Orlando Health. CHALLENGE: Conducting Timely OPPE Reviews for 2,000+ Physicians

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Rodger Gordon Barber
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Crimson Case Study Orlando Health Crimson member since 2010, Orlando, FL 1,780-Bed Hospital System CHALLENGE: Conducting Timely OPPE Reviews for 2,000+ Physicians Orlando Health is a comprehensive

data for each physician review cycle was largely manual and required queries from multiple sources, consuming several weeks After the data was compiled, paper-based physician reviews were processed

1 Crimson Case Study Orlando Health Crimson member since 2010, Orlando, FL 1,780-Bed Hospital System CHALLENGE: Conducting Timely OPPE Reviews for 2,000+ Physicians Orlando Health is a comprehensive not-for-profit hospital system comprised of five community hospitals, three specialty hospitals, and a cancer center that collectively employ over 2,000 physicians The process for aggregating OPPE data for each physician review cycle was largely manual and required queries from multiple sources, consuming several weeks After the data was compiled, paper-based physician reviews were processed manually for each department, requiring another two to four weeks ACTION: Building an Efficient Electronic Review Process Using the Crimson Platform Outlining the Measure Set Facility-level metrics were identified and submitted to Crimson to be built into the site as custom measures Medical Staff Office engaged the department chairs to select customized measure sets for each specialty, which were also embedded into the Crimson site Crimson Training for Key Stakeholders Team from the Medical Staff Office was trained by Crimson trainers and the value advisor to map measures and generate reviews Department chairs were trained by Medical Staff Office to review and sign OPPE reviews electronically 1

2 Orlando Health (continued) RESULTS: Faster OPPE Reviews Using Better Data on Physician Performance Data Ready for Review Quickly in Crimson Average days to create and screen reviews for department 70 Electronic Reviews Easily Signed and Filed Average days to complete review and file Manual Process Crimson Process Manual Process Crimson Process Far Less Time in Meetings with Medical Staff Office Average minutes spent by department chair reviewing OPPE profiles Manual Process Crimson Process 96% Reduction in time to create and screen reviews 75% Reduction in time spent by department chairs on reviews The OPPE process with the Crimson tool was smooth. It is a much easier and faster process than we previously had in place. Department Chair, OB/GYN 2

Crimson Case Study Hanover Hospital Crimson Member since 2013, Hanover, PA 93 beds Challenge: Hanover Hospital sought to streamline their OPPE process.

3 Crimson Case Study Hanover Hospital Crimson Member since 2013, Hanover, PA 93 beds Challenge: Hanover Hospital sought to streamline their OPPE process. Prior to Crimson Continuum of Care, the Quality Improvement (QI) team generated OPPE data from multiple sources. The team then internally validated the accuracy of this data and manually created unique Excel spreadsheets incorporating all OPPE metrics for each individual physician. All reports were manually reviewed by the QI team, printed in color, then shared with both the VPMA and department chair for review and signoff. The QI staff manually copied completed OPPE reports, and sent one copy to each physician. Solution: The Hanover QI team utilizes E-Reviews to complete their OPPE process for physicians every nine months. Impact: The use of E-Reviews within Crimson saves the Hanover QI team time, and eases the OPPE process. ACTION: A New OPPE Process at Hanover Hospital Validate Data QI team spends 3 hours each month validating CCC data before each data load. Additionally, team spends 10 hours running non-ccc data for Radiology, Telepsych, and Telestroke every OPPE cycle. Create Reports in Bulk Create OPPE reports by specialty, enabling QI staff to create 300 reports in less than 30 minutes Save Reports For Easy Access Save reports in provider file and within CCC to allow easy access for VPMA, department chairs, and physicians Internal Validation VPMA and Department Chairs review and sign off on OPPE reports. Comments are saved in Crimson and in a separate Excel spreadsheet Data Transparency VPMA sends update to physicians that OPPE reports are ready for review, and are available in CCC 3

4 Hanover Hospital (continued) RESULTS: Impact of Utilizing CCC for OPPE Process Time Management Prior to CCC, QI team spent 160 hours to complete OPPE process With CCC, QI team spends 36 hours across the year to validate data, 10 hours to run non-ccc data for Radiology, Telepsych, and Telestroke, less than 30 minutes to create OPPE reports, and 4 hours to complete reports. Increased Ease OPPE reports created in bulk VPMA saves notes directly in CCC OPPE reports saved in CCC for easy access hours Average number of hours saved each OPPE process 4

5 Crimson Case Study OSF HealthCare Crimson Member since 2008, Peoria, IL 1,500 beds Challenge: OSF HealthCare was interested in a quality improvement reporting tool to identify opportunities for cost reduction and time savings. With each hospital in the system performing different methods for fulfilling OPPE requirements, there was no standardized process across the ministry. Solution: OSF HealthCare implemented CCC in 2008, and utilized OPPE in Training and use of Crimson was standardized across all sites thereafter. Impact: Through increased use, review generation time was halved on average. In addition, there was increased buy-in by physicians and other staff. The quality department now also oversees reviews, alongside the medical staff office. ACTION: Addressing Standard Processes Using Crimson Results in FTE Savings 1 OPPE Process Switches to Crimson 2 Reviews Pass Through Departments Specialty Measures Create Sign Electronic report templates were created, run and signed every 8 months. Reports are generated by medical staff departments, as well as reviewed by quality departments. 3 Quality Report Generation Time Savings 4 Peer Review Time Savings Reduction in time spent by medical staff manually running reviews. Reduction in data collection, ease of use, as well as expansion of criteria to include alerts that were coded by inaccessible previously. Process for Report Generation & Signing Medical staff department runs electronic report Quality staff reviews if follow-up needed Department chair reviews in site and sights off 5

6 OSF HealthCare (continued) RESULTS: Time and Cost Savings 2 Time to Generate One Review, in Hours Pre-Crimson 0.5 Post-Crimson 0 SFMC* SAMC SJMC SMMC SJJWAMC SEMC SFH *Pre-Crimson, SFMC did not perform reviews by the Quality Department. 228% Average overall reduction in time spent on OPPE process per cycle Beyond the Numbers 29.8 minutes Average time saved per OPPE report generated through Crimson $12K+ In wage savings through time saved across 1,006 reviews performed in 2015 Crimson enabled: Larger engagement between quality staff and physicians overall logins have increased More in-depth reporting, as compared to before Crimson Consistency amongst hospitals for standardizing the OPPE process 6

7 Crimson Case Study Cox Health Crimson Member since 2012, Springfield, MO 987 beds About: Cox Health is a five hospital system in Southern Missouri with over 600 staff physicians. Challenge: Cox Health had received a nonconformity for provider performance data during an accreditation survey. Their process provided limited data and utilized time consuming manual processes. The team sought to streamline and enhance their Ongoing Professional Practice Evaluation (OPPE) process. Solution: The Cox Team developed a provider quality profile that includes a combination of electronic and manual metrics resulting in a comprehensive quality profile. The Cox Health team uses print reports through Crimson as part of their provider quality profile for the OPPE process. The Crimson report includes standard Crimson metrics as well as custom metrics. Impact: The Cox Health team spends less time reviewing charts and compiling reports and has a more robust quality profile that address the necessary elements required by accrediting bodies. ACTION: Process Change to Ensure an Efficient Workflow with Meaningful Data With Crimson Time Management Aggregates standard and custom quality and utilization metrics into user friendly OPPE report that can be pulled in minutes Drill Down Capability Provides analysis and drill down capacity on physician outlier performance to examine patient s clinical outcomes and understand path to improvement Physician Engagement Allows for enhanced data availability and provides opportunity for collaboration for metric selection 7

8 Cox Health (continued) RESULTS: Efficient and Compliant Process High Level OPPE Workflow Completed Every 6 Months Pull and fill appropriate profile template for specialty Fill in manual metrics Approximately 10 Add analysis comment for profile template Report ready for sign off and credentialing Reach out to departments for data and review manual reports Print and analyze Crimson report Drill down on metrics in Crimson where provider is an outlier Package profile template and Crimson report for review by Chief and/or credentialing committee Sample Profile Template that is Used in Conjunction With Crimson Print Reports Impact Highlights No citation in year two of survey, and significant improvement noted Data provided for providers for all applicable measures through use of Crimson and limited manual processes DNV Accreditation Requirements That Cox Has Been Compliant With Since Initiating New OPPE Process MS.9 PERFORMANCE DATA Practitioner specific performance data is required to be evaluated, analyzed, and appropriate action taken as necessary when variation is present and/or standard of care has not been met as determined by the medical staff. Performance data will be collected periodically within the reappointment period or as required as part of the peer review process. This may include a comparative and/or national data if available. Areas required to be measured (as applicable) may include: SR.1 Blood use (may include AABB transfusion criteria); SR.2 Prescribing of medications: Prescribing patterns, trends, errors, and appropriateness of prescribing for Drug Use Evaluations; SR.3 Surgical Case Review: appropriateness and outcomes for selected high-risk procedures as defined by the medical staff; SR.4 Specific department indicators that have been defined by the medical staff; SR.5 Anesthesia/Moderate Sedation Adverse Events; SR.6 Readmissions/unplanned returns to surgery (as defined); SR.7 Appropriateness of care for non-invasive procedures/interventions; SR.8 Utilization data; SR.9 Significant deviations from established standards of practice; and, SR.10 Timely and legible completion of patients medical records; SR.11 Any variation that should be analyzed for statistical significance. 8

9 Crimson Case Study Aria Health Crimson Member since 2009, Philadelphia, PA 3-Campus System CHALLENGE: Crimson FPPE Process Reveals Physician Outlier Before adopting Crimson Focused Professional Practice Evaluation (FPPE) and Ongoing Professional Practice Evaluations Process (OPPE), Aria used an antiquated process for physician review and was unable to adequately engage physicians with their data. FPPE reveals physician with significant opportunity to reduce length of stay (LOS), readmissions, and complications of care. Before intervention, select physician was not aware he was an outlier for LOS, readmissions, and complications of care; prior to intervention, physician had not logged into Crimson to review data. ACTION: Individual Physician Meetings Help Change Behavior Collegial Conversation Introduces Physician to Crimson 30-minute conversation occurs with outlier physician Conversation sheds additional light on practice variation and root cause, including insufficient coverage Time spent focusing on how to use Crimson to identify opportunities and drill into case details Focused Meeting with Medical Leadership Prompts Action Medical leadership conducts 60- minute follow-up conversation with physician Using Crimson, physician and team track changes in performance since the first meeting Hospital incorporates surgical residents in coverage plan to improve hospital internal process Outlier Physician Follow- Up to Credentialing Committee FPPE results provided to credentialing committee provisions status implemented for one year 30-minute follow-up conversation occurs with physician Training begins for all physician staff and leadership on Crimson FPPE process for improvement 9

10 Aria Health (continued) RESULTS: Decreased Length of Stay, Increased CMI Reductions in LOS and Increases in CMI Result From FPPE Process 423 Cases 62.96% % LOS CMI Cases Above GM LOS Before Initiative After Initiative FPPE Conversations Lead to Impressive Results Results Savings LOS.59 day reduction $122,000 CMI.11 increase $273,000 increase in reimbursement Total Financial Impact $393,000 for 2012 The OPPE process with the Crimson tool was smooth. It is a much easier and faster process than we previously had in place. Department Chair, OB/GYN 10

11 Crimson Case Study Abington Health Crimson Member since 2011, Abington, PA 600+ Bed Hospital System CHALLENGE: Establishing a Robust OPPE Process and Data Transparency Culture Abington Health (AH) has over 1,400 physicians on staff at its two hospitals, which include Abington Memorial Hospital and Lansdale Hospital The system had been searching for a comprehensive tool to help support compliance with the Joint Commission s mandate of providing Ongoing Professional Practice Evaluations on all credentialed providers, a significant undertaking given the size of its medical staff System leaders partnered with Crimson because of its ability to produce electronic reviews and group-level practitioner analytics Beyond compliance, the system also sought to use Crimson to provide useful information to providers regarding their own quality and utilization data ACTION: Engaging Physicians and Leadership with Interactive Reporting AH Chief of Staff introduces Crimson to physician leadership in July 2011 Physician Champion assigned to work closely with physician leaders to support on OPPE roll-out and key organizational initiatives All departments and division leaders meet with Crimson team to review metrics Final selections are reviewed by MEC and include over 150 custom specialty-specific metrics AH support staff complete 100% electronic OPPE signoff for both hospitals, including 2636 individual provider reports Culture of data accessibility drives interest in performance improvement Crimson Launch Report Build E-Review Workflow OPPE Roll-Out AH Crimson support staff and medical staff office provide Crimson training sessions Team establishes a dedicated HelpDesk line to address questions and concerns New report sign-off process requires all physician OPPE files are managed electronically on Crimson Dozens of physician leaders collaborate on review process design and implementation 11

12 Abington Health (continued) RESULTS: Data Awareness Drives Quality and Utilization Improvements Active Users of Crimson %30 Day Readmissions (Any APR-DRG) Average Length of Stay (Days) Active Users of Crimson 100% OPPE Reviews Signed Electronically $985K Actual CMI-Adjusted Cost Savings from Reduced LOS 12

2016 Medical Staff Standards Update Panel Featuring TJC, NCQA, URAC, DNV, and HFAP (Part 1) THE JOINT COMMISSION. Objectives

2016 Medical Staff Standards Update Panel Featuring TJC, NCQA, URAC, DNV, and HFAP (Part 1) Paul Ziaya, MD, Veronica C. Locke, MHSA, Donna Merrick, BNS, MEd, Patrick Horine, MHA, and Karen Beem, MS, RN