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Value-Based Purchasing: Are You Ready?

April 8, 2011
by Mark Hagland
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A new white paper examines the IT-related complexities

As value-based purchasing evolves forward into the Medicare program through the Value-Based Purchasing Program under healthcare reform, time is of the essence for provider organizations to establish quality outcomes data reporting infrastructures. Indeed, though actual payment adjustments will begin in 2013, data collection to determine payment amounts actually begins this July.

Yet only a very small minority of hospital organizations have begun to make the information systems and data gathering and reporting changes they will need in order to comply with this fundamental shift in Medicare reimbursement patterns.

In that regard, researchers in the Waltham, Mass.-based Emerging Practices Group of the Falls Church, Va.-based CSC recently published a report, authored by Jane Metzger, Larry Schmidt, and David Classen, M.D., entitled “Next-Generation Quality Management: Real-Time Measurement at the Bedside.”

Following the release of that report in late March, principal researcher Jane Metzger spoke with HCI Editor-in-Chief Mark Hagland regarding her team’s findings, and the implications of those findings for CIOs and other healthcare IT leaders in patient care organizations. Below are excerpts from that interview.

Healthcare Informatics: What were your main goals in authoring this report with your colleagues?

Jane Metzger: What we tried to do in this white paper was to shake some of the very traditional thinking in the industry. And one of the things we tackled was measurement, including issues around the newer forms of reporting that will need to replace some of the older, retrospective types of data reporting.

We’re saying, let’s stop using the term measurement; what we think this is, is next-generation care management. Not only will we need to be measuring all the time, because it’s the only way we’ll have the information about patients and the risks they’re under, in time to do something about it; but also, I think it’s really what always had been meant when we said we would have decision support for improved care quality—it was what all the IOM [Institute of Medicine] reports talked about, and what all the five-year plans in hospitals and health systems called for. And we think it means measurement all the time, and a whole new focus on capturing the data we need to do that.

In fact, you could say that this defines the minimum structured data set—the data we need to be doing to protect patients in real time and to ensure that they always get evidence-based care and high-quality care in real time. One of the things that the paper talks about is that, because people are still building this infrastructure, and because it’s so difficult to ensure that just routine documentation gives you all the structured data you need, we think that organizations will have to actively involve physicians, nurses, and other disciplines, in capturing the data in real time that will be needed. Measurement isn’t an after-the-fact process; it’s an every day process of asking a physician to confirm what appears to be a relevant diagnosis for a patient, for example.

Let’s take two obvious examples that we address in the white paper. One is around sepsis. If there are signs that a diagnosis of imminent sepsis is accurate, there will need to be an immediate care plan to reduce the risk of sepsis, which can have devastating consequences, including death, for the patient, and which is terribly costly; and everything about sepsis is time-sensitive. So that’s a great example of where you need the real-time measurement and action.

And the second example involves a potentially devastating condition, too, and that’s VTE [venous thromboembolism]. Reporting on VTE prophylaxis is in the Stage 1 meaningful use requirements, but it’s also going to be rolled into the value-based purchasing program under Medicare. So again, that’s a good example to describe this interaction between measurement and care management, in which measurement is continuous and supports care management.

Jane Metzger

HCI: The fact that VTE prophylaxis is involved in both meaningful use and value-based purchasing under healthcare reform is significant, of course.

Metzger: Yes, and it speaks to the fact that the traditional approaches won’t work, and won’t be the basis for thriving as patient care organizations. It’s going to take real assertiveness on the part of healthcare leaders to move into this new environment.

HCI: Health information technology and healthcare reform are essentially moving in the same direction when it comes to developing innovative ways to track patient status and intervene in a timely way, correct?

Metzger: Yes, and the examples we picked are particularly pointed, because they both speak to the fact that there are bad things that can happen to patients that are preventable, and part of providers’ responsibility will be to prevent those things—sepsis and VTE that develop in hospitals are great examples. These two examples have to do with fundamental elements of patient safety, and with really being on top of things, so that these often-avoidable things are in fact avoided; and that’s why we picked those two, because they’re pretty hard to shove down lower on the list of the things we should be doing.

HCI: What should CIOs and CMIOs think, when reading this report?

Metzger: First, there’s been this tendency among many in the industry to think that, collectively, we’ll do everything we have to do when we’ve reached some kind of end-state and have all the data we need. I think one of the takeaways here is that that’s not the kind of thinking that will maximize of the value of all this data infrastructure. Honestly, I think we’ll think the data will have some imperfection, forever; so it’s not tomorrow’s data, it’s today’s data. But it may take a different kind of thinking, and it may take some enhancements to the technology.

The second I would say is that the expectations of the world at large, among the policymakers, the payers, the public, around preventing untoward things that can happen—and all that is now tied to money, not just reputation—really mean that the whole game is now about superior performance, all the time. And basically, it’s going to take this kind of proactive, real-time intervention-based approach to accomplish those things [and improve patient safety].

And really, it’s in this way that all the lofty goals of the HITECH Act and other things going on are going to actually be realized. What we’ve tried to do with this white paper has been to paint a picture and suggest how we need to start thinking about it all differently, and developing the care processes and the IT to support this kind of work. But I think this is where we were always headed. It’s just that, now that we’re closer, and the environment has ratcheted up expectations so much, we’re at a point where we can visualize it better.


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