Swine flu is now widespread across the entire country, the Centers for Disease Control and Prevention announced as federal health officials released Tamiflu for children from the national stockpile and began taking orders from the states for the new swine flu vaccine. Anne Schuchat, MD, the CDC's director of immunization and respiratory disease, said there was "significant flu activity in virtually all states," which, she added, was "quite unusual for this time of year."
Effectively managing your service line requires not only an investment in developing a comprehensive system of care that engages all the key stakeholders, but also a commitment to continuously tracking, trending, and benchmarking your performance at the service line level. Outcomes management is an integral component of a destination center and acts as the driver for continuous performance improvement. Managing from metrics often separates the good from the great institutions.
To quote Peter Drucker, the man often credited with inventing modern management, "If you can't measure it, you can't manage it."
There are five key categories of measures you should be tracking:
Patient experience
Functional outcomes (i.e., post-surgical results)
Operational data (e.g., average length of stay [ALOS])
Clinical indicators (e.g., complications, range of motion, blood transfusion rates)
Financial data (e.g., contribution margins, market share)
In general, the traditional management model is weak at collecting and aggregating this data into a comprehensive service line dashboard that can easily be shared and understood.
Patient satisfaction is probably tracked most consistently because it has become essentially mandated by the government through financial incentives, has benchmarks for comparison, and is understood by most stakeholders. Unfortunately, in many institutions, patient satisfaction scores are not specific enough to lead to significant improvements.
They are often used as a grade to compare against other institutions rather than a tool to continuously improve. This is especially true if a hospital's percentile ranking is already high.
Surprisingly, hospitals often struggle to report service line data about costs, contribution margin, net margin, and market share. They, therefore, cannot effectively analyze differences in cost among physicians or other variables that might drive profitability; nor are they comfortable sharing this data with the physicians and staff who could help make important improvements.
Furthermore, without any benchmarking data for comparison, hospitals do not understand how well they are performing. This lack of transparency leads to problems when administration makes statements such as, "we are losing money on joints." Without supporting data or identification of the root causes, physicians assume that the statement must be false or that it's their colleague causing the problem—and trust is eroded.
Operational data such as LOS, discharge disposition, volume, and market share is often but not always available. The data is likewise not typically physician specific. Again, without benchmark data it is difficult for hospitals to understand whether their ALOS and discharge dispositions are consistent with practices at other institutions. The discrepancies in ALOS for joint replacement patients can vary from a low of 2.5 days to a high of 5 days. Discharge to home can vary from 10% home to 95%.
Clinical data such as complications, range of motion, distance walked, pain, and blood transfusion rates are rarely available. Although the data may be collected at the individual patient level, it is typically not aggregated in a way that can be tracked by facility or by physician. So if changes to protocols are made, there is no way to know whether changes were beneficial except by anecdotal means. The only clinical data that is consistently tracked and benchmarked for surgical procedures are process metrics such as use and timing of antibiotics (Surgical Care Improvement Project [SCIP] metrics), done so because the government has mandated or rewarded hospitals for measuring and aggregating such data.
However, with the advances in information technology and increased attention placed on data management, leading institutions are starting to redefine their approach to service line management by investing in developing service line–specific dashboards, identifying reliable benchmark comparisons, and sharing their results with a multidisciplinary team responsible and accountable for service line performance.
Electronic dashboards are now available that make it easy to track, trend, and benchmark service line performance a well as share it with key stakeholders.
Consider the following issues identified and resolved by five different hospitals using the same dashboard:
When one hospital uncovered significant differences in implant costs among five implant vendors, it shared that data with the surgeons to proactively discuss the need for consolidation.
Another hospital discovered a very high urinary tract infection rate for its joint patients compared to benchmark averages and began drilling down into the root causes.
A third hospital pinpointed major differences in reimbursement from private payers, including one that was reimbursing significantly less than direct costs. The hospital presented that data during renegotiations.
A fourth hospital identified a significant variance in average distance walked among its joint patients after surgery, which was adversely affecting ALOS, and tracked the problem back to the differences in treatments used for pain and nausea management.
A fifth hospital learned it had certain surgeons who were much more likely to discharge patients to skilled nursing or acute rehab, and discussed those findings in an effort to develop a more standardized discharge approach.
All of these examples highlight the value of managing service line performance with meaningful data and benchmarks as well as the potential impact on performance improvement. Destination centers must create a data-driven culture, institute accountability for performance, and reward service line managers for achieving superior performance.
High courts in Georgia and Maryland will decide the fate of caps on noneconomic damages in medical liability cases in each state. The Georgia Supreme Court case stems from a February trial court decision rejecting the constitutionality of the state's $350,000 cap. Maryland's Court of Appeals is set to hear arguments on whether the state's caps apply only to cases that are arbitrated.
On the sixth day of the debate in the Senate Finance Committee, Chairman Max Baucus (D-MT) declared that his panel has the votes to approve a package of reforms that would extend coverage to more than 30 million Americans who lack insurance. He and Sen. Charles E. Grassley (Iowa), the ranking Republican on the panel, said they expect to finish the bill by October 2.
In the scramble to find money to overhaul the healthcare system, Senate Democrats have been eyeing the most generous insurance "Cadillac" plans as a lucrative target to tax. But as the competing proposals are debated, few people can agree on exactly what constitutes a Cadillac plan, according to the Washington Post.
Audits of select Massachusetts businesses suggest that a substantial number may not be providing workers the health coverage required by the state's insurance law. Of the 426 companies audited so far, 40% had violated the law's requirement that most employers contribute a portion of their workers' insurance premiums or pay a penalty. Business leaders say the problem is that the rules are so confusing that many employers are having a hard time understanding what is required of them.