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 interpret...you 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.

Falls and HIT Polic Committee Measure Concepts

Yes, the title gives it away this is a serious one. I read recently on a blog that the HIT Policy Committee is creating “measure concepts” that will be applied into meaningful use standards. At the very bottom – in fact the last one listed – is "Measures of fall events and screening". While we each are passionate about one item or another on that list, I believe there is some low hanging fruit that could easily be picked off and taken care of quickly AND provide the hospital with real “meaningful” savings.

The tricky thing about falls is that you are dealing with a patient. Patient’s actions, movements, attitudes, and even behaviors are a challenge to categorize into the neat and tidy little boxes that EMR vendors need to have strong governance in documentation standards. That’s a mouthful that says patients don’t follow the rules. The key is to look at the patterns of patient behaviors, staff behaviors, and other key dynamic factors then balance them with some static information. That is where you will find the answer to identifying Key Performance Indicators that link to predictive modeling for falls.

I know, I know you have never heard me use so many $20 words in one sentence. The answer is all ready there in the data. Think of it like seeing a Picasso – some people look at a Picasso and see random shapes, meaningless strange pictures and some people look at it and can interpret a story. I see the story in regards to the data surrounding falls. I had a great experience the other day with a hospital that “got it”. While I presented the data and our assumptions on the patient behaviors and indicators the staff filled in their specifics surrounding the staff’s behaviors. We see the same thing in the data – over and over again. We see the story.

This data should be in the Medical Record, it should be part of meaningful use standards, and it is part of the patient experience in the hospital. This is low hanging fruit – as my dad would say “easy pickins” – a real problem that is solvable.

I believe the key to reducing falls in a hospital lies in the ability to categorize, capture, and document the behaviors and actions. Believe me there are consistencies that we can currently identify. You just have to know where to look.

The 5 I's of Fall Mitigation

Our Goal is to reduce falls in the patient rooms – whether or not you hire Sphere3. I believe in the power of the conversation for the overall improvement of healthcare. I encourage you to read what is written and add to it. We have had a great team working to develop this framework but I believe in the power of collaboration.

Collaboration outside of healthcare can also be powerful. As many hospitals have discovered, manufacturing may have some ideas that could answer some of the questions. What are other industries that may compliment process improvement for healthcare?


The First "I": Introduce

The basic premise of the first “I” is to describe how the patient is introduced to the unit. This is not a, “hello my name is Joe, what’s yours?” It is how do they get there and once they are there how do people know? Not that we are recommending a camp like cheering section to greet them in a tunnel but how are the caregivers on the unit provided with information that a new patient has arrived. What’s the “on-boarding” process? One consideration for this process will be, is it important for everyone to know a new patient has arrived?

There is considerable time savings opportunities (and cost savings as well) prior to arrival on the unit. There are several areas to consider including how are you tracking the time from entry to bed and all the steps in between? How is the transporter contacted and how are they tracked? How does the hand-off work?

What are your thoughts on Introduce – Transport – Notification?

Our team works with your hospital to customize a strategy to respond to the above questions. Our Fall Mitigation Analysis software program allows us to document, analyze, and provide innovative recommendations for improvement. Your information is assessed against best practices for optimal results.