nancy clarke thomas syltebo “am i doing this right? quality measurement and standards of care
TRANSCRIPT
Nancy ClarkeThomas Syltebo
“Am I Doing This Right?Quality Measurement and
Standards of Care
Which car do you want?
$48,000 $14,500
Which hospital do you want for your bypass graft surgery?
Salem Hospital
Legacy Good Samaritan Hospital
Source: Oregon Office of Health Policy and Research website, http://www.oregon.gov/OHPPR/RSCH/comparehospitalcosts.shtml
Source: Oregon Office of Health Policy and Research website, http://www.oregon.gov/OHPPR/RSCH/comparehospitalcosts.shtml
Association between Medicare spending and quality ranking -- U.S. States
Baicker and Chandra, Health Affairs, web exclusives
Oregon
New Hampshire
Texas
• Market forces don’t work in health care
• Very little information is available about either quality or cost
• Higher quality is often LESS expensive
• Entrepreneurs are filling a vacuum in misleading ways
Problem
With increasing expectations, Medicine has been required to demonstrate Quality
Impact --- creation of a new industry Quality Measurement
Am I Doing This Right?
Focus of Measurement
• Clinical Quality• Service Quality (patient experience)• Cost and Efficiency
Dimensions of Measurement
Locale of Care
• Primary Care• Specialty Care• Hospital/Institutions (ie. Nursing Homes)• Ancillary Services (ie. Ambulance)• Public Health
Dimensions (con’t)
Measurement Types
• Structural• Process• Outcome
Dimensions (con’t)
Data Source
• Claims/administrative• Surveys (ie. Pt experience)• Encounter (chart review and EHR)• Special registries• Population data/vital statistics
Dimensions (con’t)
Depends on the Entity and its accountability within the Health Care System
These Entities divide into External to the actual care process and Internal
First the External Entities
Why Measurement?
Accountability for Public Safety – Regulators
• State Boards (ie. Medicine, Nursing, Pharmacy, Chiropractic)
• CMS for Medicare and Medicaid• Oregon Public Safety Commission
Why Measurement?
Accountability for Payment – Purchasers(Public and Private, moving towards
coalitions)• Oregon Health Authority• CMS• Health Plans (local/regional vs. national)• Oregon Coalition of Health Care
Purchasers
Why Measurement?
Accountability for Professional Standards
• Specialty Societies and Boards• “Organized” Medicine (ONA, OMA, AMA)
Why Measurement?
The “Public” (small but growing)
• Oregon Health Care Quality Corp• Citizen members on State Commissions
and Committees• Patient Advisory Councils• Angie’s List
Why Measurement?
Internal – Providers of Care
• Process improvement for efficiency• Market differentiation (we’re #1!)• Altruism/wanting to do the right thing• Risk management• Enhanced payment (P4P)
Why Measurement?
National Players• National Quality Forum• NCQA – HEDIS• The Joint Commission• CMS – Hospital Process of Care; “Never
Events”• AHRQ – Prevention Quality Indicators• National Hospital Inpatient Quality
Measures• Consumer Reports • National Priorities Partnership
Quality Measurement Industry
Patient Experience of Care - National
• Press-Ganey, Picker, Sullivan-Luallin• CAHPS, H-CAHPS• Patient Activation Measure
Quality Measurement Industry
22Partner for Quality Care is an initiative of the Oregon Health Care Quality Corporation www.PartnerForQualityCare.org
23Partner for Quality Care is an initiative of the Oregon Health Care Quality Corporation www.PartnerForQualityCare.org
Local/Regional• Quality Corp• Oregon Health Authority Committees * Health Incentives and Outcomes * Health Improvement Plan * Health Information Technology * Patient-centered Primary Care Home• Standards Advisory
Quality Measurement Industry
Dilemmas• Risk Adjustment• Doesn’t do enough to address cost• Small “N” challenges• Focuses on distinct entities but many
problems relate to transitions • With fragmentation, each organization has
its own measures, guidelines, and process
Is This Enough?
Legal Issues Arise
Quality StandardDefinition
Feed back to Providers
Publicly Reported Scores
Steering Tiering & Payment
Privilege and Exclusions
www.healthcaredisclosure.org/activities/charter
"Patient Charter" for Physician Performance Measurement, Reporting and Tiering Programs
