Everyone can see the writing on the wall: patient outcomes are becoming linked to reimbursement on an ever-increasing basis. For hospitals, this means the quality and finance teams must coordinate better than ever before.
Deborah Larkin-Carney, vice president of quality at Barnabas Health, the largest integrated health system in New Jersey, has observed these changes closely in recent years. Based in West Orange, N.J., the Barnabas network includes six acute care hospitals, two children’s hospitals and multiple outpatient and ambulatory care facilities. Larkin-Carney has seen the purview of quality initiatives expand to the point that coordination between finance and quality leaders is not simply useful, but requisite for success.
Larkin-Carney spoke recently with Healthcare Finance News about how quality and finance connect at her health system, and what the future may hold.
Would you explain how the role of vice president of quality has changed in recent years at health systems like Barnabas?
Every hospital has a chief quality officer, at either the vice president or the director level. But the magnitude of quality requirements demanded by multiple organizations, such as CMS [the Centers for Medicare & Medicaid Services] and the Joint Commission, means that someone in the quality VP role must understand data metrics. It used to be that quality folks were very good at getting teams to work together, but it was not a science. But quality has really become a science, and the data has to drive improvements. Your quality VPs must be savvy at measuring improvements and understanding process analysis. The quality department used to own a lot of the quality initiatives, whereas now they are facilitating improvements throughout their organizations.
Do you tailor quality initiatives to departments, or roll out quality programs system-wide?
That’s a key point. We undertake both types of initiatives. We have system-wide initiatives, such as the reduction of central line infections or the reduction of elective deliveries. These are evidence-based initiatives, and something that all our hospitals needed to improve. This approach was system-wide and standardized, but executed at the hospital level using local staff. But there is also a need for each facility to have their own quality initiatives, based on their cultures, their practice patterns and patient populations.
You have had some good results on your hospital-acquired infection initiative. Could you discuss that quality project?
When CMS first listed the hospital-acquired conditions that they would not reimburse at the higher DRG level, we determined that this was not only significant for us financially, but also important to the safety of our patients. We decided to pay close attention to all the hospital-acquired conditions at a system level, but different conditions impacted hospitals in our system in distinct ways. We examined the data closely; the data tells you an accurate story about your processes. Without data you don’t know where you’ve been, or where you need to go. We discovered that there were documentation issues, and so we fixed our coding problems to get rid of the “noise,” and then put process improvement teams into place at our facilities. We had a 72 percent reduction in hospital-acquired conditions. That was a good collaboration between our coding and clinical teams. Coders are on our quality teams. It’s a partnership.
What kinds of projects do you see on the horizon where there is close collaboration between quality and finance?
When you think about value in patient care, it’s a combination of outcomes and cost. Traditionally, the quality folks have been involved with outcomes, and the finance team with costs, but we’re realizing that good outcomes help drive down costs. It all blends together. For example, length of stay and readmissions are two key cost issues that are closely linked to quality. Finance brings a huge expertise to quality initiatives, because of their skill in analyzing data and processes. Finance has the analytical approach that can have a real impact on clinicians. There is close collaboration. The CFOs in our system email me directly with both questions and answers, which would never have happened years ago.
Do you have any best practices you’d recommend for finance executives when working with quality teams?
Start having discussions about value-based purchasing that involve clinical and quality people. You should always try to participate in meetings where discussions about quality of care are central, because you better understand the connections between cost and quality. As an example, we have CFOs participate on our performance improvement councils. CFOs love data, so they certainly appreciate having more information on quality data.