Healthcare providers are just beginning to feel the effects of multiple Medicare funding cuts that will continue to ripple through the industry with significant impact for years to come. Some of the most noteworthy of the cuts are associated with value based purchasing as Medicare begins to hold providers accountable the quality of care and patient satisfaction.
When 34 Adventist Health System hospitals joined QUEST® in spring 2012, system executives noted that the collaborative offers significant value and improvement strategies that align with national priorities, federal policies and future reimbursement that increasingly ties payment to performance.
QUEST drives performance improvement by allowing members to identify opportunities and best practices, participate in rapid performance improvement challenges, collaborate to define performance goals, use healthy competition to drive performance improvement, share metrics transparently, as well as participate in face-to-face meetings, conference calls and webinars.
If the major goal of QUEST is to ensure that participants are better prepared to deal with reform provisions by improving in the six domains targeted by Medicare – evidence-based care (EBC), cost of care, patient experience, harm, mortality and readmissions – then one AHS facility is off to an excellent start.
At Florida Hospital Waterman, there is a definite positive trend for each of the QUEST domains. The hospital is meeting top performance threshold in four domains: EBC, cost of care, mortality and harm. The Tavares, FL, hospital has made especially dramatic improvement in the harm domain. Its baseline QUEST harm composite score in 2011 before joining the collaborative was 0.52. After participating in the collaborative for one year, the composite score has improved to 0.02.
Among harm-reduction strategies implemented, the first was a collaborative approach to investigating harms. The harm team includes representatives from Quality, HIM, clinical staff and CDI specialists. The process to review harms moved from retrospective to a concurrent review of the ICD 9 codes and the medical record. This new process allows for identification of clinical and documentation opportunities, and allows for real time correction and education.
As a result of harm reviews, the Florida Hospital Waterman team identified an opportunity within the electronic health record. The team identified numerous areas in the EHR where clinical staff document but coders were not aware. A report and a worksheet have been developed to track all harms. In addition, a utilization review medical director has been added to assist with physician documentation and education.
Through its efforts in the QUEST collaborative, Florida Hospital Waterman has improved care quality and patient outcomes while reducing costs by more than $1.3 million since spring 2012.