Implementing Core Measures for Implementing Core Measures for Vermont HospitalsVermont Hospitals

May 2, 2002

Anthony C. StanowskiAnthony C. StanowskiSenior Regional Director , Provider DivisionSenior Regional Director , Provider Division

Jacqueline White, RN, MSNJacqueline White, RN, MSNDirector Clinical Product ManagementDirector Clinical Product Management

Agenda

• Background and History

• Core Measures Review

• Solucient’s Approach

– Why We Are Different

• How It Works

• Summary and Next Steps

Background and History

Solucient - VAHHS Partnership

• Operational Performance

• Planning

• Clinical Outcomes

BusinessPerformance

Planning & Marketing Strategy

ClinicalPerformance

Core Measures Is Part of Our Clinical Improvement/ Benchmarking Series

• The Clinical Improvement Series

– EXPLORE

– 100 Top Custom Reports

– SoleSource

» Core Measures Solution

• Improving care and clinical performance

Clinical PerformanceBurning Issues

• Target the “right” opportunities• Ensure effective decisions and

maximum ROI• Drive action and create change to

improve outcomes• Meet and exceed external

mandates– HIPAA– JCAHO– Leapfrog

Solucient - Our History

• Focus is on improving outcomes

• Largest provider of ORYX based solutions to JCAHO - 470 clients

• Solucient partnered with the Georgia Hospital Association as a participant in JCAHO’s Core Measures Pilot.

Solucient and Core MeasuresPilot Program Participation

• 27 hospitals in GA, VA, SC, TX and CA

• Collecting data monthly

– UB92 data

– Sampled, abstracted medical records data

– Linking the two

• Proof of concept -- JCAHO

Goals of Pilot

• Gain experience in implementing core measures• Technical challenges with embedding core

measures into disparate performance measurement system

• Costs– Staff resources– Data collection and abstraction

• Evaluate feasibility of sampling• Assess data quality• Assess timeliness of getting data to JCAHO

Core Measures Review

Core Measures: The Basics

• The next generation of ORYX– Standardized performance measures

• Requires collection of detailed data not typically available electronically

– Premise: more detail required to understand, quantify and change treatment variations.

Core Measures: The Basics (cont’d)

• Four initial areas of focus– Acute Myocardial Infarction– Community Acquired Pneumonia– Heart Failure– Pregnancy and Related Conditions

• Most hospitals will select 2 measure sets– Patient population requirements– Patient volume requirements

Core Measures: The Basics (cont’d)

• Scenario #1: Transition to Core Measures

– Able to select two measure sets based on acute care population

– Discontinue non-Core Measures submission

• Scenario #2: Requires Core and non-Core Measures

– Population served represented by only one measure set

• Reduce non-Core Measures to 4 rather than 6

• Scenario #3: Not required to participate in Core Measures

– Avg Daily Census < 10, or

– Population served not represented in measure set

Core Measures Timeline

November 2001 JCAHO releases final specifications

January – May 2002 Vendors verify with JCAHO

-Solucient completed verification in March

June 30, 2002 Hospitals select vendor and core measures sets

July 1, 2002 Patients from this date forward captured in Core Measures

January 30, 2003 Vendor makes first data submission to JCAHO on behalf of hospitals

Data Abstraction: How Much?

# of Abstracted Fields to be Collected by Measure Set

• AMI 20 fields

• HF 13 fields

• CAP 17 fields

• PR 0-2 fields*

*JCAHO requires that users have the ability to verify and change patient discharge disposition if a discrepancy is noted; Neonatal birth weight is also required but not always present in the administrative data set.

Data Abstraction: Sampling?

Monthly Population

Per Measure Set

Minimum Required Records

< 75 100%

75 – 374 75 records

375 – 999 20% of population

>= 1,000 200

Data Abstraction: FTEs?

Initial Findings from the Pilot Project

• 2 Measure Sets

• 50 records per measure set

– Average = 1/3 FTE

• 100 Beds = 15 hours per month

• 100 Beds = 64 hours per month

• Recent independent study suggests approximately 27 minutes

Our Approach

Core Measures Solution

• Meets all JCAHO Core Measures Requirements

• Delivering to our clients:

– Reduced burden of data abstraction

– Quality checks -- before not after

– Superior client service

– Relation to our suite of products

Front End Designed by

• Develop innovative, user-friendly solutions to put the power of information technology in the hands of users.

• Specialize in Internet-abled products called "weblications". These web-enabled applications serve a broad range of quality oversight and data management needs for hospitals, managed care organizations, pharmaceutical and biotechnology companies.

• Specialize in medical record abstracting and review, utilization review, real time reporting, infection control, and benchmarking.

• Conduct and manage outcomes research for pharmaceutical and biotechnology companies.

Data Collection Improves Data Quality and Reduces Re-Work

• Secure, Internet-based solution• Administrative data interface reduces data abstraction

burden and avoids mismatched records• Integrated UB92 data submission

– Pre-populated data with patient records – Sampling model if applicable and desired by client– “Skip logic” assures collection of necessary data

• Data collection tool has built in prompts and quality checks upon data entry

Solucient’s Core Measures: Data Flow

Data Processing Schedule

Reporting Monitors Process and Data Quality Real-Time

• Data Quality Reports - identify missing / invalid data prior to JCAHO submission

• Data Analysis Reports. Analyze results at the system, facility, patient or attending physician level

• JCAHO data transmission reports - immediate access to verify accuracy Control and Comparison Reports utilizing JCAHO methodology

• Benchmark Reports based on facility-specific characteristics

Solucient’s Core Measures Solution Client Support

• Web-training• Online, facility-specific training database• Toll-free client support desk• Online community• Senior Regional Director to guide approach and

ensure satisfaction

How It Works

Core Measures

This is the Pull sheet - what records you need to

complete

Prompts user to collectappropriate and valid information by pointing them to the abstractor’s guide.• Reduces training time• Reduces data collection time• Increases accuracy

Embedded JCAHO Logic.Each survey filled out is customized for that patient• Reduces training time• Reduces data collection time

– Only relevant data • Increases accuracy

User Defined Fields

• Allow you to gather and enter information on 12 fields that can be populated with anything you want

Computes the results as you go.Enables you to examine missing data, and make

adjustments accordingly - BEFORE you send to JCAHO.

Designed to Support Ongoing Clinical Applications• Real time reporting• On-going fashion

– Looks at results in time to make change – Looks at unadjusted data - prior to send to JCAHO

• Algorithms used to base analysis -- What patient records contributed to results?• Which did not qualify but should have gotten better care?

Categories are defined based on JCAHO algorithm

Filtered on first patient. She

should have had Oxygenation

Assessment done

Summary

Review: Why Solucient?

Our system saves salary dollars by:– Reducing the burden of data abstraction. Our

system takes administrative data, and we • Feed back to you a minimal data set for

abstraction• Quality prompts during data entry. • Select patients for you as described by the

JCAHO.

Review: Why Solucient?

• Is delivered with superior client service. Solucient understands that the new Core Measures initiative will require educational support during implementation and beyond. This product is being launched with a range of support services from web-based training to helpline support to access to a Solucient Online Community dedicated to core measures.

• Market leader. As the largest ORYX vendor and a full participant in JCAHO’s pilot program for Core Measures, Solucient’s experience in meeting JCAHO requirements is unmatched. Solucient is committed to meeting current and future requirements of JCAHO and the changing needs and expectations of our members

Standard Pricing

Minimum three year agreement. After initial year, UB92 submissions are included as part of Core

Measures. Discounts will apply based on VAHHS member participation.

Per Facility

Core Measures Set (2 measures) 10,500$ Implementation of Abstraction and UB92 gathering 3,500$

Total First Year Cost 14,000$

Second through Third Year Costs 10,500$

Option - Additional Measure Sets 2,000$ (not submitted to JCAHO)

Summary and Next Steps

• Meets Your Needs: JCAHO Requirements PLUS:

– Reduced data abstraction

– Quality checks -- before not after

– Superior client service and community

– Related to our suite of services

– Solucient commitment

• Next Steps