Beyond the Ratings: Transformative Strategies in Healthcare Quality Improvement

Key Takeaways:

• Many hospitals grapple with the complexity of diverse public ratings programs, making it challenging to pinpoint where to begin their quality improvement journey.
• To tackle this problem, a large health system in the pacific northwest utilized Premier’s PINC AI™ Quality Enterprise analytics solution to monitor performance data and identify opportunities for improvement.
• As a result, the health system achieved measurable success with high Centers for Medicare & Medicaid Services (CMS) Star Ratings, Leapfrog Hospital Safety Grades® and sustained excellence aligned with Premier’s PINC AI™ 100 Top Hospitals®.

Navigating the complex landscape of hospital performance improvement can be daunting. With various public ratings programs assessing different metrics, hospitals often find it challenging to pinpoint where to start their improvement journey. Whether it’s heart failure mortality or catheter-associated urinary tract infection (CAUTI) rates, the multitude of focus areas can make improvement seem like a moving target. What becomes increasingly clear is it will take a holistic approach to quality improvement to achieve meaningful and lasting gains in public rating performance.

Understanding the financial impact of public ratings programs is vital. Programs like the Center for Medicare & Medicaid Services (CMS) Pay for Performance programs directly influence reimbursement rates, while reputation-centric initiatives, such as the CMS Overall Hospital Rankings, can guide patients in choosing their elective care at top performing hospitals. Hospitals must not only react to their reported performance but also predict future outcomes to plan for potential financial impacts. Incorporating near-term data and benchmarking against national performance allows proactive monitoring and effective improvement efforts.

Patient Centered Care and Performance Ratings

For a 10-hospital health system with an expansive medical group spanning three states in the Pacific Northwest, patient-centered care is a top priority. The health system revamped their performance tracking method, emphasizing compliance with accreditation and engaging clinicians in meaningful quality and patient safety. By strategically focusing on mortality, readmission, safety of care and custom measures, the health systems clinician performance monitoring approach enhances transparency and promotes continuous improvement.

The patient-centered approach that the health system applied to ratings tracking looks beyond measurement and focuses on the true impact of the program. “Whether it’s CMS five-star Leapfrog, National Database of Nursing Quality Indicators (NDNQI) or Magnet designations, they all have very similar foundations. We're able to take all those different strategies and build a solid platform,” said the healthcare organizations System Director for Quality Analytics.

Clear and accurate ratings, regardless of the program, are based on measurement. Measurement outcomes are dependent on articulate coding for a true understanding of program performance. “Coding is absolutely pivotal in understanding the true condition of our patients and where we need to focus…the more granular we get, the better we’re able to understand where we need to create impact,” said the System Director for Quality Analytics.

The healthcare organization utilizes Premier’s PINC AI™ Quality Enterprise analytics solution to monitor performance data. Analytics technology allows the team to view performance against publicly reported data to set direction and reflect on improvement opportunities.

Outcomes

In pursuit of top quartile performance, the health system set a pathway from their current performance and reevaluated each year of their three-year journey and applied their strategic approach to every measure tracked by the system. A unique and conscious decision made by the organization is to look beyond the program and evaluate all patients regardless of payor or age range with the intention to provide great care to all patients.

This approach has led to measurable success, with two hospitals achieving 4-Star and two achieving 5-Star in CMS Star Ratings, and all four Leapfrog eligible hospitals received A Grades. Beyond these achievements, the health system is now aligning quality goals to Premier’s PINC AI™ 100 Top Hospitals® to set more challenging targets and “level up” their performance. Performance improvement initiatives include:

• Engagement with Premier’s PINC AI™ analytics technology to dive deeper into root cause analysis, so they know where to improve and track progress.
• Utilization of Premier’s PINC AI™ Care Science™ Risk Calculator to find coding opportunities to capture the complete picture of the patient’s condition and understand where clinical opportunities exist.
• Participation in the QUEST® collaborative to support CMS Pay for Performance improvement (HAC reduction, readmission reduction, value-based purchasing) and the Perinatal Collaborative for focused understanding of drivers that impact maternal and infant outcomes in their community.

Final Thoughts

Successful quality performance improvement programs need the right tools for sustained momentum and evolution. Premier’s PINC AI™ provides a comprehensive suite of solutions that empowers the quality improvement journey, enabling healthcare organizations to identify and track the highest profile programs including CMS Pay for Performance programs, CMS Overall Hospital Ratings (Star Ratings) and the Leapfrog Safety Grades. These tools in conjunction with Premier’s PINC AI™ Quality Enterprise analytics capabilities provide a foundation to identify, set and manage the full quality improvement journey.

For More:

• Quality Solutions | PINC AI Healthcare Intelligence Engine (pinc-ai.com)
• Artificial Intelligence at Work: Cone Health Reduces Mortality Ratio for Improved Patient Outcomes
• Using Physician Incentive Programs to Enhance Care Delivery and Improve Margins

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