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Quality Manager
The document outlines best practices in quality management specifically for healthcare providers, focusing on the importance of meeting CMS quality measures for improving patient care, compliance, and profitability. It discusses the concept of meaningful use in EHR systems, which is aimed at enhancing healthcare quality while reducing unnecessary costs. Furthermore, it emphasizes the need for real-time data access and strategic quality goals to effectively manage and improve healthcare outcomes.
Quality Manager
- 1. Best Practices inQuality Management October 2009 1
- 2. Agenda • Introduction • April McLain • Dr. Sunil Rao • Demonstration • Q&A www.T-M-Partners.net 2
- 3. Technology Medical Partners • We focus on Healthcare Providers • Hospitals • Large Physician Practices • We provide Healthcare IT solutions • To Executives who want to Improve: • Profitability • Compliance • Quality www.T-M-Partners.net 3
- 4. TMP The Meaningful Use Experts • TMP has been focused on Healthcare Quality for years • Meaningful Use = CMS Quality Core Measures (Plus other items) • CMS • Pay for Reporting • Pay for Performance • Value Based Purchasing • ARRA • Certified EHR • Meaningful Use www.T-M-Partners.net 4
- 5. What Does VBPMean to CMS? Transforming Medicare from a passive payer to an active purchaser of higher quality, more efficient health care Tools and initiatives for promoting better quality, while avoiding unnecessary costs Tools: measurement, payment incentives, public reporting, conditions of participation, coverage policy, QIO program Initiatives: pay for reporting, pay for performance, gainsharing, competitive bidding, bundled payment, coverage decisions, direct provider support
- 6. Meaningful Use • “CMSis expected to publish a formal definition of meaningful use, for the purposes of receiving the Medicare and Medicaid incentive payments, by December 31, 2009.” • “Meaningful use of EHRs, we anticipate, will also enable providers to reduce the amount of time spent on duplicative paperwork and gain more time to spend with their patients throughout the day. • “Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety, and quality. A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology www.T-M-Partners.net 6
- 7. Policy Committee Recommendationsfor the Definition of Meaningful Use
- 8. Meaningful Use isBeing Defined and Will Follow an “Ascension Path” Over Time* 2009 2011 2013 2015 HIT-Enabled Health Reform Meaningful Use Criteria HITECH Policies 2011 Meaningful Use Criteria (Capture/share data) 2013 Meaningful Use Criteria (Advanced care processes with 2015 Meaningful decision support) Use Criteria (Improved Outcomes) *Report of sub-committee of Health IT Policy Committee
- 9. Healthcare Industry Key Quality Drivers Cost of Quality Compliance Patient Care • Patients-Centered Quality Care • Quality is a Board Level issue Net Profit • Compliance is Required • CMS Pays for Performance Better patient care costs hospitals less and improves patient outcomes www.T-M-Partners.net
- 10. Quality is WorthIt! • CEOs • Quality Scores of You and Your Competition Net Profit • CFOs • Cost of Bad Quality • Cost of Compliance & Reporting • COO, CNO • Nurse Staffing Shortages • Administrative burdens To maximize CMS Reimbursement, and your bottom line, you need to proactively identify Quality Improvement opportunities now. www.T-M-Partners.net 10
- 11. Flash Poll Is there a CEO or Board Level mandate to improve Quality? Does this relate to Core Measure scores or your reporting process? www.T-M-Partners.net 11
- 12. CMS Compliance More important than ever before… • Cost of Compliance • Quality Reporting Cost of • State Reporting (HB 197) Compliance • ARRA and Meaningful Use • CMS Core Measure Reporting Process • Over 100 Required reports of clinical quality • Abstraction From Many Sources • Manual Data = Error • Time & Cost of Each Report www.T-M-Partners.net 12
- 13. From Reporting toQuality How do you move from Quality Reporting or “meets minimum” To Managing the Improvement to the Quality of Care? www.T-M-Partners.net 13
- 14. Moving from Reportingto Quality Management • How does your Quality process stack up? • Retrospective Review of Quality Data? • Concurrent Review of Core Measures? • Ability to drill down and analyze Core Data? Financial • Process changes easily deployed? • Strategic Quality Goals being met? Improving Impact Process •Patient Satisfaction Concurrent •Real Time Analysis •Core Measure Scores Analysis: •Real Time Alerts •Timeliness of Data •Trending Reports •Efficient Reporting Efficient •Usefulness of Data •Rapid Changes to Reporting Better Data •Extend to include process of care •Pay for Performance •More people involved Manual Real Time Access •More Core Measures •Access to useful real Meet Minimum Workflow •Competitive •More Reports time data Late Notifications •Include more people •Incentives for change Advantage Staff Limited Level 1 Level 2 Level 3 Level 4 Level 5 14 www.T-M-Partners.net
- 15. Its Not Justsending data The tracking and reporting of Core Measure performance is a huge amount of work which occupies multiple clinical staff members “This is another unfunded mandate” and • Data is 3 months old • Vendors don’t help with abstraction • No Reuse of Quality Data • Multiple Reports = Multiple Abstractions Data does NOT improve Quality www.T-M-Partners.net 15
- 16. The Cost ofCore Measure Data CMS Core Measure Reporting data is very valuable and cost a lot to obtain • The Patient Impact of bad quality is already felt • The Cost of Fixing the problem already spent • The Cost to abstract the information is required • The Cost of waiting for CMS reports is frustrating What are you doing with this Core Measure Quality Data? www.T-M-Partners.net 16
- 17. Flash Poll Do you have access to Real Time Quality Data? Can you identify quality problems and fix them easily and rapidly? www.T-M-Partners.net 17
- 18. April McLain • MBA, RN, licensed RN in the state of Ohio • Over 25 years of hospital operation and consulting experience • Chief Nursing Officer (CNO) • Director of Quality • Hospital Surveyor, JCAHO • Current Responsibilities • Interim Director of Quality • Current Holzer Process • People, Vendor, Workflow, Data • Shortcomings (e.g. Q1 reports just received) www.T-M-Partners.net 18
- 19. April McLain • Expectationsfor 2009 • CEO Mandate • Real Time Data (Concurrent) • Improved Processes • Reduction in FTE • Executive Quality Dashboards Applying the system to do Real Time reporting, Using Real Time Data to Improve Care www.T-M-Partners.net 19
- 20. Dr. Sunil Rao •MD, MBA • Over 15 years of Healthcare Experience • Clinical, • Operational • Quality • Experience in applying Lean Process techniques • Clinical issues and other dynamics involved in performance improvement for healthcare processes involving physicians www.T-M-Partners.net 20
- 21. Dr. Sunil Rao •A Physician’s View • Evidence Based Medicine = Best Practice • Learn and Improve • Benchmark Performance • Feedback • On errors in real time • A Desire to follow proper procedure • Physician’s need for Core Measure data • In the simplest format possible • With easy accessibility • Up to date and relevant www.T-M-Partners.net 21
- 22. Applying Technology toObtain Benefits •Real-Time Quality Measures for Improvement • Get Data from Any System • Populate Any Form or Dashboard • Reduce Cost of Data Abstraction •Improving Processes • Eliminate Administrative Tasks • Reduce Task and Process Times • Notify, Escalate, Manage by Exception •Increase Net Income • Reduce Uncompensated Care • Reduce the Cost of Compliance • Improve Quality, Satisfaction, Profits www.T-M-Partners.net 22
- 23. CMS Quality Manager™ • Real Time Quality Data Quality DBMS • Abstraction • Workflow Processes (PN, AMI, SCIP, HF, OP) • Notification and Control • Quality Improvement • Management Platform • Alerts, Reports, Charts, KPIs, Never Events www.T-M-Partners.net 23
- 24. CNO Executive Dashboard •Board of Directors Report • Concurrent Review • Drill Down www.T-M-Partners.net 24
- 25. Quality Database • QualityReports • Charts • Benchmark Data
- 26. Quality Manager • SharePointPortal • Role Based • Secure Access
- 27. Abstraction & Reporting Workflow • Data Drop Starts Workflow • Data is checked against Rule Sets • Processes Launched • Tasks Assigned • QI Staff Notified • Alerts
- 28. Quality Reports • CMSQuality Reports • PN • HF • AMI • SCIP • OP • Extend • JCAHO • HB 197 • Any Report
- 29. CMS Quality Manager™ built on Microsoft Technology www.T-M-Partners.net 29
- 30. Champion Health Foundation Monthly CMS Outlook Sample Only Welcome Joe User Today is Friday, November 13, 2009 April 2008 May 2008 June 2007 2nd Quarter Print | Help | Log Out Page 1 | Page 2 | Page 3 Patient Demographics Monthly Revenues Work Queue Reporting CMS Quality Report Request 8.7 Patient Name status Assigned File Attending Physician Oncology 20 24 17.9 John Gross Pending QIN 4223 4162 - Crabtree ER 22.5 Normal 18 Rockford 19.8 M e thodist Surge ry 38.6 36 23 Radiology 25 20.4 0 10 20 30 40 50 Alerts Alerts from last 2 days Pneumonia Submissions SCIP CMS Responses Denial Rates Work queue thresholds more... New Patient List submission CNO Message DRG 461 March 1 – 4:03 A.M. I’d like to take this opportunity to publicly thank the management team and DRG 462 March 2 – 4:06 A.M. employees for the incredible job that they’ve done. This is our first dashboard DRG 437 Dietary March 2 – $119,500 4:06 A.M. and I am so excited at this team’s vision and grasp of dashboarding. The work incorporates current Enterprise Dashboard best practices and I’m told beats our competition’s dashboard.
- 31. CMS Quality Manager™ Return On Investment • Cost of Compliance = $500K+ • FTEs for growing requirements • Cost of training and change • Risk = $ Millions • 4% of Annual Payment (P4R + P4P) • Cost of Uncompensated Care • Cost of Bad Quality • Quality Benefits = Priceless • Real-Time Visibility of Quality Measures • Competitive Advantage (Hospital Compare) • Patient And Employee Satisfaction www.T-M-Partners.net 31
- 32. Sample ROI Model Your Hospital's Financial Overview of Savings Numbers Impact Scale Authority Annual Net Patient Revenues $527,284,629 FY 2007 from AHD.com Annual Medicare Payment $263,275,743 $5,265,515 2% Fines or possible Bonus Annual Inpatient Claims 38,000 7,600 20% Number of I/P Reports per year Annual Outpatient Claims 402,000 80,400 20% Number of O/P Reports per year Approximate Number of Patient Claims per Year 440,000 88,000 20% Total Number of Reports per year to CMS Amount at RISK with CMS Quality Data 4.00% $10,531,030 2% Fines for non-compliance Reporting Process 2% Bonus for Performance Cost of QI Nurse Salary $ 68,000 300 Days per year Current 18 Reports per day per QI nurse Reports per Day I/P 25 $95,704 1.4 Required FTEs Reports per Day O/P (and others pending) 268 $1,012,444 14.9 Required FTEs Proposed 50 Reports per day per QI nurse Reports per Day I/P 25 $34,453 0.51 Required FTEs Reports per Day O/P (and others pending) 268 $364,480 5.36 Required FTEs Net Impact on Staffing and Productivity $709,215 Improved Reports / Day/ QI Nurse Additional Improvements Improvements listed as a % of NPR (Notes below) Quality Measures in Real-Time 0.07% $369,099 Faster correction of Quality Issues(2) Improved Competitive Avantage from Quality 0.05% $263,642 Better "Hospital Compare" position (3) Ability to secure P4P Bonus 0.03% $158,185 Bonus based on best in class reporting and quality (4) Ability to rapidly change processes in support 0.03% $158,185 Process Changes rapidly deployed to staff (5) Total Additional Benefit from Automation $949,112 Total Value of Cash Flow at Risk $12,189,357 as a percentage of Net Patient Revenues 2.31% www.T-M-Partners.net 32
- 33. CMS Quality Manager™ Early Adopters • Holzer Medical Center Project • Full Platform roll out in progress • Case Study Published • Early Adopters sought • Discount over target market price • CMS Quality Manager Appliance • We provide the Hardware Server • We provide all Software • We provide all Services • 3-4 Month Implementation www.T-M-Partners.net 33
- 34. Other TMP Services •Methodologies for solving problems • Executive Workout, Assessments • Six Sigma, Lean, Continuous Improvement • Requirements Definition, Program/Project Leadership Methods People • Additional Resources • Added Capacity to deliver project after project Your Success • Dedicated and Experienced Team • Wider view of market and solutions Technology • Standard Technology Platforms • Complementary to existing and planned platforms • Scalable, Secure, Robust, World class, Cost Effective • Any Real Time Data, Any Hospital Process or Measure www.T-M-Partners.net 34
- 35. Summary & WhitePaper Top 10 Things to do 1. Establish Executive Priority 2. Assess your current situation 3. Start Fast 4. Identify the Baseline 5. Align Incentives 6. Establish a repeatable approach (Program) 7. Data Flow 8. Work Flow 9. Cash Flow 10. Repeat www.T-M-Partners.net 35
- 36. Establish Executive Priority •How important are Quality of Care, Core Measure Scores, and Patient Safety to the overall executive leadership? • Does the board know about the last “Never Event”? • Do you look at the public quality core measures of your competition? • In relation to the many other issues, how does this stack up? • What is the “Burning Platform” for this to take precedence? • What is it worth to improve? Budget? ROI? CEO & Board Executives & Directors Clinical & Quality Staff www.T-M-Partners.net 36
- 37. Assess your currentsituation • How well are you reporting CMS Core Measures? • Are the scores as high as possible? • How do you plan to improve them? • Do you have real time quality measures for action? • What other quality measure or process is more important right now? • Executive Quality Dashboards in need? www.T-M-Partners.net 37
- 38. Start Fast • CMSreporting is required and will continue to change, getting more and more difficult. • Make sure this is the best possible process you can have. • Measures and source data is known, is the process at its best? www.T-M-Partners.net 38