Hoag Orthopedic Institute is a hospital dedicated to orthopedic care. For the past year, the hospital has been working on a value based purchasing program and recently released the results in their annual clinical outcomes report. "Value based purchasing is one of the best things I have seen in healthcare reform," says Dereesa Purtell Reid, MBA, COO of Hoag Orthopedic Institute. "The new system gives hospitals a score card, which has your total performance score based on quality measures and patient satisfaction. Now consumers will be able to see this information and we know any time consumers can receive more information and be educated we can make better choices with our dollar."Ms. Reid discusses the benefits of value-based purchasing and how it can improve orthopedic care.
1. Benchmark can help hospitals improve. Collect data from your hospital as part of your program and benchmark against other providers constantly. Electronic medical records and other IT programs allow providers to gather data on each facet of care much more easily — from early identification of out range lab tests to room turnover times — just a few examples that make an impact on quality and efficiency of care provided.
"We've collected quality data and passed it out to the frontline employees in our organization," says Ms. Reid. "Sterile processing staff can see infection rates and know how they contribute to that in their own individual role. We recognize our employees they are doing a great job when we see our patient satisfaction scores, but we break it down even further to show each team member how they are contributors to value based purchasing every day."
With Value Based Purchasing data, hospitals can benchmark against themselves nationally to see where they stand compared to other providers.
"Many hospitals are implementing various layers of information technology to meet the electronic health record standards," says Ms. Reid. "That's a revolutionary process for any hospital, and once a hospital implements clinical documentation, then core measures and quality data is more robust and accessible because of real time reporting capabilities."
2. Clinical outcomes are better. While cost is an important benchmark to follow, clinical quality is still the main focus of value based purchasing programs. Without excellent outcomes, hospital reimbursement will be ultimately be impacted.
"We are focused on the value equation, cost and quality. We understand that great quality is important, but we also need to provide great value to our patients and payors," says Ms. Reid. "We vet the cost of supplies and decide whether we can purchase a less expensive item that has the same great quality for patients. At the end of the day, we believe that if we stay focused on quality and great value, and keep those metrics in front of our team, we'll have a great strategy for success."
There are many changes coming forth as a result of healthcare reform, including declining reimbursements, and providers must be prepared to meet those challenges head-on.
"The people who survive in healthcare reform will be able to provide reasonably priced healthcare and excellent outcomes," says Ms. Reid. "It's easy to be sidetracked on the overwhelming sea of demands and opportunities in the world of healthcare. It's our job to simplify it and help people stay connected to the top priorities."
3. Builds a more cohesive team. By working on value based purchasing initiatives and transparency, members of the HOI team become more cohesive and were able to improve employee satisfaction. After opening as a separate hospital from Hoag Hospital in November 2010, they began tracking employee satisfaction last year.
"It's important for hospitals to survey their employees regularly," says Ms. Reid. "We rank very high on employee satisfaction. There are studies that show a direct correlation between happy staff and patient satisfaction."
Ensuring that employees have the materials necessary to do their job and that they are involved in solving problems as well as providing suggestions are all aspects that build a solid team. Administrative leadership as well as physicians pay attention to staff feedback on employee satisfaction surveys to ensure sure morale stays high as well as outstanding patient satisfaction.
"It's one thing for the administrative leadership to be engaged and sensitive to employees, but our physicians are in-tune with our employees, they easily give credit employees for their contributions," says Ms. Reid. "Our surgeons were so pleased with the results of all value-based purchasing measures that they took this information as an opportunity to complement the employees on a job well done. This was another way we were able to connect employees to their individual contributions to the clinical outcomes of our patients."
4. Data gathering helps prepare for ACOs. Accountable care organizations are arriving in new healthcare markets every day, and many providers are opting to join. Hospitals that collect clinical data will be in a good position to transition into an ACO, or another population payment model in the future.
"As we evolve into ACOs, we begin to shift and think about caring for the patient over a longer episode of care as well as preventive treatments," says Ms. Reid. "At HOI, we are looking at patients to see if they have a healthy weight range to undergo surgery; if not, we have them deal with weight loss before elective procedures, which improves their ability to recover from surgery and the lifecycle of that joint replacement."
Optimizing surgical results is important, as payors are switching to a pay-for-performance model and shift more risk onto the provider with bundled payments or other risk payment methods. Focusing on the value of care provided can improve quality as well as lower cost on the overall healthcare system.
"I believe value based purchasing is actually moving at a faster pace than perhaps other commercial payers," says Ms. Reid. "Also, value based purchasing results will be very beneficial for self-insured employer groups — executives who are making decisions on behalf of employees make a more knowledgeable decision about the providers they choose for their employees. I think value-based purchasing is moving forward in a really positive way."
5. Improves transparency for consumer choices. Part of HOI's commitment to quality includes publishing results publicly. The hospital's 2012 report includes information about infection rates, patient satisfaction, complications, length-of-stay and readmissions.
"We are all about quality and we wanted to open up to show people our results," says Ms. Reid. "Data transparency pushes the hospital to be the best and once the information is public, it really sets the bar to sustain those numbers overtime."
To collect the data, HOI created a team that includes clinical and data management professionals as well as a technical writer to publish the data in an accessible format. The data also compares quality measures to the national standards.
"We benchmarked ourselves discovering that people not only wanted to know about how we are doing but also about process improvement," says Ms. Reid. "We published a book where you can see information about prescreening patients for infections and how we treat before surgery. You also see a number of performance improvement initiatives, such as how we are keeping patients warm during surgery because a consistent temperature reduces infection rates."
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