In an earlier piece, I examined key steps providers can explore in improving access to care. Just as important for succeeding in the value-based care system will be applying innovative measures to enhance the quality of care.
As providers are only too well aware, the rewards and penalties in healthcare have dramatically and relentlessly changed. One need look no further than the announcement by CMS earlier this month that two-thirds of U.S. hospitals will receive payment reductions tied to Medicare readmission penalties to see that improving the level of care will be the foundation for building operational sustainability in the future.
Immediate steps providers should take to enhance quality in their care delivery include:
Drive enhancements with data: Data will continue to be the currency of choice for driving quality improvements for providers.
Generating and using data effectively will require a robust and candid assessment, driven by the executive leadership team, of what the organization’s current capabilities and limitations are in compiling and analyzing data, as well as establishing a specific timeline for improvement and specific metrics for success.
With the penalties for readmissions expected to only get steeper, providers need to use all forms of data at their disposal to understand the root causes of their readmissions and to identify improvement priorities. The identification of individual patients and population characteristics that are associated with high risk for readmission should be the driving force behind all efforts to standardize care, develop clear discharge criteria, improve discharge education and follow-up planning, and engage post-hospital care providers in provision of services to prevent readmissions.
Data should also be used to help organizations match the initiative that is most likely to be effective for an individual or group of patients. The concept “mass customization” that Cold Stone ice cream stores have mastered is the model providers should embrace, developing a selection of initiatives and then providing only those that are most appropriate for each patient.
Improve transitions of care: Readmission penalties will continue to be one of the primary levers by which CMS will drive the goal of better and more affordable care.
A critical step for providers to meet these new demands will be to establish systems and structures to support smooth and timely transitions of patients. Examples of worthy measures to pursue include:
- scheduling follow-up doctor or other service visits before discharge
- establishing a process to send discharge or other electronic care summaries directly to the patient’s primary care physician
- communicating directly with patients within 24 to 72 hours after discharge to verify their understanding of home care and their ability to attend follow-up appointments
Also paramount to success in this area is maximizing the use of electronic data sharing, as having the primary care physician, specialist and acute care facility using the same electronic health record greatly simplifies the transfer of information.
Establish buy-in from the “front lines” of care: To truly drive a culture of care improvement, providers need to engage physicians and other staff who interact with patients in their quality improvement efforts.
Many of the questions in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey required by Medicare and by which reimbursements will be based are focused on the responsiveness and communication skills of hospital staff. Organizations should seek to utilize respected physician leaders within their ranks as change champions and establish multidisciplinary work groups of practicing physicians, nurses and other clinicians to test ideas and develop consensus.
Providers should also emphasize building understanding and support for the complexity of change and the associated stress it can have on people at all levels in the organization. Change of any kind can be difficult to adjust to, so leaders should take the time to share data measuring improvements with staff and celebrate progress that is made.
As with any significant change initiative, providers will need to have a strategy in place to keep momentum going after the initial emphasis inevitably wanes and to overcome resistance that will surely arise.
To demonstrate that enhancing quality will continue to be a priority and a core component of operations moving forward, the accountability and incentives for progress should be established by the executive leadership team and the board. While buy-in from all levels of the organization will be required for change to occur, the message that enhancing quality is a top priority should be delivered from the highest levels of the provider.
The views expressed herein are those of the author and do not necessarily reflect the views of Ernst & Young LLP.