures during the surgical recovery process; prehabilitation of surgical patients. He is the author of over 250 peer-review scientific articles and has been a recipient of over 50 peer and non peer-review grants.
10-Year Orthopedics and Spine Forecast: Factors Impacting DemandWellbe
Advances in technology and surgical techniques, fluctuations in population, ever-increasing demand for outpatient procedures combined with an array of economic and policy factors will shape our opportunity for growth in Orthopedics and Spine over the next decade. What’s in store for the next 10 years of orthopedics and spine service lines? Mike Graham of Sg2 will review future inpatient and outpatient forecasts for orthopedics and spine services, the key factors impacting their growth, and opportunities to differentiate your orthopedics and spine services to capture additional market share.
About the Speaker:
Mike Graham supports Sg2’s intelligence and analytics in both orthopedics and spine and contributes to the orthopedic and spine forecasts. As an Sg2 thought leader, he writes extensively on the development of orthopedic and spine service line strategy. He also works directly with health care executives and physicians to apply knowledge and strategy to their unique circumstances and environment.
With 20 years of experience in health care management and information systems, Mike has devoted much of his career to sharing best practices in service line development, physician engagement, care redesign and payment reform through publications, webinars, conference presentations and consulting engagements.
Immediately prior to joining Sg2, Mike engaged with hospitals and providers to grow their orthopedic service lines, improve patient outcomes and transition to value-based models of care. Earlier in his career he participated in the creation of groundbreaking approaches in comprehensive spine center development, focusing on innovative methods to improve patient access and employ nurse navigation and outcomes collection throughout the continuum of care.
Mike earned a master in health care administration from Xavier University in Cincinnati and an undergraduate degree in management information systems from the University of Dayton (OH).
Regional Anesthesia and Bundled Payments – Opioid-sparing Pain Management for...Wellbe
Speaker: Sonia Szlyk, MD, Director of Regional Anesthesia, Mid-Atlantic Division, North American Partners in Anesthesia
This webinar will:
-Discuss Enhanced Recovery After Surgery (ERAS) protocols for joint replacement
-Review the positive impact of regional anesthesia throughout the episode of care
-Spotlight the key components of successful value-based orthopedic care – length of stay, discharge to home, patient and surgeon satisfaction
About the Speaker:
Sonia Szlyk, MD, is the Director of Regional Anesthesia for North American Partners in Anesthesia’s Mid-Atlantic division. Dr. Szlyk orchestrates an outcomes-based regional anesthesia service focused on patient and surgeon satisfaction, safety, and efficiency. She oversees regional anesthesia quality metrics, billing compliance, strategic growth, and education. Dr. Szlyk specializes in opioid-sparing ERAS protocols for joint replacement, sports medicine, colorectal, general, and cosmetic surgery. Her initiatives highlight the value of regional anesthesia in the evolving era of bundled payments.
Dr. Szlyk served as the Director of Regional Anesthesia at the Ambulatory Surgery Center of Bethesda, MD where she oversaw the design and implementation of anesthesia services as well as AAAHC accreditation. The center’s comprehensive pain management program included ultrasound-guided peripheral nerve blocks and catheters for outpatient knee and hip replacements, and sports medicine procedures.
Dr. Szlyk is a board-certified anesthesiologist. She completed medical school and anesthesia residency at the George Washington University School of Medicine and was a Clinical Instructor in regional anesthesia at Stanford University Hospital.
The process, people, and tools required to bring total joint replacements to the ambulatory surgery center setting will be presented by members of the team from the Orthopedic & Sports Institute of the Fox Valley (OSI). OSI has been performing total knee & hip replacements in their ASC since 2009.
The Orthopedic & Sports Institute of the Fox Valley (OSI) was created by its independent physician-owners to offer a full spectrum of patient services under one roof. Their unique care model encompasses sports medicine, total joint replacement, spine surgery, and work-related rehabilitation. OSI’s flagship facility in Appleton includes a surgery center, MRI, physical therapy, pain management, orthotics, and a skilled nursing facility. OSI’s commitment to providing industry-leading results has spawned innovations in Direct Contracting, bundled pricing, Work Comp rehabilitation, and recovery facility design.
About the Speakers:
Curt Kubiak, CEO, OSI: Curt has been the guiding force at OSI, an innovative provider of accessible and affordable patient care since 2006. Comprehensive offerings at OSI include orthopedic & spine surgery, imaging/MRI, bundled payments, work comp rehabilitation, physical therapy, and skilled nursing.
Kim Jablonski, Joint Program Director, OSI: Kim coordinates and oversees the entire carepath experience for patients undergoing total joint replacement at the Orthopedic & Sports Surgery Center.
Aaron Bleier, Director of Finance, OSI: A member of the OSI team since its inception, Aaron has been instrumental in the development of OSI’s cost-saving surgical price bundles.
Learn about a model that is applicable to all service lines as healthcare transitions from volume to value. The model concentrates on transforming from services & procedures, to formalized programs, to centers of excellence, while focusing on the four pillars of service line management: Quality/Outcomes; Service/Satisfaction; Volume/Market share Growth; and Cost Containment. Quality and outcomes are particularly stressed as the key to program differentiation and value. Positioning as a regional destination center for managed care and industry is also discussed.
Presentation to cover:
Learn about a model applicable to all service lines
Learn how to transition from performing procedures to becoming a center of excellence
Learn how to transition from volume to value
Learn how to differentiate your centers of excellence
Learn how to create dashboards to maximize quality
Learn some marketing strategies for your service line
Learn how to position yourself as a regional referral destination
About the Speaker:
Bill Munley is a 30-year veteran of the healthcare system and a recognized leader and strategist in Orthopedics, Service Line Development, and Rehabilitation. He currently serves as Vice President of Orthopaedics, General Surgery, and Professional Services at Bon Secours St. Francis Health System in Greenville, SC, where he has served for 27 years. He is responsible for all inpatient and outpatient Orthopedic, General Surgery, and Rehabilitation programs across three campuses. During his tenure there, he has served as a consultant to other healthcare systems, on editorial advisory boards of professional magazines, as a charter board member and officer of multiple state and local organizations, and has developed numerous programs in his specialty areas. Bill has also appeared as a guest speaker at multiple local, state, and national symposiums, presentations and webinars. Bill holds a BA in General Science from the University of Rochester and a MHSA from George Washington University.
Using the Perioperative Surgical Home as a Model to Implement CJRWellbe
Watch the webinar on youtube: https://youtu.be/rNaU_P2mHXE
The transition to value-based care models has increased pressure to deliver high quality and cost effective care. The medical home concept has gained traction in the primary care setting, and now, the perioperative surgical home has the potential to improve patient satisfaction, outcomes, and cost-effectiveness in the acute setting.
Dr. Zeev Kain, Chancellor’s Professor of Anesthesiology and former Associate Dean of Clinical Operations at University of California at Irvine Health, will share challenges and lessons learned implementing their Joint Replacement Surgical Home to provide more coordinated, standardized care.
What you’ll learn:
– An overview of the Perioperative Surgical Home model, and how it can improve outcomes while reducing cost
– Lessons learned from UC Irvine’s implementation of a Joint Replacement Surgical Home
– Considerations for implementing a Perioperative Surgical Home in your organization
About the Speaker:
Zeev N. Kain is a Chancellor’s Professor of Anesthesiology & Pediatrics & Psychiatry and the Chair of the Department of Anesthesiology & Perioperative Care at UC Irvine Health. Dr. Kain completed residency training in Pediatrics and Anesthesiology, a fellowship in Pediatric Anesthesia and was received an MBA from Columbia University. After 19 years at Yale University he joined UC Irvine Health in 2008. Dr. Kain has had continuous NIH funding since 1996 and had published over 200 publications in the peer-reviewed literature. His main research focus was stress in children undergoing surgery and invasive procedures.
Dr. Kain established the annual summit on the Perioperative Surgical Home and is a member of the steering committee of a 43 hospital collaborative on this topic. His training in Lean Six Sigma and his MBA and his management background have enabled him to embark on the quest to make the Perioperative Surgical Home ubiquitous at UC Irvine Health and to help bring this care model to institutions nationally.
Registry Participation 101: A Step-by-Step Guide to What You Really Need to K...Wellbe
– Is your hospital contemplating joining a registry but you don’t know where to begin?
– Do the acronyms CJR, QCDR, and PROMs cause you angst?
– Have you heard that registry participation can count towards quality programs but you don’t understand the connection?
– Are you a surgeon needing a registry to meet Meaningful Use requirements?
– Are you in one of the 67 geographical areas mandated by the CMS’s Comprehensive Care for Joint Replacement (CJR) program?
– Is your hospital considering a patient-reported outcome measure (PROMs) program and you want to know more about what that entails?
If so, the American Joint Replacement Registry (AJRR) will walk you through everything you need to know about participating in a registry. This session will focus on best practices from over 4,500 surgeons and 675+ hospitals who have successfully implemented and engaged with the data from over 400,000 hip and knee replacement procedures. AJRR will help you to debunk the myth that submitting private health information is complicated, time consuming, and that it takes hundreds of man-hours to participate in a registry.
You’ll also learn how:
• Registry participation can support mandated quality programs – including Meaningful Use, CJR, and PQRS
• To implementing a PROM system in your hospital – what to look out for when starting and helpful tips from current users on what they have learned
• Not all data elements are mandatory – what are the different levels, what does the national registry require, and what is optional
About the Speakers:
Joe Greene is currently the Program Manager of Outreach and Development for the University of Wisconsin Hospital and Clinics in the Department of Orthopedics and Rehabilitation. In this role, Joe coordinates business and philanthropic development activities for the UW Hospital department and University of Wisconsin Department of Orthopedics and Rehabilitation. He represents the needs of all orthopedic subspecialties and has worked for the UW since 1991 when he initiated his career there as an athletic trainer and clinician. He has worked in management and administration across the Department since 1997.
In addition to his role with the UW Hospital, Joe also is the CEO and Owner of OrthoVise. OrthoVise is an Orthopedic advisory firm that assists orthopedic practices of all types with operational and business development needs. His experiences have allowed him and his advisors the opportunity to consult formally with orthopedic practices since 2010. He has particular areas of interest that include Orthopedic and Sports Medicine Program Business Development, Service Line Development, Health Information Technology and EMR Operational Optimization for Orthopedics, Innovative Service Delivery Implementation, Smart Staffing, and Workflow Enhancement.
Joe will be joined by AJRR staff who are experts in guiding individual surgeons and hospital orthopaedic service line directors through the process.
Using Patient Navigation in an Orthopedic Service Line to Drive Outcomes and ...Wellbe
Preparing for joint replacement surgery can be overwhelming for many patients; they often feel inundated with the number of tasks that need to be completed prior to surgery such as medical appointments, preadmission testing, and preparing for their recovery. Learn how one health system used technology and nurse navigation to guide their patients through the joint replacement journey.
About the Speakers:
KateG100Kate Gillespie is the AVP of the Orthopedic Service Line at Virtua in Southern New Jersey. Kate received her BSN from the College of New Jersey and her MBA in Health Care Administration from Eastern University, she is certified in Nursing Administration. As the Orthopedic service line leader her responsibilities include driving efficiency through standardization, cost containment and quality outcomes. Kate is a certified Six Sigma Black Belt with expertise in operation efficiency and lean methodology. As a Six Sigma Black Belt, Kate has led quality and financial projects, and co-led multiple Kaizen projects. She is also active in New Jersey State Nurse Association and chairwoman for the NJ INPAC.
J Smith100Jennifer Smith is the Director of Clinical Outcomes for the Orthopedic Service at Virtua in Southern NJ. Jennifer received her BSN from Thomas Jefferson University and her MSN in Nursing from Villanova University. As the Director of Clinical Outcomes her responsibilities include driving standardization and quality outcomes for the service line. Jennifer is certified as both a Clinical Nurse Specialist in Adult health and Professional in Health Care Quality.
Developing and Operating Post-Acute Networks in Value-Based ProgramsWellbe
Today’s value-based programs (ACOs, bundled payments, etc.) are shifting the responsibility for total spend from the payer to the provider. As the primary contractor under many of these programs, hospitals take on the responsibility for post-acute spend while generally having little experience in that area. This creates a significant challenge to create a successful and profitable programs.
This session will focus on the design and development of an effective post-acute provider network through implementation and ongoing operation. Specific areas to be covered include:
– The role of post-acute care in value-based programs
– Identifying post-acute opportunity for your partnerships
– Designing a post-acute network
– Developing your network
– Operational issues
– Monitoring performance
Learning Objectives:
1. Establish an effective post-acute network
2. Understand performance drivers for post-acute partners
3. Create incentives for post-acute partners to participate
4. Evaluate partner performance within your program
5. Communicate network value to patients
About the Speaker:
Sheldon Hamburger is an alternative payment model advisor for hospitals and healthcare firms nationally. With a focus on program implementation, he brings extensive knowledge and experience gained from more than 25 years of healthcare financial consulting, technology design and development, and sales & marketing strategy for Fortune 1000 clients. He is a frequent speaker and writer on regulatory and technology trends affecting hospital operations, provider reimbursement issues, BPCI and CJR, programs and regulations, medical expense strategies and payer-provider dynamics.
Residing in Raleigh, he is an Executive-In-Residence at North Carolina State University – Poole School of Management and an investor at RTP Capital Associates. He continues to be an active member of national and regional HIMSS and HFMA.
He holds a degree in Computer Engineering from the University of Michigan.
Making CJR Work for You: A Roadmap for Successful Implementation of Medicare ...Wellbe
This presentation will describe a structured approach to successfully launching a program for the Comprehensive Care for Joint Replacement (CJR) Model. Based on years of experience with bundled programs, this roadmap provides the basis for developing a targeted plan for your organization as the April 1, 2016 deadline for CJR rapidly approaches.
Key topics to be addressed include:
• Overview of CJR rules and program requirements
• CJR implications for your organization
• Bundle evaluation – financial and clinical issues
• Gainsharing considerations with program collaborators
• Designing an effective post-acute care network
• Using analytics to develop and monitor your program
• Key “must-dos” for an April 1, 2016 launch
Learning Objectives:
1. Describe the rules and requirements of CJR
2. Assess the key success drivers in bundle performance
3. Evaluate where and why organizations fail in bundles
4. Develop strategies and tactics to create a post-acute partnership
5. Illustrate risk stratification factors in bundle design
About the Speaker:
Sheldon Hamburger is an Alternative Payment Model advisor for hospitals and healthcare firms nationally. With a focus on program implementation, he brings extensive knowledge and experience gained from more than 25 years of healthcare financial consulting, technology design and development, and sales & marketing strategy for Fortune 1000 clients. He is a frequently sought-after speaker and writer on regulatory and technology trends affecting hospital operations, provider reimbursement issues, BPCI / CJR, programs and regulations, medical expense strategies and payer-provider dynamics. Residing in Raleigh, he is an active member of HIMSS, HFMA, & ACHE. He earned his B.S.E. in Computer Engineering from the University of Michigan.
Fundamentals of Bundles for Joint Replacement – Creating the Competitive EdgeWellbe
Medicare is expected to issue the final rule for the Comprehensive Care for Joint Replacement (CJR) initiative soon. As proposed, hospitals in chosen MSAs must be ready to take on this new challenge by January 1, 2016.
The Connecticut Joint Replacement Institute (CJRI) at Saint Francis Hospital has performed more than 20,000 procedures since opening in 2007. CJRI has been on the forefront of bundled payments for joint replacements since implementing their first bundle agreement in 2010. CJRI will share the essential elements to developing a bundle program and the challenges of evolving towards a value-driven, risk bearing model in today’s healthcare environment.
Attendee Takeaways:
– Learn the essential ingredients to develop a successful bundle payment program
– Understand the fundamentals of value-based healthcare
– Learn how to create sustainable bundled payments and maintain a competitive edge in the marketplace
About The Speaker:
Maureen Geary is the Program Director at the Connecticut Joint Replacement Institute in Hartford, Connecticut. Maureen been involved with bundle payments since 2009. CJRI signed their first commercial contract in 2010. She leads strategic initiatives and new product development for the company. Maureen also provides consultative services for orthopedic organizations seeking to develop a bundled product or expand their service line.
Implementation of a Perioperative Surgical Home (PSH)Wellbe
The PSH is a patient-centered, physician-led system of coordinated care that guides patients through the entire surgical experience. From the decision for surgery to 30-90 days post discharge from a medical facility, the PSH model of care is re-engineered to improve patient care and outcomes while decreasing total cost. Learn how your physicians can earn financial incentives from both the PSH and the new CMS requirements for Alternative Payment Models (APMs).
What does SGR Reform and PSH have in common? Dr. Mike Schweitzer, a national leader in PSH, will show you how physicians can leverage a PSH to meet the new APM requirements. The Medicare Access and CHIP Reauthorization Act (MACRA) replaces SGR with a new performance-based payment system and financial incentives for participation in alternative payment models. The law requires that major changes occur by January 1, 2017 – the measurement year for penalties and rewards in 2019. Dr. Schweitzer will describe how to develop a PSH program in your organization. He will share strategies to engage physician leaders to prepare for MACRA or Value Based Payments through PSH.
This webinar will enable you to:
- Identify the burning platform for a PSH
- Define the elements of a PSH
- Outline the infrastructure needed to implement a PSH
- Build and sustain the metrics to support a PSH
- Learn how to engage physician champions
About the Speaker:
Dr. Mike Schweitzer is the Vice President of Healthcare Delivery Transformation at VHA Southeast in Tampa, FL. Mike is also the Medical Director guiding the ASA-sponsored Perioperative Surgical Home Collaborative involving 44 healthcare organizations across the nation. Dr. Schweitzer is a nationally recognized speaker and has published many articles on the Perioperative Surgical Home.
Dr. Schweitzer previously served as the Chief Medical Officer for Northeast Baptist Hospital in San Antonio, TX where he was involved in the CMS Pilot for Acute Care Episodes, ACO development, and co-management programs.
Disease-Specific Care Certification for Hip and Knee Replacement ProgramsWellbe
The Joint Commission Disclaimer: This presentation is current as of June 30, 2015. The Joint Commission reserves the right to change the content of the information as appropriate.
The Joint Commission’s Disease-Specific Care (DSC) certification program is designed to evaluate clinical programs across the continuum of care. Orthopedic joint replacement programs (hip, knee and shoulder) are certified under the standards for DSC programs.
Joint replacement programs seek certification because it:
Demonstrates commitment to a higher standard of service
Provides a framework for organizational structure and management
Provides a competitive edge in the marketplace
Enhances staff recruitment and development
Is recognized by insurers and other third parties
In this webinar, David Eickemeyer, MBA, Associate Director of Certification for The Joint Commission, will:
Define the main components of certification
Provide examples of performance measures
Provide tips on assessing readiness and preparation timelines
Discuss how and when to apply
About the Speaker:
David Eickemeyer is Associate Director for The Joint Commission’s certification programs. In this role, he manages all of the marketing efforts for Disease-Specific Care certification, Palliative Care certification and Health Care Staffing certification.
In his 18 years at The Joint Commission, Eickemeyer has conducted marketing efforts for most of The Joint Commission’s various accreditation programs, as well as marketing for publications and educational offerings from Joint Commission Resources.
Before joining The Joint Commission in 1993, Eickemeyer marketed health care consulting services and third-party administrative services for Price Waterhouse and Unum Insurance Company.
Eickemeyer holds a bachelor’s degree and master’s degree in business administration from the University of Illinois, Urbana, Illinois.
90 Days to Bundled Payments: Roadmap and Methodology for Implementing Your Bu...Wellbe
CMS’ recent announcement to “double down” on value-based models including bundled payments demonstrates their commitment to this paradigm. Providers need to respond in kind and launch their programs ASAP.
The complexities and time associated with changing focus, care design, and operations can be daunting and this has caused many organizations to delay or reject implementation. But it doesn’t have to be this way.
This session will describe a structured approach that was successfully used to launch a BPCI Model 2 program in 90 days. This particular case study involved an organization that needed to change conveners making the challenge even more difficult. Nevertheless, the program moved along on schedule.
Key topics to be addressed include:
Organization, planning, project management, and priorities
Selecting (or changing) the convener
Bundle selection (even in the absence of data)
Expediting the CMS application process
Keys to establishing/launching an effective post-acute care network
Organizational alignment and change management
Performance metrics – another approach
Leveraging success to expand the program
Learning Objectives
Learn how to prioritize objectives to simplify the bundled payment project plan
Understand the key drivers in bundle selection to avoid analysis paralysis
Learn how to measure real-time progress of the plan and the bundle
Develop strategies and tactics to create a post-acute partnership
Understand the role of change management in a complex project
About the Speaker:
Sheldon Hamburger serves as a Principal of The Aristone Group, a healthcare consulting group. With focus on helping healthcare enterprise organizations address emerging trends, Aristone provides expertise in strategy, process, and technology. With over 30 years of experience in developing and marketing healthcare technology products and services, Mr. Hamburger’s career includes various “firsts” in medical and pharmaceutical financial processing systems.
Evaluating the Effectiveness of Current Pain Management StrategiesWellbe
Pain management of orthopedic surgery patients is being impacted by the changes in health care regulation and reimbursement. There is a need for safer, more effective pain management pathways that can provide opportunities for early discharge without increasing the risk of readmissions or compromising outcomes.
Current pain management strategies for joint replacements, spine surgery and outpatient knee and shoulder procedures will be examined from clinical, safety, satisfaction and cost perspectives. The process of implementing and evaluating these pathways will also be discussed.
Nina Whalen will demonstrate how she evaluated, developed and improved pain management pathways for patients. These pathways include:
– Multimodal pain management for total joint and spine
– Peripheral nerve block utilization for inpatients and outpatients
– Customized pain pathways for special populations
– The use of intraoperative tissue infiltration with medications as a primary pain management strategy in joint replacement surgery
About The Speaker:
Nina Whalen, RN, APN-C, has over 30 years of experience as a nurse practitioner in orthopedic medicine. She has been involved in every phase of patient care at both the clinic and tertiary care levels. In the 1990’s she created and worked in a nurse practitioner hospital program at Presbyterian St Luke’s hospital that provided 24 hour coverage for the needs of hospitalized orthopedic surgery patients. She has worked in research and has co-authored publications in the areas of sports medicine and total joint. She is currently the manager of clinical outcomes at OrthoIndy Hospital (formerly Indiana Orthopaedic Hospital) which is a 38 bed, physician owned, orthopedic specialty hospital in Indianapolis.
The external healthcare environment is changing rapidly and providers are under increasing pressure to innovate with increasing speed and efficiency.
Be it experimenting with new care delivery models to improve care coordination, redesigning workflows to enhance efficiency, or developing new products that improve clinical outcomes, hospitals and their service lines are looking for effective ways to harness the creative power of physicians and employees to solve problems that matter. However, few organizations innovate in an orderly, reliable way.
Great ideas remain captive in the heads of physicians and employees and one-off attempts to spur innovation through “hack-a-thons” and “pitch days” prove disappointing. As an academic medical center and a world leader in orthopedics, Hospital for Special Surgery has a long history of results-oriented innovation.
In this webinar, we will share:
– HSS’ systematic approach for driving innovation
– strategies for generating new insights and developing novel solutions
– processes for piloting and testing new ideas
– guiding principles for creating a culture of innovation
– advice on how to build your very own innovation infrastructure
About the Speaker:
Mark Angelo is Vice President, Innovation & Business Development for Hospital for Special Surgery. Mark joined HSS in 2009 and has held various senior management positions at the Hospital across operations, strategy and business development. As Vice President, Innovation & Business Development, Mark is responsible for advancing hospital strategic priorities related to quality and efficiency, innovation, growth and diversification. One of his key responsibilities includes leading the Operational Excellence program, a hospital-wide initiative that leverages industrial engineering principles to maximize quality and efficiency. Mark also leads the HSS Innovation Center whose mission is to support the development and commercialization of early-stage technologies and solutions.
Prior to joining HSS, Mark worked as a management consultant for Monitor Group where he specialized in operations strategy and organizational design. Mark holds a Bachelor of Applied Science in Biomedical Engineering from the University of Toronto and a Master of Business Administration from Harvard Business School.
Implementing Bundled Payments: A Deeper DiveWellbe
A Bundled Payment can be defined as “a single package price that provides a positive margin for a comprehensive and specific set of healthcare services delivered by multiple providers over a specified period of time.”
There is growing consensus that this payment methodology, and the powerful spillover effect from extensive care redesign associated with its implementation, may be the most effective strategy to reduce spiraling healthcare costs.
The secondary hypothesis is that bundled payment creates sufficient financial incentives to encourage multiple stakeholders to re-align and focus on improving the value of healthcare delivered to the patient.
There is data, including from the Connecticut Joint Replacement Institute (CJRI), which supports these hypotheses. Despite growing interest in bundled payment methodology, however, there are numerous upside challenges and downside risks. In this webinar, these issues will be reviewed and a cogent strategy for implementing a bundled payment program presented.
About the Speaker:
Dr. Steven F. Schutzer graduated with Honors from Union College 1974 and then the University of Virginia School Of Medicine in 1978. Dr. Schutzer was a Lieutenant in the Medical Corps of the United States Navy between 1979 and 1981. He did his General Surgical training at the University of Rochester and then completed his Orthopedic Residency at the University of Connecticut in 1985. He was then a Fellow in Adult Hip and Reconstructive Surgery at the Massachusetts General Hospital and entered practice with Orthopedic Associates of Hartford in July 1986.
He is currently on the staff of St. Francis Hospital, Hartford Hospital and the University of Connecticut John Dempsey Hospital. Dr. Schutzer is a Founding Member and the Medical Director of the Connecticut Joint Replacement Institute. He is also President of Connecticut Joint Replacement Surgeons, LLC. Dr. Schutzer is a member of AAOS, AAHKS, and the Orthopedic Research Society.
10-Year Orthopedics and Spine Forecast: Factors Impacting DemandWellbe
What’s in store for the next 10 years of orthopedics and spine service lines?
Kristi Crowe, Associate Vice President and Orthopedic service line leader at Sg2 will review future demand for orthopedics and spine services nationally, key factors impacting this demand, and opportunities to build your access channels and differentiate your orthopedics and spine services to capture growth.
About the Speaker:
As a member of Sg2’s Center for Strategic Planning, Kristi Crowe leads Sg2’s intelligence and analytics in orthopedics and works with leadership teams to improve growth and performance across the care continuum. She also leads the development of orthopedics service line–oriented publications and educational offerings and speaks nationally at a variety of physician and health care leadership conferences.
With 18 years of clinical, management, and consulting health care experience, Kristi brings a variety of strategic skills to Sg2, which have included physician alignment strategies, volume growth initiatives, and performance enhancement for orthopedic services.
Before joining Sg2, Kristi worked in orthopedic service line consulting for Accelero Health Partners, a fully owned subsidiary of Zimmer. While at Accelero, Kristi established and executed strategic plans for the musculoskeletal service line and led the organization’s internal spine and outcomes development initiatives. Working as the liaison between hospital administration and physicians, Kristi facilitated completion of higher level physician engagement strategies such as comanagement agreements. Earlier in her career, Kristi worked as a physical therapist in inpatient, outpatient and management positions.
She graduated summa cum laude with bachelor’s and master’s degrees in physical therapy from the University of North Dakota.
She is a member of the Healthcare Financial Management Association and American Society for Quality, and maintains her Colorado license to practice physical therapy.
The Value-Based Musculoskeletal Service LineWellbe
As healthcare reform continues to impact the provision and payment of care, hospitals and healthcare systems are challenged with redesigning the way musculoskeletal (MSK) services are delivered. Reimbursement and incentive structures are evolving toward value-based models and, in turn, organization must evaluate their MSK service lines to ensure that they are:
Integrated – MSK services must encompass the complete continuum of care and bother operative and nonoperative services need to be designed around preventive medicine, acute care, and post-acute care.
Scalable – Prevailing MSK service lines will be aligned with strategic partners to secure needed services and enhance market coverage, strategically and efficiently deploy capital for resources, cultivate population health competencies, and achieve economies of scale.
Rationalized – In addition to reducing costs and enhancing efficiencies, leadership of MSK services across a system of care increasingly must consider the consolidation or redistribution of key programs (e.g. Joint replacement) to optimize resources and ensure high-quality care is provided in the most accessible manner.
Informed – MSK service line leadership will be well informed about potentially drastic shifts in the payment environment at the local, regional, and national level. Further, they will effectively leverage operational and clinical data to inform the decision-making process.
Responsive – In addition to being informed, high-performing MSK programs will exhibit lean, vertical, and proactive leadership and decision-making structures that decisively drive the organization forward, particularly during times of change and uncertainty.
During this 60-minute webinar, John Fink and Todd Godfrey will share examples of how organizations are developing innovative MSK service line programs to keep pace with the shift toward a value-based environment.
How to Transform Your Orthopedic Program Into A Destination CenterWellbe
How do you excite all levels of the organization and motivate them to move towards one true north? The key is creating focus, energy and alignment.
- Learn how to listen and connect with the voice of your customers (VoC), the voice of your business (VoB) and the voice of your employees (VoE)
- Break down department silos and create a thriving team culture eager to drive innovation and improvement
- Delight your patients and watch 'word of mouth' marketing become a major driver of sales for your program
Stephanie Allison is the founder of Right Brain Left Brain. Stephanie is a Biochemical Engineer from Auburn University. She has more than 20 years of experience in scientific industries, from nuclear and chemical to medical device and healthcare. Early in her career she was exposed to Lean Six Sigma, changing and improving her engineering approach to become much more about people and process interactions. Steph has saved millions of dollars utilizing her Master Black Belt certification in Lean Six Sigma while simultaneously creating positive culture environments.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
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FECAL INCONTINENCE
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PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
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How to Engage Physicians in Quality/Safety Improvement Using Metrics
1. How to Engage Physicians in
Quality/Safety Improvement
Using Metrics
Lorraine Hutzler
JANUARY 13, 2016
2. How to Engage Physicians in Quality/Safety Improvement Using Metrics
Will discuss:
• How to build a quality infrastructure for your orthopedic program
• What quality metrics to measure and how to engage surgeons using them
• Lean and Six Sigma principles to use to accelerate improvement
3. OVERVIEW
The unsustainable rising cost of medical care is creating financial pressures that will
critically alter the way that health care is both paid for and delivered. Limited
resources dictate that we become more efficient at providing high quality care. In an
effort to provide financial incentive for delivering quality care the Federal
government instituted Value Based Purchasing (VBP) and Bundled Payments. In
order to maximize reimbursement under these programs, providers of health care
must follow to the basic tenants of the quality principles.
4. VALUE BASED PURCHASING
• Under the Hospital VBP Program hospitals receive payment bonuses or
reductions based on performance measures.
• The program is budget neutral. Bonuses for high performing hospitals are funded
by payment cuts from low performing facilities.
• FY2016: the at risk amount under the program is 1.7% of the base operating DRG
payment. Increases to 2% in FY2017.
• When the Hospital VBP Program began clinical process measures were weighted
heavily in the total performance score.
• Over the last 3 years process measures have gradually been supplanted by
outcome (mortality rates) and efficiency measures (spending per beneficiary).
• Reimbursement under the program depends on patient experience as measure
by the HCAHPS survey.
5. VALUE BASED PURCHASING CONTINUED
• In FY2017 the program will add a safety domain.
• The safety domain will represent 20% of a hospital’s total performance score.
• Safety measures include: MRSA infection rate, C diff. infection rate
• FY2019 complication rates following elective primary total hip and total knee
arthroplasties will be included.
6. VALUE BASED PURCHASING CONTINUED
• Approximately 3,400 hospitals were included in at least one of the 3 CMS pay for
performance programs in FY2015.
• Only 14% of these hospitals received no penalties
• 44% received 2 or more penalties
• 1,202 were penalized for excess readmissions
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8. VALUE BASED CARE: NYU HOSPITAL FOR JOINT DISEASES EXPERIENCE
• Our research efforts and clinical initiatives focus on increasing the value of
healthcare by:
• Controlling costs
• Minimizing complications
• Eliminating disparities
• Several of our recent studies have examined the rates and causes of patient
readmission following orthopaedic surgery.
• These studies are helping us to develop targeted interventions to reduce
rehospitalization rates and improve performance under the government’s
readmission reduction program.
9. VALUE BASED CARE: NYU HOSPITAL FOR JOINT DISEASES EXPERIENCE
• Overall our research initiatives are improving our understanding of:
• How to maximize safety
• Minimize complications
• Control the cost of care through consistent use of evidence-based medicine
and clinical practice guidelines
• This overall effort is providing the industry with valuable guidance on optimizing
performance under value based payment.
10. DOMAINS OF CARE
• The clinical process of care domain encompasses 12 performance targets in the
care of acute myocardial infarction, heart failure, pneumonia, healthcare
associated infections and surgical care.
• The patient experience of care domain is measured by the Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS) score.
• A subjective measure of patients’ opinions regarding care they received
• 3rd domain measures mortality outcomes and iatrogenic complications
• CMS then determines the hospital’s total performance score for achievement and
improvement levels and will calculate appropriate incentive payments based
upon these measures.
11. DOMAINS OF CARE CONTINUED
• Using performance data from July 2009 through March 2010 CMS established
minimum achievement and benchmark thresholds for each measure of clinical
care.
• Thresholds are calculated using the 50th and 90th percentiles of compliance in
each domain.
• Scores for each measure are determined based upon where a hospital falls within
the achievement range.
• The total performance score is calculated with clinical process of care measures
70% and patient experience measures determining the remaining 30%. Incentive
payments are then made using a linear scale with budget neutrality determining
the allocation of funds.
12. DOMAINS OF CARE CONTINUED
• Quality can be measured via internal metrics evaluating the elimination of errors
(clinical process domain) or via external metrics evaluating patient satisfaction
(patient experience domain).
• The principles of value based purchasing ensure that both sets of metrics
will play a role in determining the quality of care a hospital provides.
• Improving clinical process domains must be guided by eliminating errors from the
process of care delivery.
• This method of quality improvement can be approached using techniques to
improve operating efficiency, reduce variation, avoid defects, and reduce waste.
• This complements the patient experience domain which is focused on achieving
patient satisfaction.
• Improvements in patient satisfaction should be approached with the goal of
enhancing long term success through customer satisfaction.
13. MEASURING QUALITY METRICS
• Improving metrics involves detecting and correcting errors.
• It is vital to properly identify where improvements should be made in the process
of care delivery.
• The objective nature of internal metrics simplifies their measurement and allows
straightforward calculations regarding improvement.
• Identify appropriate indicators such as HACs, VTEs, SSI, LOS, Readmissions,
Patient Satisfaction
• Look at overall numbers
• Then on a procedure or physician level
14. MEASURING QUALITY METRICS
Metrics we oversee
• Quarterly vs. Monthly and Real Time
• Patient Satisfaction
• Readmissions
• Length of Stay
• CLABS Infection Rate Non-ICU
• Infections
• Case Times
• Discharge Disposition
• PE/DVT Cases
• Surgical Site Infections
• Bundled Payments Data
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20. PATIENT SATISFACTION AND PHYSICIAN FEEDBACK
• We distribute physician specific patient experience scores (both inpatient and
ambulatory) as well as quality data.
• Low score outliers are contacted to understand the etiology of the
score variation and are offered assistance for improvement.
• The purpose of this exercise is to promote self- awareness and improve patient
care and is both financially and philosophically the right thing to do.
21. GAINSHARING AND PHYSICIAN METRICS
• NYU Hospital for Joint Diseases implemented a quality improvement and cost
reduction incentive program (Gainsharing) by aligning incentives with that of
eligible physicians.
• The program was intended to improve the efficiency of the delivery of inpatient
medical and surgical services while maintaining as well as improving the quality of
care.
• Physicians are compensated by reducing unnecessary medical services
• Implementing more efficient practice patterns that could prevent delays in
the discharge process
• Using generic drugs whenever possible
• Using ICUs and ORs in a more cost effective manner
• Engaging in effective admission and discharge planning
• Gainsharing applies to commercial and Medicare and Medicaid managed care
patients only
23. ENGAGING YOUR SURGEONS
• Although the days of fee for service may be coming to end many of your
physicians may be against this paradigm shift in payment structure.
• Physicians generally mistrust hospitals. To work efficiently, the hospitals and the
surgeons must work together.
• We recommend multiple strategies to prepare for this including gain sharing
formulas and alignment strategies.
• By utilizing gain-sharing and monitoring quality, you will give your physicians a
stake in the profits realized through care improvement.
• Real time quality dashboards and strategies for physician engagement are critical
to insure physician cooperation.
• Accurate data and timely feedback are also necessary to insure confidence in the
system. The value generated by the efforts of the care episode team can be
shared by all stakeholders using a mutually agreed upon formula.
24. LEAN AND SIX SIGMA PRINCIPLES USED TO ACCELERATE IMPROVEMENT
• Improving speed, quality and cost
• Define, measure, analyze, improve, control
• Lead a team logically from defining a problem through implementing
solutions linked to underlying causes, and establishing best practices to
make sure the solutions stay in place.
• Process mapping
• Data collection
• Descriptive statistics and data displays
• Variation analysis
• Identifying and verifying causes
• Reducing lead time
• Selecting and testing solutions
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28. EXTERNAL METRICS
• In the patient care domain outcomes are governed by: patient preferences,
attributes, expectations, and perceptions.
• These factors are difficult to measure and vary from person to person and
population to population.
• HCAHPS provides a standardization for this.
• To improve patient satisfaction it is imperative to be aware of the standards that
comprise its evaluation: aspects of hospital experience including communication
with doctors and nurses, responsiveness of hospital staff, cleanliness and
quietness of the hospital environment, effectiveness of pain management,
communication about medications, receipt of discharge information, and
whether they would recommend the hospital to others.
29. EXTERNAL METRICS CONTINUED
• Patient dissatisfaction is likely when patients experience adverse side effects from
treatment or are harmed as a result of medical errors.
• Two concepts that must be kept in mind for these patients are service recovery
and the grapevine effect.
• Service recovery is the process of restoring a patient’s trust and confidence
in the ability of the hospital or doctor to provide high quality care.
• This includes a 6 step process for intervening: apologize for and
acknowledge the error, listen, empathize, ask open ended questions, fix
the problem quickly and fairly, offer atonement, follow up and
remember promises made to the patient.
• The grapevine effect stems from the observation that only 50% of
unhappy customers complain to the offending organization, but 96%
will tell 9 or 10 friends about a bad experience.
30. MOVING FORWARD
• Increasing pressure to provide value presents a new set of challenges to the
current healthcare practices.
• The goal of obtaining the best clinical outcome has always guided and will
continue to guide medical decision making, physicians have never been forced to
document quality because the focus had been on maximizing clinical volumes.
• Monetary pressure to cut costs while improving outcomes represents a new force
in the marketplace.
• Applying principles of quality management is vital to comply with the changing
structure of healthcare reimbursements and to provide the best care for an aging
population.
31. THANK YOU!
Lorraine H. Hutzler, Principal
Labrador Healthcare Consulting Services
Lorraine.hutzler@labradorhealthcareconsulting.com
www.labradorhealthcareconsulting.com