Friday, February 4, 2011

Hospital Value-Based Purchasing Program (VBP)

I am pleased to welcome my first guest blogger.  Rebecca Mackinnon has been working with Sphere3 for several months.  She successfully built a HIT company called Beyond Now Technologies which is now part of Cerner's portfolio.  A brilliant woman who offers great insight and perspective.

Hospital Value-Based Purchasing Programs

We've been told for years that hospitals would be judged and paid upon performance, and now it looks like the time has arrived!

The Hospital Value-Based Purchasing Program is the first concrete step with defined timelines of performance measure for the purposes of calculating premium to the DRG. The interesting detail in the labyrinth of language: there will be a baseline reduction in the DRG and then VBP calculation will be applied on the new DRG base.

Unwind and will be penalized if you can’t prove minimum quality performance.

The CMS proposal: 17 clinical processes of care and 8 measures (from HCAHPS) with a currently proposed ticking clock beginning from 7/1/2011 through 3/31/2012 to adjust the FY 2013 DRG payments. If I do the counting on my left hand correctly, five months before the clock begins ticking.

So here is what I know. Regardless of what any hospital wants to purport, some of the very expensive and very avoidable clinical measures are not being managed.

Here are the basic questions every hospital CEO should be using to challenge the CMO and CNO:

What is our Falls Ratio (falls/1000 patient days)? How are we assessing the Root Cause?  Is the information being used in and educational and reforming way to improve for the future?

What is our rounding procedure and how often is it adhered to on the Unit level?

What is the actual response time to a patient request? Response time to pain? Response time to toileting?

What is our hospital noise coefficient?

What are our alarm frequency measures and response times?

Each of these is the most basic unit level measure of performance and ties directly to the ability to improve performance in the FY 2013

A very insightful CEO of an inner city health system spoke to a small group in the recent weeks. His best advice to his audience, “you have to get into the bowels of your organization, you have to know what’s happening and be able to create a clear line of sight from staff activities to mission critical performance”

Sphere3 has been expecting this for two years. This month, we will debut of a comprehensive option for managing quality.

Sphere 3’s business intelligence software endeavor combined with our consulting team who are experienced in clinical process, Nurse Call and other alarming technology design is now more important than ever.

1 comment:

  1. Very good post. Hospital executives have seen this coming and most have instituted "nurse rounding" initiatives because they have seen the AJN study ( that says rounding reduces monthly call-light use by 38%, patient falls by 50%, and skin breakdowns by 14%, while simultaneously increasing satisfaction scores. There is also a JEM study ( that reports similar findings specific to the ED.

    The question becomes: How can we make these rounding initiatives sustainable? (I personally have seen several "rounding logs" mid shift that are completely blank. I can only assume that they are hastily filled out at the end of the shift and, not surprisingly, reflect 100% compliance. I don't blame the nurses. So much to do caring for patients and dealing with admin tasks that compliance logs are the least of their worries.)

    One answer is through monitoring using real time location systems (RTLS). An RTLS system that provides 100% room-level certainty and near real-time updates can be used to not only monitor compliance but proactively alert nurses as to which patients are due for scheduled rounding.

    Going further, an RTLS system integrated with an advanced nurse call system provides hospital management with insight into call response time and increases staff communication (especially when you add VoIP phones into the mix).

    There's a lot of money on the line. I've seen estimates into the millions of dollars annually for the average hospital are at risk with VBP. If rounding works, hospitals need to make sure their initiatives are being carried out.


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Kourtney Govro