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WHA Improvement Forum For November    “Building the Business Case for Quality”   - PowerPoint PPT Presentation


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WHA Improvement Forum For November    “Building the Business Case for Quality”   Tom Kaster. Courtesy Reminders: Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) Please do not take calls and place the phone on HOLD during the presentation.

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  • WHA Improvement Forum

  • For November   

  • “Building the Business Case for Quality”

  •  

  • Tom Kaster

  • Courtesy Reminders:

  • Please place your phones on MUTE unless you are speaking (or use *6 on your keypad)

  • Please do not take calls and place the phone on HOLD during the presentation.


The value equation
The Value Equation

Increase Quality = Increase Value

Decrease Cost = Increase Value

Increase Quality and Decrease Cost = Accelerated Increase in Value


Institute of medicine iom cost of poor quality of care in lives and dollars
Institute of Medicine (IOM): Cost of Poor-Quality of Care in Lives and Dollars

The scope of poor quality of care (3 forms)

  • Overuse: Provide unneeded care

  • Underuse: Fail to provide needed care

  • Misuse: Make a mistake and cause harm


Iom overuse
IOM: Overuse Lives and Dollars

Overuse occurs when a drug or treatment is given without medical justification.

  • Examples includes:

    • Treating people with antibiotics for simple infections

    • Failing to follow effective options that cost less or cause fewer side effects

  • Avoiding overuse can decrease cost


Overuse examples
Overuse Examples Lives and Dollars

Both examples can have a negative impact to the patients and to costs:

  • Prescription overuse

    • Prescribing antibiotics for a viral illness

    • Using brand name when generics are available

  • MRI overuse

    • When use appropriate MRI’s are valuable

    • Often MRI’s do not change the treatments prescribed or a patients outcome.


Iom underuse
IOM: Underuse Lives and Dollars

Underuse is when doctors or hospitals neglect to give patients medically necessary care or to follow proven health care practices

  • Examples include:

    • Failure to give beta-blocking drugs to people having heart attacks

    • People receiving necessary preventative care like mammograms or vaccinations

  • Avoiding underuse improves quality


Consequences of underuse
Consequences of Underuse Lives and Dollars

  • As many as 91,000 Americans die each year because they do not receive evidence-based care for chronics conditions like HBP, diabetes and heart disease

  • Billions of dollars a year are spent reacting to the consequences of underuse


Iom misuse
IOM: Misuse Lives and Dollars

Misuse occurs when a patient does not fully benefit from a treatment because of a preventable problem, or when a patient is harmed by a treatment.

  • Some examples include:

    • Prescribing a drug that a patient is allergic to

    • The appropriate care protocol is not given resulting in patient harm

  • Avoiding misuse improves quality


Consequences of misuse
Consequences of Misuse Lives and Dollars

  • Billions of dollars a year are spent on helping patients recover from health care harm

  • Conservatively between 44,000 and 98,000 people die annually from preventable errors


Building the business case
Building the Business Case Lives and Dollars


Obstacles to building a business case for quality
Obstacles to Building a Lives and DollarsBusiness Case for Quality

  • The complexity of healthcare

  • The fragmentation of payer types

  • Lack of reliable performance indicators that correlate QI to cost savings

  • The perception that waste elimination will negatively effect patient care

  • The perception that increased efficiencies may reduce FTE’s


Preparing yourself to talk the talk
Preparing Yourself to Talk the Talk Lives and Dollars

  • Learn and Understand Healthcare Financial Terms and Payer Dynamics

  • Develop methodologies to measure the financial impact of improvement (ROI etc…)

  • Understand the importance of connecting financial impacts to gain management support



Examples of light green
Examples of Light Green Lives and Dollars

  • Organize equipment and supplies room to reduce hunting and searching time

  • Streamline workflow to increase efficiencies

  • Enable care givers more time at the bedside to meet patient needs

  • Reduces patient harm from falls, pressure ulcers

  • Make work more enjoyable and experience less attrition

  • Improves patient experience

  • Improves HCAHPS scores


Light green to dark green
Light Green Lives and Dollarsto Dark Green

May 2, 2012 (San Francisco, California)—

  • Blood-product management plan put together by the Virginia Cardiac Surgery Quality Initiative (VCSQI) helped optimize the process and lowered the overall use of transfusions, cutting related mortality by half.

  • Savings of $50 million statewide over two years

http://www.medscape.com/viewarticle/763272


Light green to dark green1
Light Green Lives and Dollarsto Dark Green

A house-wide hourly rounding initiative…

…Requires the improvement of overall efficiencies:

  • Nurses spend their time in more value added activities at the bedside

    … Which is shown to improve patient and family satisfaction on HCAHPS scores

    … Which will positively effect Value Based Purchasing factors

  • Reduce Harm by lessoning Falls and Pressure Ulcers

    ... Which will reduce average length of stay for our Medicare patients

  • Decrease overall medication doses per stay

    … Which in turn will improve profit margins for fixed payment patients



Ihi equations to measure quality in dark green dollars
IHI: Equations to Measure Quality in Dark Green Dollars Lives and Dollars

  • Total Wages per Admission

  • Total Medication Cost per Admission


Ihi total wages per admission equation
IHI: Total Wages per Admission Equation Lives and Dollars

Total wages per admission

(Worked hours per patient day)

(Average wage per hour)

(Patient days per admission)


Ihi total wages per admission equation1
IHI: Total Wages per Admission Equation Lives and Dollars

Average wage per hour:

  • Cost associated with recruiting and training new staff for vacant positions

  • Increased cost associated with contract labor to fill vacancies

  • Premium overtime pay


Ihi total wages per admission equation2
IHI: Total Wages per Admission Equation Lives and Dollars

Worked hours per patient day:

  • Inappropriate ICU staff time due to discharge delays to other units

  • Excess budgeted hours due to uneven staffing needs due to poor scheduling of surgeries with disregards to workflow

  • Excess budgeted hours due to poor prediction of demand


Ihi total wages per admission equation3
IHI: Total Wages per Admission Equation Lives and Dollars

Patient days per admission:

  • Excess patient day due to delays in discharge and poor coordination of the process

  • Excess patient days due to lack of setting and executing daily goals for the patient, family and care team

  • Excess patient days associated with and adverse event or complication


Ihi total medication cost per admission equation
IHI: Total Medication Cost per Admission Equation Lives and Dollars

Average cost per dose:

  • Excess cost of brand names when generic are available

  • Excess cost associated with failure to make a timely switch in Med Administration mode (IV to Oral)

  • Excess cost associated with overuse of expensive meds when less expensive alternatives are available


Ihi total medication cost per admission equation1
IHI: Total Medication Cost per Admission Equation Lives and Dollars

Number of doses per admission:

  • Excess cost associated with failure to stop medications appropriately (continuing preventative antibiotic use longer than 24 hours after surgery)

  • The medication cost associated with treating an adverse events


Ihi tying equations to dollars
IHI: Tying Equations to Dollars Lives and Dollars

Reduction in overall SSI:

  • Patient days per admissions: Decreased

  • Number of doses per admission: Decreased

  • Average length of stay: Decreased


The financial impact of quality
The Financial Impact of Quality Lives and Dollars

  • Medicare Fixed Payments (DRG’s)

  • Privately Insured

  • Uninsured

  • Regulatory


The Financial Impact of Quality Lives and Dollars

Medicare Fixed Payments--Diagnosis Related Groups (DRG)


Consequences of low quality
Consequences of Low Quality Lives and Dollars

  • Medicare Fixed Payments--Diagnosis Related Groups (DRG)

    • Falls / PUP / CAUTI / Falls

    • Efficiencies / Increase Length of Stay / Increase of Rx Cost

  • Increased financial deficit

  • Increased harm to patient



Consequences of low quality1
Consequences of Low Quality Lives and Dollars

  • Privately Insured

    • Falls / PUP / CAUTI / Falls

    • Efficiencies / Increase Length of Stay / Increase of Rx Cost

  • Increased financial revenues

    • Eventual lower negotiated reimbursements

    • Eventual pressures to adjust or change payment models

  • Increased harm to patient



Consequences of low quality2
Consequences of Low Quality Lives and Dollars

  • Uninsured

    • Falls / PUP / CAUTI / Falls

    • Efficiencies / Increase Length of Stay / Increase of Rx Cost

  • Increase financial burden on patients

  • Increased likelihood of unpaid claims

  • Increase charitable care

  • Increased physical and or financial harm to patient


Federal pressures to improve quality do not pertain to cah s
Federal Pressures to Improve Quality Lives and Dollars(do not pertain to CAH’s)

  • Hospital-specific historical quality performance compared to national performance standards

  • Dynamic programs that change each year

    • Measures and domains (additions/deletions)

    • Performance standards (moving target)

  • Increased financial exposure each year (max exposure shown below)

Slide provided by the Hospital Association of New York State


Takeaways
Takeaways Lives and Dollars

  • Improving quality and / or reducing cost increases value to the patient

  • Financial and Quality leaders can drive huge improvement and cost reductions by teaming up and learning each other’s world

  • As data becomes more available, so will the ability to tie ROI to quality

  • No matter what the industry, improving value and reducing cost equates to long term sustainability

  • Even if a quality improvement project does not impact the bottom line it may still be the right thing to do


Next month
Next Month Lives and Dollars


Resources
Resources Lives and Dollars

  • Institute for health improvement– Increasing Efficiency and Enhancing Value in Health Care

  • Institute of Medicine: Overuse, Underuse and Misuse of Medical Care

  • Blood Use Article: www.medscape.com/viewarticle/763272

  • Hospital Association of New York State - Regulatory Pressures to Improve Quality


Thank you
Thank You! Lives and Dollars

Questions

Please complete 3 question survey when closing webinar window.


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