Measuring Clinical Quality

The Quality of medical care is a statistical measure. No single definition of healthcare quality is all encompassing or uniformly agreed upon, but certainly no product or service can be improved if it cannot be defined and measured. The Office of Technology Assessment (OTA), JCAHO, and most other organizations use quality definitions that acknowledge the relationship between medical processes and their resultant outcomes, as well as the limits of medical knowledge.

In its definition of quality, JCAHO describes the relationship between care processes and outcomes as “the degree to which the processes of delivering health service increases the probability of desired patient outcomes and decreases the probability of undesired outcomes...” Implicit in these definitions is the valid observation that the extent or measures (degrees) of the processes utilized by care providers to deliver health services are responsible for the observed outcomes.

Verras provides hospitals with the technologies and metrics to measure and improve organizational and clinical process to continuously improve all three dimension of quality – Structure, Process and Outcomes. The most comprehensive expression of inpatient quality improvement is the Index of Accountable Care (IAC). It is a flexible tool that allows a hospital to measure addition outcomes in conjunction with the five fundamental metrics, which are three years of trended performances of: National Hospital Quality Measures, Reductions In Variation, Risk-adjusted Mortality Rates, Risk-adjusted Morbidity Rates and Resource Consumption.

The IAC is easily interpreted by patients, employers and providers alike, much like a Dow Jones Index that can be analyzed down to its most basic quality measures. These same metrics are used by hospitals and clinicians to improve each measure and, where deployed, reimburse the hospitals and physicians on value (quality and costs).

• Acuity Index Method
• Best Practice Analyzer (Sherlock™)
• Accreditation Support Measures
• Index of Accountable Care (IAC)
• Index of Quality Improvement (IQI)

Physician Directed Best Practice Improvements

Over the past decade, Verras has developed its unique, physician-driven, clinical process improvement (CPI) method that enhances the quality and cost efficiency outcomes of physicians’ practice patterns and hospitals’ service lines.

The common language with which physicians communicate is clinical data. Verras’ physicians capitalize on this phenomenon as they interact with the hospital’s doctors using AIM’s severity-adjusted, patient-level information in conjunction with non-threatening educational techniques. This combination of education and clinical information produces experience-based, clinical process improvement at the physician and hospital service levels. The hospital’s physician leaders incorporate these techniques into their quality improvement activities to achieve quantifiable and sustained quality and efficiency enhancements.

Although many hospitals have attempted clinical pathways, the Verras approach is superior for a number of reasons. Physician acceptance is achieved because:

1. The clinical pathways are based on their own physician-driven, best-demonstrated practices, not on an externally generated set of ”cook-book recipes”.

2. Experience-based CPI concentrates on improving processes rather than on punitive ”good doctor vs. bad doctor” approaches.

3. Verras physicians work with the hospitals’ medical leaders to apply these processes and facilitate physician-to-physician communications in all of the hospitals’ clinical services.

4. Verras can supply chart-level data gathering templates that optimize the hospital’s Clinical Improvement Process.

• Documentation and Coding Enhancement Services
• Inpatient Physician (Hospitalist) Data Analysis Services
• Outpatient Surgery Clinical Services
• Hospital Competitor Analysis
• Service Line Opportunity Analysis

Physician-Hospital Collaboration

Provider Opportunities Afforded by New Federal Initiatives

The Congressional Budget Office (CBO) stated in June, 2010 -”Slowing the growth rate of outlays for Medicare and Medicaid is the central long term challenge for federal fiscal policy.” Two recently deployed federal initiatives are being used to align hospitals’ and physicians’ incentives and thereby control costs. Both programs are synergistic with the providers’ and purchasers’ desires to improve both the quality and cost efficiencies for all patients. Both the Accountable Care Organizations (ACO) and Acute Care Episodes (ACE) use global (shared) fees to align hospitals’ and physicians’ financial incentives and facilitate quality improvements. Innovative providers are taking advantage of these opportunities to gain market share and increased profits. A third program targets commercial patients and creates federally subsidized, not-for-profit insurance companies that can be formed and managed by integrated hospitals and physicians. These Consumer Operated and Oriented Plans (CO-OP) are the means by which providers can market directly to employers and self-pay individuals and share profits generated by improved efficiencies. The strength of the CO-OP concept for providers is that contracting is done without a traditional insurer or HMO.

Verras answers the three most important questions facing hospitals that are considering becoming an ACO or CO-OP:

1. Does the hospital have the data to objectively measure clinical outcomes improvements that will determine the percentage of year-end financial savings to be shared between the hospital and physicians? (Only objective, transparent and clinically reliable data can create a “trust but verify” environment that will satisfy both the hospital and physicians as they share financial savings.)
2. Does the hospital have the objective outcomes to measure each clinical service’s (cardiology, orthopedics etc) quality and financial improvements that will determine the percentage of year-end, financial savings to be shared among the physician groups?
3. Does the hospital have the ACO mandated, interoperable information infrastructure for secure, standards-based data sharing between the hospital and physicians’ present and future office EMRs?

Accountability and Transparency: Objective, comprehensible clinical data are the basis for collaborative hospital and physician relations as well as the means of effective communication with patients, employers and governmental agencies.

• Physician Incentives
• Acute Care Episodes (ACE)
• Consumer Operated and Oriented Plans (CO-OP)
• Accountable Care Organizations (ACO)

Innovative Leadership

Innovative leadership and creative strategies are exactly what is needed to act on the implications of healthcare reform and begin early adoption of leadership, operational and strategic initiatives.

Our team will become trusted advisors that promote the achievement of core professional and organizational goals and inspire new thinking when all the obvious strategies have been exhausted.  We have unrivaled expertise in analyzing, guiding, coaching and revitalizing leaders and their organizations.

The Three "C's" of Success - Courage, Creativity, and Competency

Our seasoned professionals who have dedicated their careers in the healthcare industry will work with leaders and their teams to gain courage, creativity, and competency in achieving excellence. In addition, the Verras team will guide leaders in developing a roadmap to deliver a higher level of performance that will translate to improved financial performance, clinical quality, stakeholder engagement and patient satisfaction for the entire healthcare enterprise.

It is our goal to help organizations successfully integrate clinical and operational systems that will facilitate improvement in quality and efficiency of care.

We have a full range of programs around Innovative Leadership and Executive Coaching and can customize programs to meet your individual organizational needs:

1. Executive Coaching
2. The ASU Innovation Leadership Certificate Program,
3. The LEAD Program for Front Line management, and
4. Energized Leadership to revitalize and energize your leaders while reducing compassion fatigue.

The focus of Executive Coaching is to align individual and organizational goals and successfully execute strategies to enhance leadership effectiveness and improve outcomes for the organization.  Many of our Innovative Leadership products incorporate Coaching within their content.  Executive Coaching can also be contracted and deal with on a specific and individual bases.  Coachinig can be contracted on a per diem bases or with a defined context in mind.

We have the partnership with the ASU College of Nursing & Health Innovation to help organizations by delivering the new and innovative program called the Innovation Leadership Certificate Program.  This program will help infuse your organization with new, creative and innovative ideas as well as strategies for moving forward those promising ideas and projects that have become "stuck" during the implementation or planning phase.  This program will help to strengthen the organization using practical applications of innovative leadership through project work and coaching.

The LEAD Program will assist the Front-line management to improve the patient journey.  Through coaching and leadership development guidance we focus on improving the management capabilities and behaviors by helping managers deliver benefits through specifically defined projects. This program is to help front Line managers learn and utilize all the skills necessary for them to be effective in their roles - from interpreting and understanding data and variations to working with process and flow improvements.

"Energized Leadership" is a program that is designed and customized to your needs to help nursing and healthcare leaders across the continuum from C-suite to front line managers.  This program will energize your leaders to move forward in this time of healthcare reform and change.  Energized Leadership deals with gaining new insight and perception around engagement, beliefs, presence, and intent for self and others with the focus of re-energizing the individual and team. Utilize this program to revitalize and energize your leadship team while reducing compassion fatigue within your organization.

As trusted advisors, we have worked with governing boards, executive level management, physician leaders and other healthcare professionals to unlock new potentials and achieve higher levels of performance for the organization.  We have the experience and expertise to deliver the innovative program and experience for you and will customize it to meet your organizations specific needs