Benchmarks: Elusive and Expensive, yet Essential to Improving Health Care

One of the most common questions we receive is around benchmarks; whether we have one benchmark or another, how to find one, etc. Usually the person asking is looking for such a specific benchmark, it just doesn't exist. Or if it does exist, it's very expensive to purchase (for example, fall rates or radiology turn around times).

In our experience, when a client purchases a benchmark or obtains a third party benchmark in some form, it usually ends up not exactly matching their own data set. Then their analysts usually spend more time explaining the differences between their institution's performance versus the benchmark (for example, they include overhead cost while we do not). Too many times have we seen hospitals spend large amounts of money on these "benchmarks" only to ultimately explain them away as irrelevant -- especially if the hospital doesn't look so good against them.

Despite these challenges, benchmarks remain essential to determining whether our hospitals are performing within a reasonable range. So what can you do to get benchmarks and cost effectively assess your hospital's performance?

1. Check with your local hospital association. Many, like the Michigan Health & Hospital Association have data sharing, mining and benchmarking systems already in place.
2. Make your own benchmark. Use data from your organization's best performers and compare them to everyone else. Make sure your population is large enough (i.e. statistically significant) and, if you're using people data (like lengths of stay by physician), consider whether you should keep individual performance private. And probably most importantly, severity adjust your data whenever possible.
3. Partner with other organizations. Partner with organizations similar to yours to pool data and create a data-sharing co-op. Chances are, they're working on similar improvement projects and could use the same benchmarks. If competition is too fierce between yours and your ideal benchmark organization and you don't feel comfortable approaching them, ask a neutral third party such as a consultant to broker the deal. Make sure you approach organizations of similar size, case mix and acuity and that they are respected by your project's stakeholders. Finally, make sure your organization has something to offer your potential partner organization. Maybe they don't need your lab TAT data but would gladly make an exchange for radiology data.
   

Finding the perfect benchmark doesn't have to break the bank or consume all of your project hours. Like all health care improvement projects, it just takes a little creative thinking.

Do you have other tips for obtaining or creating benchmarks? Share them here by posting your comments below.

Health Reform: How Hospitals Should Prepare

In the wake of all the health reform discussion, one important issue is rarely raised: Quality of healthcare. Most of the attention is on health insurance and covering the uninsured. However, we know quality reform is on the President's agenda. From the White House website:

"The President’s plan includes proposals that will improve the way care is delivered to emphasize quality over quantity, including: incentives for hospitals to prevent avoidable readmissions, pilots for new "bundled" payments in Medicare, and support for new models of delivering care through medical homes and accountable care organizations that focus on a coordinated approach to care and outcomes."

You can't count on this going away quietly either, because quality improvement is center in the President's strategy to pay for health insurance for everyone.

This could mean a lot of significant changes will be headed toward providers, especially hospitals. The sooner we prepare, the better. So what should you do to prepare your organization?

We'll focus on readmissions here, since some private-sector initiatives are already in place. First and foremost, start looking at your hospital's readmission rates. Don't track them in all areas? Start. Your quality department might already track readmission rates of open heart patients, but this won't be enough. Surely financial incentives will start with the most common diagnostic groups and eventually be rolled out across the board. For many hospitals, just implementing the ability to track and monitor these readmissions could prove to be difficult. If you're using a manual method, you better start thinking about upgrading your technology and improving your process. Otherwise, it will be very costly to manually track readmissions of large numbers of patients down the road.

Once you have an efficient monitoring system in place, you'll need to develop a methodology to determine whether readmissions were clinically related to the initial admission. Make sure your entire team from physicians to coders are properly recording evidence along the way that clearly indicates when readmissions are not related to the initial admission. This could mean re-evaluation of processes, physician and staff education, and building new rules to hold people accountable. As such, this too could prove to be a difficult task, so the sooner you prepare and practice, the better.

With accurate coding data, you'll be able to weed out the unrelated readmissions and focus on those admissions which are related. Only then will you be able to efficiently determine why readmissions are occurring and how you can prevent them. You'll be able to identify trends and sources (such as nursing homes) and solutions will become evident.

Underscoring the importance of reducing readmissions, the Institute for Healthcare Improvement has already begun an initiative to address readmissions. Reducing readmission rates is important from both a financial as well as quality perspective.

Secret Shoppers to Improve Your Healthcare Business

Any health care business can benefit from implementing a secret shopper program. Hospitals, nursing homes, assisted living facilities, medical clinics and doctors' offices can improve not only patient satisfaction, but also quality, efficiency and profitability.

A healthcare secret shopper program is unique from retail programs in that the shoppers may have to undergo clinical testing to gain the full experience. Some programs go so far as to subject the shopper to diagnostic tests such as MRIs and blood draws, but rarely further than that. Your program need not go quite that far to reap the rewards of a secret shopper program; that's a choice you can make and depends on how far into the patient experience you want to evaluate.

Obviously, you'll have to weigh the cost of unnecessary procedures against the knowledge you'll gain from delving into those experiences from a patient perspective. If you're evaluating an imaging center's patient satisfaction, undergoing an exam is a major part of the patient experience. You should take that into consideration before you decide. On the other hand, if you're evaluating an emergency room, undergoing clinical procedures and exams might not be your primary concern (and they are more costly in this setting). You might prefer to evaluate just the triage experience and ask your shoppers to refuse treatment once they're sent to the back.

Whatever you decide, we've compiled a few tips to get you started on designing a successful healthcare secret shopper program.

1. Involve employees from the beginning. Secret shopper programs can be devastating to employee morale if executed poorly. Avoid this by simply keeping them informed. Better yet, involve them in the design process. For more information, read our previous post about getting your team invested in a project.

2. Set measurable goals and make them clear. Before you design your secret shopper program, identify your organization's goals. And don't pick goals like "improve patient satisfaction" or "reduce wait time." Make them specific and measurable so you'll know if the program is working. "Improve ER patient survey scores by 15%" is a good start. Make sure you clearly communicate your goals to employees before the program starts.

3. Evaluate strategically. Think carefully about what you measure and how you measure it. Include the visitor's perspective as well as the patient's. Establish a consistent grading system so you can compare units and departments. Measure on the same scale and use standard dimensions like "service," "process," "friendliness" and "professionalism." Don't use employees as secret shoppers. You run the risk that they'll be recognized and perhaps more importantly, you don't want to allow bias in the evaluation (or even the perception of bias). Finally, consider measuring process as well as experiential data. Have your shopper track wait times and how long it takes to accomplish key tasks like registration.

4. Analyze, report and share the results with employees. Post the results of every secret shopper encounter for all employees to see and to learn from. Consider creating friendly competition with contests and always reward positive outcomes.

5. Make improvements and educate staff. When outcomes aren't so positive, learn from the results, make improvements and educate staff. Do not make it punitive. Again, involving staff is very important and this is another opportunity to do that. Gather your team and identify solutions together.

6. Publicize your work. Let the public know what you're up to; it's a great way to show your commitment to your patients and visitors. Plus you could win over some new fans and increase your market share.

Our healthcare consultants can help you design and implement a successful secret shopper program. Contact us to learn more.

National Hospital Week Giveaway May 10-16

The week of May 10-16 was designated as National Hospital Week to recognize hospitals and their employees and volunteers for all the good that they do for their communities.

Enovasis Healthcare Solutions is celebrating by giving away consulting hours and a WhereToFindCare.com Premium Home Page to one lucky hospital.

For the free consulting hours, we'll analyze a data set (up to 1,000 patients) and identify areas to improve revenue, cost or quality. These projects typically yield a return of $250,000 to $500,000 in opportunities.

The free Premium Home Page is a 1-yr subscription and is a great way to share testimonials of satisfied patients and display your marketing message to consumers choosing a hospital and comparing hospital quality/satisfaction performance.

To enter the drawing, just contact us or DM @bjoconnell by 5pm Friday 5/15/09 and mention the Hospital Week Giveaway. We'll draw one winner Monday 5/18.

Good luck and happy hospital week!

4 Tips to Improve Hospital Bottom Lines

Not even health care is immune to current economic conditions. Hospitals are reducing staff to control their increasing loses. But is this the best strategy?

Sure it’s a good time to reassess staffing levels but reducing staff costs money and hurts morale—critical to patient satisfaction scores. So what else can be done? Some ideas that can save at least a few FTEs:

1. Make sure Medicare is not unnecessarily penalizing you with transfer DRG payment reductions. For example CABG patients sent home too early and with homecare will not earn full payment. Be mindful of Medicare’s expected lengths of stay.

2.Take steps to ensure proper documentation of critical criteria for DRG assignment and avoid DRG downgrading. For example with PTCA patients, documenting the use of drug eluting stents or the presence of major cardiovascular diagnoses is imperative to the correct DRG assignment. Consider modifying the physician operative note to include reminders or create a new document that will trigger proper documentation.

3. Verify that Medicare’s “3-day rule” is being implemented correctly by your automated billing rules. Services unrelated to the inpatient admission do not apply and may be billed separately, thereby increasing revenue.

4. Reduce infections, complications and fall rates (see Falls article, this issue)

Don’t like these tips? There are plenty of other options. You can find new ways to improve profitability by performing methodical and thorough data analyses. Start by assessing the profits and losses on each of your service lines, drilling down to the DRG, physician and even patient levels while looking for patterns.

Need help? Find out how we can support you for as little as $100.

Patient Satisfaction Data: Healthcare Improvement Goldmine

There are no shortage of improvement projects to be done, but how do you know which ones are the most important? Ask your patients.

Health care is becoming increasingly competitive every day. Providers are trying to steal market share as overall volumes decrease. As any good business course will tell you, it is far easier and cheaper to retain customers than to obtain new ones. So how do you retain patients? One way is to keep them and their visitors happy.

Patient surveys can be immensely valuable in identifying trends or even uncovering unknown issues. Yet many organizations still have very separate patient satisfaction initiatives that rarely coordinate with improvement experts. Often patient satisfaction initiatives are led by a customer service department that doesn’t have the training or tools required to be successful.

Improvement experts and consultants can make a big impact on their organization’s performance and improve the efficiency of their customer service counterparts by incorporating patient satisfaction data in their opportunity analyses.

Doing so may reveal new or previously unknown issues before they become larger issues. Patients will tell you if that new check-out process designed to improve throughput is actually more difficult for them.

Patient satisfaction data will also help you prioritize projects. Why would you want to spend time and money shaving a few minutes off your billing process when your patients’ discharges are delayed 45 minutes because no wheelchairs can be found?

Some advice on using patient satisfaction data to identify improvement projects: Do identify trends, but don’t ignore comments. This experiential data is harder to mine, but is often better at identifying root causes. Categorize comments to speed up the process. Also, save money and increase response rates by using free web-based survey tools. Another source of experiential data is secret shoppers. These trained professinals pose as patients and record how they were treated as well as process issues.