ProHealth Care and Children's Hospital of Wisconsin are in discussions with Waukesha Memorial Hospital's to have Waukesha's neonatal intensive care unit and its inpatient pediatric unit become part of Children's Hospital. Children's Hospital has similar arrangements with Kenosha Medical Center and Theda Clark Medical Center in Neenah. The agreement would enable Children's Hospital to provide care closer to home for children in the Waukesha County area. It also would enable Waukesha Memorial to affiliate with one of the largest children's hospitals in the country.
The University of Kansas Hospital has implemented a mandatory training program—the first of its kind in the nation—to train staff on how to handle delivery emergencies. The exercises are designed to save newborns and their mothers during potentially catastrophic emergencies. About 100 members of the hospital's staff have been going through two days of classroom and hands-on training. They have been learning how to deal as a team with a variety of obstetrical emergencies that are each relatively rare, but account for many of the deaths and serious injuries of childbirth.
Over the next few years, the world is likely to see a lot more investment, medical staff, and patients crossing borders into other countries. The surge in global medical tourism could prove a powerful catalyst for government bureaucracies and sclerotic American health-maintenance organizations to think afresh about what they do, according to this article in The Economist. It may even introduce competition to private healthcare in America and elsewhere, say the authors.
Is there a point where CMS' demands will become more important to hospitals than providing actual patient care? I suspect that most CEOs would immediately answer "No!" But as CMS reporting requirements continue to increase, there may come a time when healthcare organizations are forced to choose between collecting data and providing patient care.
The 13 new reporting requirements added by CMS late last month probably won't add too much of an additional reporting burden on most hospitals. Most of the 13 added indicators are already calculated from Medicare billing information. But by adding these 13 requirements, CMS is sending a clear message to hospitals that data reporting is the way of the future, and many in the industry believe these new mandates are the tip of the iceberg. There may come a day when a hospital will have to choose between hiring an additional nurse for the intensive care unit, or an additional staffer to collect and report data.
Which will you choose?
Answering that question will no doubt be difficult. Hospital executives know how important reimbursement from CMS is to the financial health of a hospital, and they must do everything they can to position their organization to receive the appropriate amount. But on the other hand, making someone a data collector rather than a caregiver seems to go against the mission of any hospital. And as patients get more demanding, the care you offer them can also have a financial impact on your organization.
Studies have shown that patients remain unconcerned with data when it comes to healthcare, and they are even less interested when the data is something that they don't understand. Most patients, for example, don't know why the time between when a patient comes out of surgery and when he or she receives a beta blocker is important. What does matters most to patients is that they have a nurse who responds quickly when they hit the call button, gives them medication on schedule, and helps them out of bed to use the restroom. For patients, quality is receiving the care they need when they need it. And if they don't receive the care they want, they're likely to take their business elsewhere, and that of friends and family who hear about their poor hospital experience.
Thankfully, the 13 additional reporting indicators that CMS will require in this year's rule won't be significantly taxing to a hospital's resources. The new requirements are significantly less than the 43 the agency proposed earlier this year. However, I'm not convinced that the 30 requirements that didn't make this year's cut are gone forever. Down the road, CMS will place further reporting mandates on America's hospitals, and at some point, executives might have tough choices between patient care and the organization's financial wellbeing.
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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More evidence shows that medication is often just as effective as an artery-opening angioplasty for patients with chronic chest pain. Although angioplasty remains the top treatment for such patients, the number of those performed has declined since 2007.
Physician practices do not always realize the level of change necessary to successfully implement and use a pay-for-performance (P4P) program. Before you can see the benefits of P4P, you first have to weave through some obstacles and find new ways to approach quality performance.
One of the obstacles many physicians face when starting a P4P plan is changing the practice's perspective of clinical care to match set requirements. Consider these three steps to resolve this issue:
1. Restructure your practice. Meet with the front office staff and educate them about this program. Teaching staff members the measurements will help doctors achieve their performance. For example, staff members need to know which patients have diabetes in the office. They need to know what specialist to refer the patient to, and they must give clinical staff members the proper follow-up information for a particular patient.
2. Organize physician notes. Practices' patient information system need to be redesigned to show patients' demographics, such as weight, height, age, and medication documentation.
For example, group all the major diabetes medicines by blood pressure and cholesterol.
3. Implement a health maintenance profile. The profile could be a list of metrics for a diabetes patient, including dates for his or her flu shot, when he or she needs to see a specialist, and when the previous blood work appointment was made, for example. Be sure to update these regularly.
P4P can be complicated to understand and requires the practice and its physicians to change their perspectives of care in order to see rewards. Consider the following questions before diving into a commitment.
Can this plan help with quality of care in my practice? Do the cost benefits add up in my favor? Am I ready to change?
What conditions and protocols or procedures will I measure with this P4P program?
Who will analyze the charts, data, and patient information to measure my performance accurately and according to the plan?
This article was adapted from one that originally ran in the August issue of The Doctor's Office, a HealthLeaders Media publication.