In preparing the white paper, Metzger continues, “We decided also to sort them by timeframe, by looking at the first year in which measurement for a measure will actually influence reimbursement. That cuts through all these many different applicable dates. And when we did that,” she says, “it turned out, as we suspected, that the future is now; and regardless of what happens with the ACO rule and whether hospitals participate in the shared-savings program or not, there is this pretty significant accountability agenda hitting the industry. And none of these other programs are voluntary.”
REGARDLESS OF WHAT HAPPENS WITH THE ACO RULE AND WHETHER HOSPITALS PARTICIPATE IN THE SHARED-SAVINGS PROGRAM OR NOT, THERE IS THIS PRETTY SIGNIFICANT ACCOUNTABILITY AGENDA HITTING THE INDUSTRY. -JANE METZGER
The bottom line? The data reporting requirements under the three mandatory healthcare reform-triggered programs under Medicare are a here-and-now concern, not some futuristic menu of optional issues to consider.
What's more, with reimbursement-cut provisions in all three of the mandatory programs beginning in the last few years, the stakes are high. “By 2015, when the healthcare-acquired conditions program kicks in,” Metzger notes, “low-performing hospitals could potentially lose 3 percent of their Medicare reimbursement because of HACs [healthcare-aquired conditions], on top of 1.5 percent under the value-based purchasing program. In fiscal year 2015, the bottom-performing hospitals will lose 1.5 percent from the value-based purchasing program, 3 percent from the readmissions reduction program, and a further percentage from the HAC program; so it starts adding up; it's a big deal.”
For CIOs, CMIOs, and other healthcare IT leaders, the implications are clear, Metzger says. In her view, what will be key is that, “Going forward, data capture will be the foundation not just for informed care-that you have a medical record that's complete-but what will be essential will be the data that you need for measurement, and bringing that measurement into real time, so you can track patients, and if there are gaps in care, take care of those in real time.”
PART II: THE PIONEERS
Case Study: At Allina, Drilling Down to Actionable Change
One thing that is becoming clear over time is that the patient care organizations-hospitals, medical groups, and integrated health systems-that are moving forward comprehensively to improve patient safety, care quality, clinician effectiveness, efficiency, and cost-effectiveness all at once, are also the ones whose potential to be winners under the new accountability agenda in healthcare is greatest. The leaders of those organizations have committed themselves and their teams to doing what's right for patients-and yes, for purchasers-by pushing hard to improve the core care delivery processes that make a difference. And they are looking systematically at the potential for change, and very often using formal performance improvement methodologies, such as lean management, Six Sigma, the Toyota Production System, and PDCA (plan-do-check-act) in order to map and improve processes. Not surprisingly, such efforts are drilling down into areas that all the mandatory and voluntary programs under the ACA are working to improve, as well.
MEDICATION RECONCILIATION AT THE POINT OF DISCHARGE HAS BEEN A WEAK LINK, SO WE BROKE DOWN THE WORK, AND HAVE CREATED SEVERAL ALERTS TO LET DOCTORS AND NURSES KNOW IF CHANGES HAVE OCCURRED AT THE TIME OF DISCHARGE. -MICHAEL SHRIFT, M.D.
And it is in such organizations that clinician, IT, and clinical informaticist leaders are most often able to drill down the numerous layers needed in order to analyze underlying problems and really correct them. Such processes are taking place on a broad scale at the Minneapolis-based Allina Hospitals and Clinics, where leaders like Michael Shrift, M.D., the system's CMIO and vice president for clinical knowledge management, are guiding their colleagues through optimization work that is improving performance across the health system's 11 hospitals and 100-plus clinics.
Shrift is leading his team off 45 clinical informaticists, in concert with IT leaders and leaders from Excellian (Allina's name for a suite of clinical applications, including Epic's EMR), measurement and analytics leaders and clinician leaders across the Allina organization, in a wide variety of improvement initiatives. “We're blessed to have such strong clinical leaders at Allina; so the organization's clinical priorities are fairly easy to define,” Shrift says. “As we focus on priorities among our clinical service lines, such as the cardiovascular service line, and specifically for heart failure or acute MI, or for readmission prevention, our teams are specifically assigned to each of these pieces of work, to break down the workflow into pieces that can be either made into evidence-based practice or best-practice. the work is then hardwired by handing it off to the technical teams whose members design solutions. We work very closely with the clinicians and their support staff throughout this process, to find out which decision support tools most effectively support the care.”
There are numerous examples of progress and process change that Shrift could cite, but one initiative that exemplifies the disciplined sort of work that he and his colleagues are engaged in is in the area of medication reconciliation at the point of discharge.
