NAPH-UHC Clinical Improvement Tools NAPH Annual Conference June 20, 2002 David Burnett, MD, MPH. NAPH Annual Conference June 19-22, 2002. UHC Information Tools to Support Quality, Safety, and Efficiency Improvement. Clinical Data Products Patient Safety Net Faculty Practice Solutions Center - PowerPoint PPT Presentation
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UHC Information Tools to Support UHC Information Tools to Support Quality, Safety, and Efficiency Quality, Safety, and Efficiency
ImprovementImprovement• Clinical Data ProductsClinical Data Products• Patient Safety NetPatient Safety Net• Faculty Practice Solutions CenterFaculty Practice Solutions Center• Operational Data BaseOperational Data Base• Benchmarking Benchmarking
The UHC Clinical Data Base Provides The UHC Clinical Data Base Provides Comparative Data on Peer Academic Medical Comparative Data on Peer Academic Medical
CentersCenters
• CDB pools clinical and financial data using discharge abstract CDB pools clinical and financial data using discharge abstract summaries and UB-92 datasummaries and UB-92 data
• Key Outcomes: Key Outcomes: Cost, LOS, Mortality, Complications, Cost, LOS, Mortality, Complications, Components of CostComponents of Cost
• CDB data is CDB data is fully risk-adjustedfully risk-adjusted
• CDB provides CDB provides cost estimatescost estimates, not charges, not charges
1.1. What are my top generic drugs within a product line or DRG?What are my top generic drugs within a product line or DRG?
2.2. Where is Drug A being used most in the hospital?Where is Drug A being used most in the hospital?
3.3. What % of my CABG pts receive albumin compared to other HCOs?What % of my CABG pts receive albumin compared to other HCOs?
4.4. Which glycoprotein iib/iiia inhibitors are other HCOs using in the Which glycoprotein iib/iiia inhibitors are other HCOs using in the cardiology product line?cardiology product line?
5.5. What anticoagulants (DVT prophyx) are other HCOs using in pts What anticoagulants (DVT prophyx) are other HCOs using in pts undergoing total hip replacement (THR)?undergoing total hip replacement (THR)?
6.6. Which physicians are using more antifungals in the BMT pt group?Which physicians are using more antifungals in the BMT pt group?
Design of the Patient Safety NetDesign of the Patient Safety Net
• Internet based (server at UHC in Chicago)Internet based (server at UHC in Chicago)
• Point of care data entry for adverse events & near missesPoint of care data entry for adverse events & near misses
• Simple common classification systemSimple common classification system
• Rapid event reportingRapid event reporting
• Fields for medication errors, ADR’s, falls, transfusion Fields for medication errors, ADR’s, falls, transfusion events, procedural events, complications, equipment events, procedural events, complications, equipment issues, behavioral events, skin integrity, otherissues, behavioral events, skin integrity, other
• Secondary (password protected) fields for analysis of Secondary (password protected) fields for analysis of events by nursing, pharmacy, quality/risk managementevents by nursing, pharmacy, quality/risk management
• Facilitate the open sharing of practice management and physician Facilitate the open sharing of practice management and physician productivity data across institutionsproductivity data across institutions
• Develop and provide access to statistically valid and stable comparative Develop and provide access to statistically valid and stable comparative benchmarking data (physician productivity, departmental finance and benchmarking data (physician productivity, departmental finance and operations, billing office performance)operations, billing office performance)
• Provide easy to use tools for clinical activity reporting and analysisProvide easy to use tools for clinical activity reporting and analysis
• Facilitate knowledge transfer and experience sharing among academic Facilitate knowledge transfer and experience sharing among academic practice managerspractice managers
• Provide access to UHC, AAMC, and third-party content on practice Provide access to UHC, AAMC, and third-party content on practice management issuesmanagement issues
Objectives of the Faculty Practice Solutions Center
• 5+ consecutive years of MD-level CPT billing data5+ consecutive years of MD-level CPT billing data
• Menu of routine and custom comparative reports/analyses, provided Menu of routine and custom comparative reports/analyses, provided on a quarterly basison a quarterly basis
• existing comparative data not existing comparative data not reflective of AHC faculty groupsreflective of AHC faculty groups
• inaccuracies of “survey” datainaccuracies of “survey” data
• missing or misclassified datamissing or misclassified data
• significant year to year variability in significant year to year variability in existing comparative dataexisting comparative data
FPSC Approach:FPSC Approach: numerous faculty groups participatingnumerous faculty groups participating broad scope of specialties broad scope of specialties continuous feedback and refinement through continuous feedback and refinement through
member involvementmember involvement data submitted electronicallydata submitted electronically consistent methodology in RVU calculationconsistent methodology in RVU calculation
individual MD detail allows exclusion of individual MD detail allows exclusion of outliers and analysis of coding behaviorsoutliers and analysis of coding behaviors
UHC-AAMC FPSC ParticipantsUHC-AAMC FPSC Participants• Alabama Alabama • Albert Einstein/MontefioreAlbert Einstein/Montefiore• ArizonaArizona• Arkansas *Arkansas *• Baystate/TuftsBaystate/Tufts• ChicagoChicago• CincinnatiCincinnati• Cleveland Clinic *Cleveland Clinic *• ColoradoColorado• ConnecticutConnecticut• DukeDuke• East CarolinaEast Carolina• Emory *Emory *• FloridaFlorida• George Washington *George Washington *• GeorgiaGeorgia• Harlem HospitalHarlem Hospital• Harvard/Beth Israel-DeaconessHarvard/Beth Israel-Deaconess• Harvard/Brigham and Women's Harvard/Brigham and Women's • Harvard/Mass GeneralHarvard/Mass General• IndianaIndiana
• IowaIowa• Johns Hopkins *Johns Hopkins *• KansasKansas• Kentucky *Kentucky *• Loyola-StritchLoyola-Stritch• MarylandMaryland• UMassUMass• Med University of So CarolinaMed University of So Carolina• Medical College of WisconsinMedical College of Wisconsin• Michigan *Michigan *• Missouri-ColumbiaMissouri-Columbia• Missouri-Kansas CityMissouri-Kansas City• Mt Sinai (NYC) *Mt Sinai (NYC) *• NebraskaNebraska• New MexicoNew Mexico• North CarolinaNorth Carolina• NorthwesternNorthwestern• Ohio StateOhio State• Oklahoma *Oklahoma *• OregonOregon• PennsylvaniaPennsylvania• RochesterRochester
• Sinai of Baltimore *Sinai of Baltimore *• South FloridaSouth Florida• Stanford *Stanford *• SUNY-Stony BrookSUNY-Stony Brook• Tufts (NEMC) *Tufts (NEMC) *• UC-Los Angeles *UC-Los Angeles *• UC-San DiegoUC-San Diego• USAF Surgeon GeneralUSAF Surgeon General• Utah *Utah *• UT-GalvestonUT-Galveston• VanderbiltVanderbilt• Vermont Vermont • VirginiaVirginia• Virginia CommonwealthVirginia Commonwealth• Wake ForestWake Forest• Washington University-St Louis *Washington University-St Louis *• West Virginia West Virginia • Wisconsin *Wisconsin *• YaleYale
• Can be used in conjunction with other UHC tools Can be used in conjunction with other UHC tools to address/overcome identified productivity barriersto address/overcome identified productivity barriers
Operational Data Base ProgramOperational Data Base Program
• A data base reporting system and related services designed to provide A data base reporting system and related services designed to provide UHC members and associate members with comparative operational data. UHC members and associate members with comparative operational data.
– Focuses on operational characteristics of hospital departments (i.e., Focuses on operational characteristics of hospital departments (i.e., hours worked/unit of service, skill mix, labor and supply expense/unit of hours worked/unit of service, skill mix, labor and supply expense/unit of service, and operational practices).service, and operational practices).
– Provides information for analyses to support performance Provides information for analyses to support performance improvement, budgeting, cost reduction, and identification of best improvement, budgeting, cost reduction, and identification of best performersperformers
– Creates direct networking opportunities among UHC participants and Creates direct networking opportunities among UHC participants and between UHC participants and non-UHC participants*between UHC participants and non-UHC participants*
– Facilitates the tracking of key performance measures resulting from Facilitates the tracking of key performance measures resulting from UHC operational benchmarking projectsUHC operational benchmarking projects
*There are 59 UHC members and approximately 450 non-UHC participants in *There are 59 UHC members and approximately 450 non-UHC participants in the data base.the data base.
• PC based software to support on-site data collection, reporting and PC based software to support on-site data collection, reporting and analysis; migrating to web in 2003analysis; migrating to web in 2003
• Quarterly staff and expense performance information using standardized Quarterly staff and expense performance information using standardized data collection instruments data collection instruments
• Up to nine quarters of data from over 500 institutions including more than Up to nine quarters of data from over 500 institutions including more than 50 UHC members50 UHC members
• Standard and user-defined cost center and facility reports which enable Standard and user-defined cost center and facility reports which enable the user to customize analyses the user to customize analyses
• Quarterly enhancements of methodologies, software and/or product Quarterly enhancements of methodologies, software and/or product documentationdocumentation
• Includes UHC data starting first quarter 1998Includes UHC data starting first quarter 1998
*The HBSI ACTION and PEERnext products will be combined in 2003 *The HBSI ACTION and PEERnext products will be combined in 2003 resulting in more data collection tools and greater participation.resulting in more data collection tools and greater participation.
Use of ODB Data By UHC Members Use of ODB Data By UHC Members
• Majority of members are using data for budgeting/cost reduction:Majority of members are using data for budgeting/cost reduction:
– Fifty-two percent will use the data for FY2003 budgetingFifty-two percent will use the data for FY2003 budgeting
– Ninety-one percent will use the data for budgeting and/or targeting Ninety-one percent will use the data for budgeting and/or targeting areas for cost reductionareas for cost reduction
• A variety of methods have been used:A variety of methods have been used:
– The 25th or 50th percentile across the board for all departmentsThe 25th or 50th percentile across the board for all departments
– Target the 10 departments with the largest opportunities each quarterTarget the 10 departments with the largest opportunities each quarter
– Sliding targets based on the respective department’s performance (i.e., Sliding targets based on the respective department’s performance (i.e., 40th percentile if at the 50th percentile, 60th percentile if at the 70th 40th percentile if at the 50th percentile, 60th percentile if at the 70th percentile, etc.) percentile, etc.)
Patient Accounting *Patient Accounting *Laboratory *Laboratory *Surgical Services **Surgical Services **‡ †‡ † Employee Benefits *Employee Benefits *Imaging *Imaging *Emergency Department *Emergency Department *Adult ICU Phases I and II *Adult ICU Phases I and II *Purchasing Process *Purchasing Process *Ambulatory Clinics *Ambulatory Clinics *Medication Use Process *Medication Use Process *Medical Records *Medical Records *Trauma *Trauma *Health Info. Technology *Health Info. Technology *Inpatient Admitting *Inpatient Admitting *Customer Service *Customer Service *Clinics Organization andClinics Organization and
Registration *Registration *
Kidney Transplant*Kidney Transplant*CABG*CABG*PTCA*PTCA*Hip Replacement*Hip Replacement*Bone Marrow Bone Marrow
ImplementationImplementation ‡ ‡ Adult ICU Follow-upAdult ICU Follow-up††‡‡Small & Large BowelSmall & Large Bowel††Transplant ServicesTransplant Services† ‡ † ‡
Women’s Health *Women’s Health *Pediatrics *Pediatrics *Complementary Medicine *Complementary Medicine *Performance Improvement Models *Performance Improvement Models *Medical Records Follow-up *Medical Records Follow-up *Cardiology*Cardiology*Supply Cost Management* Supply Cost Management* Claims Denials*Claims Denials*Imaging Services *Imaging Services *Clinics Billing and Coding *Clinics Billing and Coding * Managing Patient Flow *Managing Patient Flow *Blood and Blood Products Blood and Blood Products ‡ ‡
IP Charge Capture, Bill.and Collect. IP Charge Capture, Bill.and Collect. Leadership and Mgmt Dev. Leadership and Mgmt Dev. Use of Decision Support ToolsUse of Decision Support Tools††
Gather data fromGather data fromyour organizationyour organizationand from “best-in-class”and from “best-in-class”• SurveySurvey• Site visitsSite visits
• Implementation Strategies and SupportImplementation Strategies and Support
Information is accessible through the UHC Web Site (Information is accessible through the UHC Web Site (www.uhc.eduwww.uhc.edu under Improvement and Effectiveness) under Improvement and Effectiveness)