Bending the Healthcare Cost Curve The Value of a Comprehensive CQI Database
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1 Bending the Healthcare Cost Curve The Value of a Comprehensive CQI Database Bryan V. May, MD, MBA Chair, Quality Committee American Anesthesiology of the Southeast Charlotte, North Carolina
2 The Changing Landscape of Healthcare
3 Concerns About the Future of Healthcare Cost of healthcare continues to rise Quality of Care delivered is variable Little transparency regarding quality or outcomes Current quality measurements tools Are they having an impact?
4 U.S. Healthcare Spending as a Percentage of GDP Source: Centers for Medicare and Medicaid Services
5 U.S. Healthcare Spending as a Percentage of GDP Source: Organization for Economic Cooperation and Development, OECD Health Data, 2008
6 Medicare Cost and Non-Interest Income by Source as a Percentage of GDP Source: 2012 Annual Report of the Board of Trustees - CMS
7 The Changing Landscape of Healthcare CMS Value Based Purchasing Program Volume to value transition from fee for service Patient Experience Process of Care Clinical Outcomes Domains FY 2013 Weights Patient Experience of Care Clinical Process of Care 30% 30% 70% 45% Outcomes N/A 25% FY 2014 Weights
8 The Changing Landscape of Healthcare CMS Value Based Purchasing Program Volume to value transition from fee for service Patient Experience Process of Care Clinical Outcomes Efficiency Measures Domains FY 2013 Weights Patient Experience of Care Clinical Process of Care FY 2014 Weights 30% 30% 20% 70% 45% 30% Outcomes N/A 25% 30% Efficiency N/A N/A 20% FY 2015 Weights
9 The Changing Landscape of Healthcare Better health outcomes Superior service Lower overall costs
10 Concept of Value in Healthcare Quality and Safety = Value Cost per unit
11 How are we currently measured? CMS HCAHPS Studer, Press Ganey, PRC, HealthStream Social Media
12 A Data Driven Quality System How do we design a data driven CQI system to help clinicians improve clinical outcomes wile at the same time, reduce costs? Define relevant parameters Patient Satisfaction (Patient focused) Efficiency/Timeliness (Value/Productivity) Practitioner Performance (Individual Accountability) Clinical Outcomes (Systems issues)
13 A Data Driven Quality System How do we design a data driven CQI system to help clinicians to improve clinical outcomes and reduce costs? Continuous real-time feedback loops Clinicians CQI Committee Department Chiefs Medical Directors Hospital Administration Patient Safety Managers and Officers
14 A Data Driven Quality System Steps in data collection, entry and reporting
15 Feedback Reporting: January 2010 August 2013
16 CQI Data Audit Process First Level Review and Data Abstraction by QA RN Reconciliation audit to assure all cases are captured Incomplete fields on data record are identified Inter rater reliability Audit Minimum of 30 cases per QA RN reviewed annually. (2003 reviews with 99.5% accuracy) Data Validation Audit Minimum of 50 cases per facility reviewed annually. (3453 reviews with 99.55% accuracy)
17 Checklists DO Work!
18 Why Checklists Work Help improve the effectiveness of individuals or groups performing complex tasks Ensure effective communication amongst team members especially when each person (group) is performing subtasks for the procedure. Help catch errors or omissions Ensure both routine procedures and emergency responses are handled appropriately
19 Experience With a Checklist Power on stall Familiarize the student with: The warning signs of a stall at the takeoff condition Reaction of the airplane when stalled Recovery techniques required
20 Experience With a Checklist Engine Failure in Flight Airspeed to 60 KIAS Carb Air Hot Best field SELECTED Primer in and LOCKED Fuel Valve ON Mixture RICH Magnetos BOTH or START Attempt RESTART
21 Experience With a Checklist
22 Data Collection Through Checklists Incorporates both positive and occurrence based measures Allows completion in seconds Results are available almost immediately
23 Data Reporting and Utilization Feedback Loops and Reporting Constant measurement and re-measurement Peter Drucker - If you can t measure it, you can t manage it. Hawthorne Effect What you measure, improves! Benchmarking facilitates positive competition Alerts that focus on key metrics Real time reporting that enables quick analysis, intervention and re-measurement Implement best practices
24 Improving Clinician Performance Systems approach: Analysis of aggregate data and EBM guide the development of: System-wide best practice Organizational practice change Systems approach to error reduction Decreased variability Measure data against evidence based protocols Individual Accountability: Measures, benchmarks and real time feedback loops assure individual accountability and facilitate clinician practice change
25 Immediate Clinician Feedback Loop Critical Alert automatically generated Involved parties are notified as soon as the case is closed
26 Benchmark Reporting
27 How Many Think We Are Average?
28 Benchmark Reporting
29 Benchmark Reporting: 2012 Data
30 Trending Reports - Continuous Hawthorne Effect
31 Introduction of CVL Protocol Checklist December ,000 catheter related infections/yr 28,000 deaths/yr *Estimated Average cost $45,000 ($11,971-$54,000) Up to $2.3 Billion/Yr 66% reduction at 16 to 18 months after implementation
32 Putting EBM to Work
33 Putting EBM to Work Central venous line protocol checklist introduced December 2008
34 Sustained Improvement
35 Bending the Healthcare Cost Curve Peri-operative Myocardial Infarction 2012 SAC total cases 122,857 SAC Incidence MI measured: 0.01% = 16 cases per year Published Benchmark Incidence Post-Op MI 0.19% = cases per year Cost per MI $38,501* cases /year benchmark $8,987, cases/year $616, = $ 8,371, Annualized Cost Savings *Obtained from Milliman Research Report Benefit Designs for High Cost Medical Conditions, April 22, 2011.
36 Bending the Healthcare Cost Curve Peri-operative Stroke 2012 SAC cases 122,857 SAC incidence of Post-Op Stroke measured via Quantum: 0.02% = 23 cases/ year Published Benchmark Incidence Post op stroke : % = cases/year (using 0.5% for calculation) Average Cost per post op stroke - $15,000* cases/year benchmark $9,214, cases/year $345,000/year = $8,869,257 Annualized Cost Savings *Perioperative stroke in noncardiac, nonneurosurgical surgery. Anesthesiology Oct;115(4):879-90
37 Bending the Healthcare Cost Curve MEDICATION ERRORS 2012 SAC Total cases 122,857 SAC Incidence of Medication Errors: 0.01% (14 cases per year) Published benchmark incidence: 0.75% Cost per medication error: $4,685* Cases / year at benchmark / 921 cases = $ 4,316, 888 year Cases/year SAC/ 14 cases = $18,740 = $ 4,251,298 Annualized Cost Savings *Obtained from Quality Progress Journal, 2007 January, Hospital Reduces medication Errors Using DMAIC and QFD
38 Bending the Healthcare Cost Curve DENTAL INJURY/LOSS 2012 SAC cases 80,315 (Peds patients excluded) SAC Incidence of Dental Injury 0.04% (29 cases per year) Published benchmark incidence 0.02% % (Average 0.05%) *Cost per dental injury $6,025 per claim Cases / year at benchmark (0.05%) / 40 cases = $ 241, year Cases / year SAC (0.04%) / 29 cases = $ 174, = $66, Annualized Cost Savings *Obtained from ASA Closed Claims Database
39 Efficiency Measures OR Utilization Lower Healthcare Costs and Higher Customer Satisfaction Through Improved Efficiency Using Medicare fee schedule total revenue loss per cancelled case was $4,550 or $1440 to $1700 per hour of delay* Anesthesiology 2005; 103:855-9
40 Bending the Healthcare Cost Curve
41 Patient Satisfaction/Experience
42 Patient Satisfaction/Experience HealthStream Confirms QCNS 2012 Patient Satisfaction Results %s reflect combined 2 top box scores QCNS: 8400 patients surveys received between June and Sept. CL/CI: 95% +.82 HealthStream: 610 patient surveys received between June and Sept. CL/CI: 95% +.21
43 Thank You GO TIGERS!
44 References:
Richard L. Gilbert, MD, MBA. Chairman/CEO, Southeast Anesthesiology Consultants. Charlotte, NC
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