HMC News•
on October 21st, 2011•
NRHA Partners with iVantage Health Analytics to Benchmark Rural Health
KANSAS CITY, MO, September 28, 2011 – The National Rural Health Association (NRHA) announced today at its Critical Access Hospital Conference the names of the Top 100 Critical Access Hospitals (CAHs) in America. The Top 100 scored best on the Hospital Strength Index™, in this first-ever comprehensive rating of CAHs. NRHA also announced a partnership with iVantage Health Analytics to improve and advance business intelligence and benchmarking for rural healthcare and to support the 1,750 rural hospitals whose executives are seeking to improve performance.
This Index offers hospital executives, trustees and boards of directors an objective way to measure their relative performance among their peers and across 56 different performance metrics, the most comprehensive tool on the market.
“Now is the time for us to advance the analytics and transparency of the rural health sector. We play such a critical role in providing needed care to Americans, yet our challenges are completely different in access while equally complex in delivery as urban hospitals. We celebrate this diversity and these every day challenges and will need new solutions to ensure our sustainability under the Affordable Care Act. NRHA is committed to advancing performance improvement in our hospitals,” said Alan Morgan, Chief Executive Officer of the National Rural Health Association.
read more
HMC News•
on October 21st, 2011•
PORTLAND, ME, September 21, 2011 – The first hospital ratings system to address the new challenges required by healthcare reform that includes all U.S. acute care hospitals and traditionally unrated rural and critical access hospitals was launched today by iVantage Health Analytics, a newly formed healthcare business intelligence and technology company.
Called the Hospital Strength Index™, the strategic planning tool is designed to deliver hospitals a balanced scorecard and comparable rating of their performance as they begin implementing mandates of the 2010 Affordable Care Act. This Index offers hospital executives, trustees and boards of directors an objective way to measure their relative performance among their competitors and across 56 different performance metrics, the most comprehensive tool on the market. read more
HMC News•
on October 21st, 2011•
PORTLAND, ME, September 21, 2011 – Veteran healthcare industry executives Hud Connery, Tom Day, LeeAnne Denney, and John R. Morrow today announced that they have combined their respective companies (Performance Management Institute, LLC, of Portland, ME; The Healthcare Management Council, Inc., of Needham, MA; Health InfoTechnics, LLC, of Nashville, TN; and The Ratings Guy, LLC, of Belfast, ME) under the umbrella of a common parent company to provide a single source of business intelligence solutions to help providers address the complex requirements of managing under the new healthcare. Although the existing companies will continue certain operations, all new business opportunities will be pursued by the newly formed parent entity, and ultimately all consolidated into the single entity.
Named iVantage Health Analytics, Inc.™, the privately held company, provides comprehensive and objective business information products to help hospitals and health systems strategically manage their growth during a period of significant health reform. read more
HMC News•
on January 18th, 2011•
The extraordinary insight HMC provides for benchmarking and performance improvement is now available to use in your OPPE scorecards!
The Joint Commission (JCAHO) requires accredited hospitals to examine and evaluate performance data for all practitioners with privileges on an ongoing basis as part of their Ongoing Professional Practice Evaluation (OPPE) initiative.
JCAHO requires:
- Data on actual performance & performance issues
- Ongoing internal review and evaluation (more frequent than annually)
- Use of data to guide decisions on whether to continue or take action on privileges
- Incorporation of data into credentials files
It’s a worthy initiative – but many hospitals have been struggling to comply with the new standards.
HMC Can Help
HMC’s clinical benchmarks have long provided “deep-dive” drill downs to examine utilization patterns at the procedure code and diagnosis code level. The drill downs also enable clients to uncover off-quality sources and their costs, and find problems and focus on solving them.
However, with JCAHO’s Ongoing Professional Practice Evaluation (OPPE) initiative the world of physician analysis has been inverted. Rather than find the 10 things to focus on and fix, this initiative requires organizations to examine and evaluate performance data for all practitioners with privileges, on an ongoing basis.
The same information HMC uses to evaluate utilization patterns, off-quality problems, and costs is essential for this task – however, its access and “direction” changes. Instead of “Which physicians drive my biggest quality issues?” the question is: “How does each physician’s practice compare?”
The HMC OPPE component shows a profile for each physician – types of cases, quality performance, resource utilization, unexplained practice variation, and economics. This data is compared to internal and external peers. Instead of an annual benchmark for the purpose of setting priorities, it has become an ongoing system applicable at any time during the credentialing and clinical management process. It’s a resource, a scorecard, and a goal setter for physicians – in short, a critical step along the path of evidence-based care.
HMC’s OPPE Component Supports
Medical Staff Governance
- Physician profiles detail performance
- Quality performance (AHRQ indicators & outcomes)
- Resource utilization
- Unexplained practice variation
- Economics
Risk Management
- Quality analytics identify performance issues, sources, and associated costs
Compliance
- Get out front of JCAHO requirements
Improving Reimbursement and Cost of Off-Quality
- Know the sources and costs associated with “should-not-happen” events
ACO development
- Quality, Economics, Resource Utilization—all in one place
And, it’s fast and easy to get started. One month from now you’re up and running – just open your browser.
Contact HMC to learn more.
See example panels from HMC’s web-delivered OPPE scorecard here.
HMC News•
on September 24th, 2010•
The KnowledgeWeb expands and changes with clients’ needs
NEEDHAM, MASS. – September 24, 2010 – The Healthcare Management Council, Inc. this month has marked the addition of the 8,550th solution to its KnowledgeWeb portal.
While HMC is the leading provider of actionable benchmarks and dashboards, it offers clients even more. It delivers an online platform of easily searched solutions to the challenges its analytical applications define. It doesn’t just identify such things as excess and off-quality events – it provides easy-to-follow steps to solve them. With healthcare reform, technological advances, and a myriad of other changes afoot in the healthcare industry, hospital administrators need a practical easy-to-use guide to assist them.
“The KnowledgeWeb is an archive of thousands of ideas, insights, collaborations, and events that solve real world problems,” says HMC Director of Knowledge Management Shelley Burns. “It’s not a theoretical or abstract database. This has peer-submitted ideas and recommendations that have stood the ultimate test – that of working in the real world. HMC’s insights, combined with the in-depth knowledge of on-the-ground hospital managers, is unparalleled.”
“We all know that institutions contain vast amounts of knowledge, though it is largely inaccessible on a broad basis,” says HMC President Thomas Day. “Collecting and disseminating knowledge – commonly called “knowledge management” – has such huge potential, which, despite the tremendous investment of time and energy by many people and firms, remains largely untapped.”
He says: “Most knowledge is trapped within individuals and for the most part, is thought of as expertise. A consulting firm has case teams working on similar problems, and they may be able to find some help and direction within their own firm. Healthcare providers do similar work, yet clinical variation is so profound that reducing clinical variation around a best practice is often cited as a huge cost and quality improver.”
HMC not only has gathered these solutions into a single web-based repository, but has made it accessible in the most user friendly format available. According to Day: “We’ve built some excellent methods and tools which allow us to ‘issue-ize’ our knowledge. You ask about an issue, and we share the knowledge others have used to solve that problem. Knowledge is ranked, tagged, indexed, and applied to the analytic tools to tightly integrate them. The definitions of problems allow the direct presentation of the solution knowledge to our clients.”
In addition to being a rich idea archive, the HMC KnowledgeWeb is a real-time collaboration and idea generation platform. Nurses, managers, and staff participate in ongoing web conversations around ideas and topics to add insights on a Best Practice or enter a new idea into the database. “Interaction is key,” says Burns, “to grow the collective knowledge of the group and build a thriving community around specific topics.”
She says: “If you can’t find what you need or have a challenge to solve, there are two solutions. One is to call HMC and talk to one of our knowledge consultants. If the solution is in the KnowledgeWeb, we can find it for you quickly. Two, if we need to engage other HMC Partners in developing the solutions, we can do that, too, through surveys, conference calls, and targeted inquiries.”
Expanding world of knowledge
Just what is available on the HMC KnowledgeWeb? You can learn how to streamline discharge processes; or gather staffing ideas to reduce overtime; or develop keys to building a palliative care program, and much more. Ideas and solutions are available around the clock, every day, to every member of the hospital staff.
More specifically, KnowledgeWeb contains :
Three thousand, one hundred and fifty Best Practices. HMC’s Best Practices Exchange is an online forum designed to spark discussions around real-life issues such as preventing patient falls, managing equipment service contracts, and improving patient satisfaction with environmental services. Our clients can add suggestions or vote “pro” or “con” on a given idea to help create perspective and improve decision-making processes.
Two hundred and sixty-eight Successes & Good Ideas (SGIs). HMC endlessly seeks case studies and interesting articles to stimulate thought and solve problems. Its knowledge managers are frequently adding well-written and informative pieces on every conceivable topic. These SGIs stimulate thought and help you define and solve the healthcare challenges facing you daily.
Two thousand, one hundred and ninety-six Surveys. HMC keeps its pulse on what is happening out where you are, in the actual healthcare field. HMC online surveys have yielded a wealth of data on such topics as off-quality events, nursing staff frustrations, and more. This delivers insight into what is happening in peer facilities and enhances decision making.
Six hundred and seventy-six iConferences. HMC sponsors phone and web-based collaborations called iConferences to allow peers to freely share ideas and solutions to common problems. Administrators from small regional hospitals can receive best practice suggestions from the largest and most successful systems in the country. Contrarily, large hospitals learn the creative ways small hospitals perform tasks such as cross-training staff and streamlining processes. HMC archives the results of these events for convenient access.
Two hundred and fifty Documents. These documents cover technical and clinical specification sheets, flow and organizational charts, and white papers. They include PowerPoint presentations, PDFs, and templates that can be downloaded and shared through your organization to enable you to leverage existing best practices.
HMC considers the KnowledgeWeb a work in progress that will improve and change as the clients’ needs vary. “HMC’s KnowledgeWeb has been evolving for over 10 years and will continue to develop into the future,” says Day. “And as excited as I am about where we are today, it’s an exciting and never-ending journey.”
HMC News•
on July 14th, 2010•
HMC honors cutting-edge hospitals
NEEDHAM, MASS. – July 14, 2010 – The Healthcare Management Council, Inc. (HMC) has recognized client hospitals for its first annual Top Quality Award winners.
“Over the past several years the microscope has been increasingly focused on improving quality in healthcare,” notes HMC Principal John Whittlesey. “The Centers for Medicare & Medicaid Services (CMS) has adopted the Agency for Healthcare Research and Quality (AHRQ) standards for uniform reporting on patient safety and inpatient quality across all hospitals in the United States, and more indicators are coming down the pike.”
To assist clients to achieve their performance initiative goals, in 2008 HMC implemented the Quality Benchmark tool. HMC has steadily improved the product since then, and subsequently, most clients have deployed it as part of their integrated performance improvement programs. ” Many clients have successfully realized significant improvements across a wide variety of indicators, and HMC is recognizing these high achievers with its 2010 Top Quality Awards. We congratulate the winners,” says Whittlesey.
The need to improve quality is increasing, given the prevalence of easily accessed data sources about hospital performance. Whittlesey notes that quality comparisons are readily available online to the public via web sites. Moreover, consumers are quickly becoming savvier about evaluating cost and quality measurements in making their healthcare decisions. “Hospitals are also on the financial hook for off-quality events that occur in their facility,” he says. “So there’s a strong incentive to reduce these events and improve patient outcomes.”
Six winners judged according to strict criteria
HMC scored each of its client facilities along five dimensions:
- Overall AHRQ patient safety quality score in the best one-half of peer group
- Cost versus quality performance in the upper left quadrant of the peer matrix (i.e., low cost/high quality)
- Overall patient safety quality score showed improvement versus the previous year
- Off-quality savings potential was less than two percent of total inpatient clinical costs
- Off-quality savings potential decreased versus the previous year
Finalists had to score “Yes” in each of the five categories to qualify. HMC also considered additional tie-breaking factors including: performance on AHRQ inpatient quality indicators, percent improvement in quality score; largest decrease in off-quality excess; and lowest ratio of off-quality excess to total clinical costs.
The Best Overall Performer was Logan, Utah-based Logan Regional Hospital, a nonprofit, full-service regional medical center located 80 miles northeast of Salt Lake City. It is a member hospital of the Intermountain Healthcare system. ”Logan showed one of the highest overall quality scores in the HMC partnership and has been in the top quartile of cost versus quality for the past two years,” says Whittlesey.
The facility saw a 14 percent improvement in overall quality score from 2008 to 2009, and a 30 percent improvement since 2007. It also realized a 40 percent reduction in cited savings potential for off-quality cases, and had only .28 percent of its clinical costs in off-quality excess.
The Top Performer was American Fork Hospital, based in American Fork, Utah (and also an Intermountain Healthcare member), a 117-bed community hospital and a runner-up for HMC’s 2009 Top Performer Award. “AFH has traditionally been one of the lowest cost facilities in HMC’s database, and this year saw a remarkable improvement in its quality position, as well,” says Whittlesey. “AFH had the largest reduction in cited excess for off-quality from 2008 to 2009 and the second largest improvement in overall quality score.”
In the Honorable Mention category were Sentara Leigh Hospital, based in Norfolk, Va. (part of Sentara Health System); Howell, Mich.-based Saint Joseph Mercy Livingston Hospital, and Ann Arbor, Mich.-based Saint Joseph Mercy Hospital (both are members of the Saint Joseph Mercy Health System). The most improved facility was Rome, Ga.-based Floyd Medical Center.
For inquiries regarding the Top Quality award, please contact John Whittlesey:
Email: jwhittlesey@hmccentral.com
Office number: (781) 449-5287
HMC News•
on June 22nd, 2010•
Supplies, computer systems, and other issues keep nurses from bedside
NEEDHAM, MASS. – June 22, 2010 – The Healthcare Management Council, Inc. (HMC) has found time-consuming and redundant patient processing and documentation are among the biggest time-wasters for nurses.
Time away from patients to complete redundant or non-medical tasks is a huge source of frustration to nurses. It can reduce quality of care, create patient dissatisfaction, and lead to staff turnover, says Michelle Gray-Bernhardt, an HMC knowledge manager. “Time-wasting is a serious problem for nurses. They are eternally frustrated by the tasks that take them away from patients. Their aggravation can create low morale and that causes turnover. That means you’re spending time, money, and resources to hire and train more nurses. That’s expensive, and it’s not always an easy thing to do, given today’s healthcare climate,” she says.
To address this, HMC recently sponsored an online survey on the KnowledgeWeb portal to pinpoint where the greatest inefficiencies were. “We asked nurses what tasks take them away from the patient bedside and feel like time-wasters,” Gray-Bernhardt says. “A wide-ranging sample of nurses from various units chose broad categories, such as documentation, gathering supplies, physician interaction, patient flow, and the lack of support staff.”
And the winners are….
Nurses outlined the greatest time-wasters as follows below. Each category is ranked in the order of the percentage of nurses that selected it:
Charts and documentation (55%). These are interrelated topics: Overall, documentation creates inefficient processes, but especially when nurses are working with computer systems. Nurses cited electronic documentation as the worst time waster – this includes having to enter data twice into separate incompatible systems, or working with “hybrid” paper and electronic systems.
“Anything that requires duplication and looking at different sources of information is a waste of time,” notes Gray-Bernhardt. “In some cases, nurses enter patient status information on one system, and then have to reenter the identical data on another system.” Nurses were also frustrated when discovering that charts were missing or incomplete, or by situations that required them to add what they considered excess information.
Finding and gathering supplies and equipment (19%). Whether seeking supplies or equipment, time spent searching equals time spent away from patients. Hospitals should look at improving utilization patterns to ensure the availability of supplies in the particular units where nurses are.
Patient flow (15%). Nurses in medical and surgical groups said waiting for – and sometimes admitting – patients was a major time-waster. Also in this category were the unavailability of exam or treatment rooms and having anomalous patients on units. Sometimes nurses found they needed to find patients and retrieve them from other units, as well as locate beds for them when their own units had no available space.
Physician interaction (15%). Waiting for communication with physicians is highly frustrating for nurses. Moreover, doctors and hospitals are behind the curve when it comes to high speed electronic communications. Nurses often wait for return phone calls, and find it challenging to gather post-round information, medication orders, discharge orders, and other necessary information.
Redundant and decentralized communication with families (11%). Patients’ family members call frequently and unexpectedly, and when there is no clear family spokesperson, this leads to redundant communications. Factor in that multiple family members will call daily with status requests and discharge information, and the result is that nurses spend too much time providing the same data.
HMC offers solutions to these challenges and many others on its KnowledgeWeb portal, available to clients.
HMC News•
on June 9th, 2010•
Physicians drive cost without performance feedback
NEEDHAM, MASS. – June 9, 2010 – The Healthcare Management Council, Inc. (HMC) is creating a new cutting-edge physician scorecard tool.
Given that physicians drive most healthcare costs, it’s crucial for hospital managers to better understand their performance. In turn, managers must communicate with the doctors about their performance, and how it affects overall hospital quality and patient satisfaction. They order the tests, approve supplies, and suggest admissions and treatments. However, doctors receive no feedback on how their decisions impact cost, and little empirical evidence about how their decisions impact quality.
“Auto manufacturers and retailers pay close attention to their primary cost drivers,” notes Shelley Burns, head of knowledge management at HMC. “Why not healthcare? To that end, we’re organizing a peer group that will focus on building meaningful physician scorecards. This virtual group will collaborate via the HMC KnowledgeWeb with surveys, discussion forums, and Webinars. Our databases already house extensive clinical data and comparisons. Additionally, clients have asked about standard metrics or reports to find opportunities to improve utilization and quality via physician profiles or scorecards.”
HMC will enable hospitals to understand the impact of their physician groups. The scorecard will uncover how physician practice, utilization, length of stay (LOS), and quality directly impact the bottom line, patient satisfaction, and market share.
A physician scorecard will enable insight in the following areas:
Pattern comparisons. Managers will understand practice patterns and cost variations by LOS, supplies, and ancillary utilization. It will uncover practice variations that drive costs, outcomes, and clinical utilization across physicians.
Profitability. This will enable managers to understand which physicians are losing or making money for the organization. It will also permit administrators to uncover internal cost variances and compare them to external costs.
Quality. Administrators can identify the physicians who are negatively impacting quality, and the ones improving it.
HMC clients interested in joining the development group, please click here and start to explore the world of physician scorecards.
HMC News•
on May 11th, 2010•
Medicare reimbursement levels force hospitals to improve
NEEDHAM, MASS. – May 11, 2010 – The Healthcare Management Council, Inc. (HMC) has found that current conditions demand hospitals consider the Medicare break-even point (BEP) as a key strategy for profitability.
Medicare is typically the single largest hospital payer by far, covering 45 percent to 65 percent of all inpatient costs. HMC research of 40 facilities revealed only 10 percent of them were profitable with Medicare, and 10 percent were on the cusp of Medicare profitability. The large majority of hospitals lost significant money on Medicare work. With the healthcare reform bill now law, hospitals face an even greater payment reduction risk. In light of this, HMC found its more successful clients proactively reevaluating their Medicare management and reimbursement strategies.
“Medicaid, the other major public funding mechanism for hospitals, in most states has negative margins, and that’s not likely to change in the foreseeable future,” says John Whittlesey, principal at HMC. “With that in mind, facilities must find a way to reach a financial BEP with their Medicare patients. Resetting your facility’s ‘water table’ by even just a few percentage points can mean the difference between thriving versus merely surviving. Achieving a Medicare BEP as an organizational strategy will shift the cost position for the rest of the payers, and make overall profitability more secure,” he says.
Currently, there are a growing number of Medicare cases risking denied reimbursement because of hospital acquired conditions (HACs), such as decubitis ulcers. Additionally, it’s likely the government will establish benchmarks for quality-based performance in healthcare, with the potential for additional financial incentives and punishments alike. Addressing the issues around cost, resource utilization, process flow, and quality for all patients will provide a strategic advantage. “HMC has been highlighting this concept for the past couple of years,” says Whittlesey. “We see focusing on better management of physician utilization and the reduction of off-quality events as major opportunities for real cost savings in the future.”
Given these factors, three of HMC’s more cutting-edge clients are actively pursuing a Medicare BEP strategy as part of their overall financial plans, he says. Senior management in each facility sees it as a key component to long-term financial viability. Whittlesey notes how some clients are more focused on how much their total cost structure has to change beyond just Medicare, as well. “Breaking even on Medicare is just a pointer towards how to target their cost management efforts across the board,” says Whittlesey.
Managers: Think about nursing levels, margins, and supplies
In general, facilities that are profitable on Medicare have slightly more aggressive cost positions, particularly in supplies and ancillaries. Recently, HMC used its proprietary data to create a benchmark to see which hospitals were profitable on Medicare patients. One client used this data to see how it compared against its standard benchmark analysis for each of its five facilities. Overall, reaching the client’s Medicare break even required a 16 percent more aggressive improvement plan target, a significant ratchet up. Three of its facilities showed 15 percent, 28 percent, and 49 percent higher excess. Two of its facilities were 5 percent and 9 percent lower in cited savings.
HMC also made discoveries administrators can use to improve performance in the following areas:
Margin requirements. Many organizations would benefit significantly from achieving a 5 percent reduction in inpatient cost position. Hospitals typically view a 5 percent margin as healthy, making that a worthwhile goal to attain.
Nursing levels. HMC found that nursing levels didn’t vary much for Medicare BEP facilities versus others, while overhead and support functions were mixed.
Supplies and ancillary functions. In this category, HMC found much greater differences in BEP facilities when compared with other hospitals. This indicates that those hospitals with stronger Medicare cost positions also demonstrate leaner and more efficient clinical resource utilization.
HMC News•
on April 20th, 2010•
NEEDHAM, MASS. – April 20, 2010 – The Healthcare Management Council, Inc. (HMC) has compiled a cutting-edge white paper of best practices to address the expensive and widely prevalent problem of decubitus ulcers.
Research from HMC has indicated that decubitus ulcers cost around $575,000 for an average hospital annually. A patient acquiring a pressure ulcer requires an average of $9,200 in extra care. This cost is not reimbursed by Medicare or Medicaid and in the future probably won’t be reimbursed by private insurers, either. What’s worse is that this is a preventable off-quality condition, according to Shelley Burns, HMC’s director of knowledge management.
There are solutions, however, says Burns. “Being able to readily discern patterns in your ulcer incidence increases the likelihood that you can fix your decubitus ulcer issues quickly and effectively,” says Burns in a recently released white paper. The first step required is to identify the prevalent patterns of the ulcers in a hospital with the HMC Cost of Off-Quality online cascade. Other types of data analysis are available in the HMC tool set. For instance, the HMC Clinical Analyzer can present many types of rich data around decubitus ulcer incidences, including diagnosis-related groups (DRGs), Physician of Record, Length of Stay (LOS), and cost.
What to look for
Using this data, wound care coordinators and skin teams can identify patterns and begin to take action, says Burns. Administrators should look for these common patterns:
Nursing unit and diagnosis-related group clusters. Ulcers tend to appear most in particular nursing units and DRG clusters. Because of this, administrators can target remedial action through specific training programs. This approach costs less time and money than implementing a facility-wide educational initiative.
Long LOS. Typically, patients with longer stays are more likely to develop ulcers. If the ulcer incidence is clustered in patients with a longer LOS, wound care coordinators can ensure there are special measures applied, such as more frequent skin assessments. Or they can initiate preventive care protocols for these patients.
Admitting Physician. Sometimes there is a correlation between the admitting physician and the occurrence of pressure ulcers in their patients. Wound care coordinators can take action to see if the pressure ulcer assessments are effective and if the physicians are showing due diligence in their documentation.
Random occurrences still happen, too
Of course, there are also facilities that will face ulcers that appear outside these categories, seemingly at random. Clinicians in facilities with random ulcer patterns should then consider common patient characteristics, such as nutrition. If they can’t find a common factor, they should assess the house-wide skin protocols, procedures, and education.
