This is the Healthcare Delivery Providers part

of the Healthcare Marketplace Specialization.

This is Module 2.2.2, Measuring Clinical Quality.

Learning outcomes for this lecture are that we will understand the themes

along which clinical quality is measured for a hospital, and

then we will discuss what happens with all the results of these measurements.

Value Based Purchasing,

Hospital Readmissions Reductions,

Hospital Acquired Infections,

Hospital Acquired Conditions.

Let's begin looking at the performance of a hospital with the most important domain,

which is the clinical quality.

Because at the end of the day, what patients and families and

the community want and expect is exceptional clinical quality

from a hospital when they enter the hospital's four walls to get their cares.

So let's start looking at a couple of the quality measurement systems that we have.

So here we have the hospital, one of the measurement

systems we will talk about is the value based purchasing measurement system.

Another one is the readmission reduction program.

Another one is the hospital acquired infection reduction, or

the hospital acquired condition program.

Also there is a program similar to the inpatient quality measurement,

which is called the hospital outpatient quality reporting program.

And I won't spend too much time there given it is very similar to the inpatient

quality measure program.

Now through all of these programs and underlying those are quality metrics,

such as mortality or the death rate, and many other metrics

that are then posted on the website called Hospital Compare.

In order for the final consumer, for example Harlan Reeves, or

his family, to be able to view it.

And then the point being,

that the consumer will then make a decision about the hospital.

And if the hospital is a good hospital or not,

and if they should or should not go to that particular hospital.

So that's the whole point of this transparent

hospital quality measurement program.

Let's get started first with the hospital value based purchasing program.

This is a program maintained and

administered by the federal government, or Medicare.

I won't talk too much about the quality

reporting programs by each of the insurance companies.

They follow a very similar methodology of collection of quality metrics and

then rewarding the hospital or

health system based upon if they hit the target or did not.

So for the value-based purchasing program, there are many measures

which are continuously reviewed by national organizations, so these metrics

are validated, they are researched, they are discussed in committee, and

then published as a validated way of measuring clinical quality.

They are continuously updated, reviewed, and modified.

Now, in the VBP, Value Based Purchasing Program,

the weight of the clinical quality measures is also continuously updated.

So there is definitely a move in the government to move

away from process measures, and more and more towards outcome measures.

Now, in the VBP program, there's a couple of other domains outside of

clinical quality, which is efficiency or financials, and

patient satisfaction, which we will cover in the upcoming lectures.

So here's a couple of specifics around the hospital value based purchasing program.

There are two different types of measures.

The first one is Process of Care Measures, which are weighted at 10%.

And there are outcome measures, which are weighted at 40% of the program.

The Process of Care Measures,

a couple of those as examples would be if a medication for a heart

attack is receive within 30 minutes of coming into the hospital or not.

So, think about how Harlan Reeves when he went into the hospital,

did he get this particular medication right away within 30 minutes or not.

If he did, the hospital would get a plus, if he did not,

the hospital would not get that point.

Similarly immunization status of some different vaccines.

Also another type of example would be a urinary catheter

that needs to be removed from the patient in a standardized time.

If it is removed, the hospital gets a point.

If it is not removed in that time period, the hospital does not get that point.

Now for outcome measures, for

example, death rate related to congestive heart failure or heart attack.

Now remember, both of these thing happened to Harlan.

So had he passed away in the hospital,

that would have counted against the hospital in the quality measurement.

Certain infections, and there's quite a few

infections in the bloodstream or in the catheter or in the central lines.

And then also there are what are called composite measurements.

And these are measures that have many different measures that underlie it and

then they're added up and they become the composite measure.

Let's take a very short quiz now.

The other important program, which is complimentary to the value-based

purchasing program, is the Hospital Readmission Reduction Program.

For this particular program, any readmission which is unplanned and

happens within 30 days of the first admission is penalized for

certain conditions, and the number of these conditions is growing.

So heart failure, which Harlan had, heart attack,

which Harlan had, pneumonia or elective hip or knee replacement.

Now the readmission to be penalized does not have to happen

in the same hospital as the first admission.

It can happen in any hospital, and that is tracked by the government.

And so as you can see, there is a distinct move towards

looking at readmissions in the hospital as a failure of care.

So had everything been done correctly the first time around,

the patient would not have needed to come back into the hospital within 30 days.

And hence, that is a failure of the value chain.

The third complementary program to the readmission reductions and

value-based purchasing is the Hospital Acquired Conditions Program.

This, parts of this are similar to the VBP.

There is also a composite here,

which is the patient safety indicator, PSI composite, and

then there are five infections that make up this particular metric, so

there could be an infection in the central line, so this is a IV,

intravenous line put into the central veins in a patient or

a catheter that is put to take out urine for a patient.

Or an infection after a surgery on the surgical site.

Or there are two superbugs, and what I mean by that are resistant bacteria or

bacteria that are becoming more and more resistant to antibiotics.

Those particular infections are also counted in the HAC program.

So beyond the programs that we have discussed,

there are many other Quality Measurement paradigms that a hospital or

health system needs to look at.

So each of the Private Health Insurance companies that has contracts with

the hospital health system may have its own requirements for quality measurement.

Although there is certainly a move towards getting all of these quality measurement

much more aligned with the federal and state government, so that the hospital or

health system does not have to do many different onerous measurements.

Also, the State and Federal Regulatory Agencies, like the Department of Health,

or bodies such as the Joint Commission, which reviews hospitals,

or CMS itself may have its own Quality Measurement and reporting frameworks.

Medicaid on a state level made audits, and also may require some quality measurement.

And also there are many other national and local quality ranking organizations.

Some are pay for play and some are free.

Again, there's a lot of quality measurement happening out there,

some of it, especially the quality rankings, can get quite confusing,

especially for the end customer.

A couple of other issues to note.

We talked about the transparency already.

That particular website again is called Hospital Compare.

I would really like you to go and check it out on your Internet so

you can look at what it looks like and also what it measures, and

the other point I wanted to make was that as physicians and

hospitals start coming under an umbrella of an ACO or

physicians and hospitals get employed by the same organization or health system.

Then the hospital quality measurement and the physician quality

measurement which is separate, start really becoming one in the same thing.

And we will discuss the physical quality measurement in the next module.

But I wanted to make the point that as we look at the hospital,

we also need to start looking at the physician quality measurement and

sometimes if the physicians and hospitals belong to the same system,

both of these measurements can be super additive.

Either the penalties would be doubled or the gains would be doubled as well.

And then finally, there is a roadmap and

some work happening nationally to align and

make sense of all of these disparate quality measurement systems.

So that they become much more intelligible to the final customer,

the patient, the families, the communities.

And also to the front line staff, physicians, and

leaders that are responsible for improving continuous quality.

So in summary, quality metrics are measured using many different and

very complicated systems, which do require infrastructure at the hospital and

health system to look at those data, to submit those data.

To look at those results and to make sense of all of this reporting and

the results that come back.

Quality measures are becoming increasingly linked to reimbursement under the pay for

performance or pay for quality or value paradigms.

2.2.2 Measuring Clinical Quality

Healthcare Delivery Providers

Meet the Instructors