Quality A Board Level Priority

1
Quality - A Board Level Priority

• Peter H. Short, MD, FAAP
• Senior VP of Medical Affairs
• Northeast Hospital Corporation
• Beverly, Massachusetts

2
WHY?

• We are in the business of caring for people
• The board has a fiduciary responsibility to know
  that its agents (doctors, nurses, etc.) are
  providing the highest quality care possible and
  acting in a way consistent with their mission
  statement
• The public has information available to them
  about the quality of health care
• Board members need to know what information is
  out there, how their institution compares, and
  what is being done to improve care

3
HOW?

• Describe the various reporting requirements
• External scorecards
• Internal scorecards
• Publicly reported
• Privately reported
• Mandated reporting
• Voluntary reporting

4
HOW?

• Describe the credentialing, appointment and
  reappointment process
• Describe the ongoing quality initiatives
• Invite Board members to attend a meeting
• Provide the Board with monthly updates on quality
  initiatives

5
WHAT

• P4P updates
• Rapid response team
• ICU/CCU dashboard
• OB Hospitalist program
• Patient satisfaction
• Physician satisfaction
• External scorecards
• Credentialing criteria
• Measles outbreak

6
How Do We Measure the Quality of Individual
Physicians

• Historically, we have measured individual quality
  metrics from a 100,000 foot level
• Mortality rate
• Average length of stay
• Volume
• Type 4 BORM reports
• Complications
• Return to the OR
• Reputation

7
How Do We Measure the Quality of Individual
Physicians

• We must be able to convince the Board, the
  public, and ourselves that we have a high quality
  medical staff
• In order to do this, we need a set of agreed upon
  criteria that we can measure and manage
• If we dont do it first, outside agencies are
  going to impose them upon us (why-because they
  control the money)

8
How Do We Measure the Quality of Individual
Physicians

• For physicians to accept any measurement criteria
  they need to be convinced of its validity before
  accepting it
• At our Institution, we are presenting
  department-specific criteria for discussion.
  After a consensus is reached, the department
  votes to accept the criteria
• This provides a predetermined set of criteria
  that can be presented to the department,
  individual physicians and the Board to
  demonstrate improvement
• The idea is not to eliminate physician input, but
  to narrow the Bell Curve and shift it to the left

9
EXAMPLES

• Department of Surgery
• Inpatient/outpatient volume
• Mortality
• Return to the OR
• ALOS
• Positive blood culture
• Transfusion and pre-transfusion Hgb/Hct
• MI as a secondary diagnosis
• Were beta-blockers given pre-operatively
• Pneumonia as a secondary diagnosis
• Wound infection
• DVT/PE and was anti-coagulation used
• OR time by procedure
• Cost/Case, by MD/by procedure

10
EXAMPLES

• Department of Family Practice (mostly outpatient)
• Newborn bilirubins and readmissions
• COPD readmission rate
• Heart failure readmission rate
• PT/INR management
• Hgb A1C levels
• LDL testing and levels
• Peer reference letter
• Reference letter concerning outpatient management
  before an admission

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IMPOSSIBLE

• Not anymore
• Working with the Institute for Health Metrics we
  are developing a dashboard that will produce this
  type of information by physician and by
  department. It is called the Physician Quality
  Management System (PQMS). It will also reference
  national databases and their database for
  comparison
• The information is current (it is produced 2
  weeks after the end of the month)
• The information is based on the information in
  MEDITECH and not dependent upon coding. (It is
  what I call front-end data and not back end
  charge data)

12
Physician Quality Management System (PQMS)
13
THE FUTURE

• Using the information in MEDITECH we will be able
  to cross reference test results and make sure we
  are taking care of the whole patient and not just
  the presenting symptom. We will be moving from
  disease treatment to disease evaluation and
  management
• For example, we know that there is an overlap
  between Coronary Artery Disease, Peripheral
  Vascular Disease and Carotid Disease. If a
  patient has a positive finding in one area, this
  will allow us to see if they have been evaluated
  for other disease and if not, provide their PCP
  with the information