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Quality Management Pays

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An anesthesiology group's Web-based tool is now standard in a North Carolina system's hospitals.

From Medicare's increasing emphasis on quality as a key component to reimbursement levels to commercial insurers' focus on pay-for-performance measures, it's clear that quality pays. But getting from measuring and improving quality to a clear return on investment is often a difficult climb. Doing so across service lines can be fraught with many different systems that bring varying results and confusion for physicians, but one way to get there across service lines is to develop such a tool for surgery, as Charlotte, NC-based Southeast Anesthesiology Associates did.

The Web-based tool, called the Clinical Navigation System, helps the physician group document patient satisfaction, OR efficiency, practitioner performance, and clinical outcomes through the perioperative care continuum. It was developed prior to many P4P programs to improve clinical quality, but now has real dollars attached to it. The tool has documented performance for the practice that exceeds national benchmarks from The Joint Commission, the Centers for Medicare & Medicaid Services, and the Institute of Medicine.

"With 2% of Medicare payments at risk based on quality measures, that means real money to the physician group and the hospital," says Richard L. Gilbert, MD, chairman and CEO of the group and chief of the department of anesthesiology with Carolinas Medical Center, the flagship of the 14-hospital Carolinas Healthcare System based in Charlotte. Further, Southeast Anesthesiology Associates has been able to knock 8% off its medical malpractice insurance rates, and has achieved better commercial reimbursement by demonstrating the quality outcomes they've achieved with the tool since they began developing it five years ago. Now being marketed to other hospitals and physician practices through Quantum CNS, a subsidiary of the group, the tool is used in CHS' 14 hospitals and its ambulatory surgery centers.

Although the system doesn't have an impact with CHS hospitals in revenue capture, it does have an effect on quality measures, says CHS Chief Financial Officer Greg Gombar, who adds that the key challenge to getting such systems to work is not developing the tool itself, but in getting clinicians to adapt to the change.

"One of the challenges in healthcare is recording and tracking quality data and whether the clinicians are going to adapt to the change," he says. "With Southeast Anesthesia Associates, their culture is to do this."

The real-time data the system can generate is a key to improving quality in surgery, says Roger Ray, MD, chief medical officer for CHS.

"We battle constantly learning about events remote from when it happens," Ray says. "They can see a trend emerge much quicker than some other systems that depend on patients to be discharged and data collected on the back end."

Ray says as the electronic medical record evolves at CHS, there will be more opportunities for the hospital system to get involved with potential cost savings from the product, which, in essence, relies on its constantly updated reporting feature to develop order sets, policies and procedures, and best practices in the OR.

"Going forward, there will be much more of an opportunity for us to participate," he says. "As we get more into EMR in all our facilities the data will be captured as a byproduct of care rather than data entry as its own event."

Further, he sees potential cost savings to CHS to the degree that the tool measures start times and OR turnaround. "That's clearly a potential cost benefit under the heading of efficiency," he says.

As medical errors have cost consequences attached to them in more and more cases, the tool can help with incident avoidance "just as much," he adds. For any anesthesiologist-hospital partnership, "our hospital is interested in continuous quality improvement and tools that can assist in that journey, Southeast has put a lot of time and thought into how to do it well, and that part's been impressive."

Philip Betbeze

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