Week 6

My 6th week was far more interesting than my other ones so far. I learned much about quality metrics and their contribution to Banner Health Network's revenue. 

Quality measures are tools that help medical groups measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care. These goals include: effective, safe, efficient, patient-centered, equitable, and timely care. Many of these metrics monitor the health of patients by ensuring providers are spending sufficient time screening their patients. 

The Center for Medical Services (CMS) uses quality measures in its quality improvement, public reporting, and pay-for-reporting programs for specific healthcare providers. Data on quality measures are collected or reported in a variety of ways, such as claims, assessment instruments, chart abstraction, registries. Click on Related Links Inside CMS below for more information.

CMS is currently testing the submission of quality measures data from Electronic Health Records for physicians and other health care professionals and will soon be testing with hospitals. 

The shift to ensure that providers are hitting these quality metrics began for the most part in the last 4 years. So, I spent this week looking at Banners success in reaching these metrics. The way Banner ensured that its providers were reaching these metrics was interesting. As i said before, provider productivity is measured in relative value units, and these providers are given bonuses based on these RVUs. Banner Health Network gave more RVUs to providers when they successfully achieved these quality metrics. 

As healthcare reform continues, the industry’s headlong shift from fee-for-service to a pay-for-performance model means quality improvement projects have become more top-of-mind for hospitals and healthcare systems, and this means that clinical metrics are more important than ever.

Between government regulations that carry heavy penalties for poor or unacceptable outcomes and financial incentives for improving population health, hospitals and healthcare systems are finding increased urgency in evaluating how care is being delivered and determining the best practices to follow in the future. As always, follow the money.

What makes all of this possible, of course, is the wealth of clinical data now available. While electronic health records (EHRs) aren’t quite perfect, they have given us a way to take data that was once isolated and proprietary to individual physicians or practices and use it to see a larger picture of management. When clinical data is combined with financial, operational, and other data, organizations have a powerful foundation to use in driving quality.