By Maggie Van Dyke
This infographic highlights Alegent's and Spectrum's quality transparency approaches.
If you have trouble reading this jpg file, download a PDF of this infographic.
The phone did not ring off the hook as expected. In September 2005, Alegent Health thought it was making a dramatic move by posting its quality scores on its website and in the local Omaha, Neb. paper. "We thought it was an enormous deal. We thought we'd get all kinds of questions and start discussions in the community," says president & CEO Richard A. Hachten II, FACHE. "But most of the questions came from our competitors who wondered why we were doing this," he added with a laugh.
However, one very important contingent-Alegent physicians and employees-took the publicly posted metrics very seriously. Unhappy with their performance on nationally recognized quality measures, they committed to meeting aggressive improvement targets. Within a year, Alegent's scores rose to 94 percent on average, from below 90 percent. Today, the health system scores 97 percent or better on 40 quality metrics.
Alegent has successfully achieved one of its transparency goals: "This is about delivering the very best care that we can for our patients, and continually challenging ourselves to improve," says Rick Miller, DO, senior vice president & chief quality officer. The health system is also inching toward its second goal of giving patients useful information that can help them make educated decisions when selecting a hospital. More than 5,000 people a year now visit Alegent's online quality scores.
Nationally, patients have been slow to make use of healthcare quality reports. Only 12 percent of adults who responded to a 2011 Pew Internet survey have consulted online rankings or reviews of providers. "We're still very early in the process of educating the public about quality," says Miller. "And we're continually challenged about how we present and explain quality information. Patients are beginning to try and dig in and understand things. But we have a responsibility in that process and in helping educate people."
Like Alegent, Spectrum Health saw a significant improvement in quality scores after the Grand Rapids, Mich. health system posted results on its website in 2008. "We have a lot of internal incentives that motivate our staff to continuously improve quality," says John Byrnes, MD, senior vice president of quality. "But when staff know data is going to be shared publicly, it provides an additional motivation. Some of our teams really got to work and made improvements very quickly."
Spectrum posts scores on all the core measures, or the metrics reported on Medicare's Hospital Compare website. It also shares scores on additional metrics for cardiac and orthopedic care, which are two of the health system's key service lines.
Before posting its scores, Spectrum consulted patients for advice. "We worked with our Patient and Family Advisory Committee and held numerous patient focus groups for more than a year to try to determine how we could present the quality scores in the most understandable way," says Byrnes. The key messages from patients included the following:
Spectrum staff used this feedback to develop quality reports for six conditions or procedures, including community-acquired pneumonia and heart attacks. Plus, there is a separate quality report for the Surgical Care Improvement Project.
Many of these reports graphically compare national readmission and mortality rates against Spectrum's rates (see the exhibit below).
The reports also graphically highlight and explain Hospital Compare metrics. For example, on the community-acquired pneumonia report, patients can see what percentage of Spectrum pneumonia patients received a pneumococcal screening and/or vaccination-compared to the national and Michigan averages (see the exhibit below).
Three elements help make this Spectrum graphic more meaningful to patients:
Spectrum also includes additional information on its website (under the banner "Quality") that educates patients and other visitors on How to Evaluate Quality and Resources for Quality.
A lot of what Spectrum has done in creating its quality reports follows best practices laid out by the Agency for Healthcare Research and Quality (AHRQ). For instance, AHRQ recommends that organizations use color, symbols, and simple words to help consumers process and interpret data quickly.
See the sidebar: Tips for Designing and Promoting Quality Reports
Alegent took a somewhat different approach to simplifying quality information for consumers than Spectrum. When visitors click on "Quality" on Alegent's website, they are brought to a single scorecard, or composite report, entitled Alegent 40.
"We roll the scores up into composites for the various disease states that we measure," says Angela Ward, quality and ancillary services executive. "To make it personal for us, we rebranded the scorecard as the 'Alegent 40' because we want it to be about the care that Alegent provides and show that it is important to us to continually improve that care."
The Alegent 40 includes:
"The difficulty with quality and safety measures is that the things we are measuring are fairly technical in nature," says Hachten. "For example, the measure 'how many patients got a beta blocker after an MI' means something to me, but it doesn't necessarily mean anything to the average person on the street."
To get around that problem, the Centers for Medicare & Medicaid Services (CMS), as well as some consumer organizations and payers, have put together aggregate scores. "For CMS' Hospital Compare, a hospital is at the national average, above the average, or below," says Hachten. "I think that approach is helping the public understand an organization's overall quality."
For website visitors who are interested, Alegent also posts more granular reports on how each of its hospitals is performing on all the Hospital Compare metrics.
Neither Spectrum nor Alegent list the quality scores of their competitors or even noncompetitive peers on their public quality reports. On Spectrum's reports, patients can compare Spectrum's performance against the national and Michigan hospital averages. But only Spectrum facilities are singled out on the health system's quality reports.
Alegent doesn't even provide national or regional averages-only the scores of Alegent facilities. "This is not about marketing," says Miller. "The motives are very pure."
"This is truly about feeling a clear sense of responsibility to be transparent about all the aspects of care that we are providing to the public," adds Hachten. "It not only holds us accountable to our patients but it hold us accountable to ourselves to provide the kind of care to patients that we like to think we provide to them."
Interested consumers can easily compare the performance of Spectrum or Alegent hospitals against other hospitals via the Hospital Compare website-and both Spectrum and Alegent do link to Hospital Compare from their websites. "It's all nationally reported data," says Miller.
On their quality reports, both Alegent and Spectrum purposely detail how well each of their hospitals is performing on various metrics to inspire internal improvement. "We initially got some push back from some of our physicians about publishing these scores," says Miller. "But it set up a competition of sorts among our physicians and employees, and the scores started significantly improving."
One score that has improved dramatically is hand washing. "I remember when we first started talking about handwashing, our scores were in the 60th percentile," says Miller. "Now we report this metric every month for all of our campuses. We use secret shoppers who go out and actually observe whether staff is washing their hands when they should be."
Now handwashing scores at all Alegent hospitals are in the 98th percentile. Most important, healthcare-acquired infections have gone down. "As our hand washing went up, our rate of Methicillin-resistant staphylococcus aureus (MRSA) went down-directly proportional to the amount of hand washing," says Hachten.
Communicating the linkage between process measures (such as handwashing) and outcome measures (such as lower MRSA rates) helps further motivate staff to improve, says Ward. "It's really important for staff to see the 'so what'? Everyone wants to do best thing for our patients."
Alegent furthers drives continuous improvement across the health system in two ways. First, all leaders and frontline staff have performance incentive goals around the Alegent 40 quality metrics, as well as patient satisfaction. "We take this seriously," says Hachten. "It's everybody's job."
Second, Alegent has developed formal approaches to sharing best practices with the goal of creating the same standard of care across the health system. "We have a care redesign process that involves all our campuses," says Hachten. "Each team takes a diagnosis and redesigns that diagnosis to meet national best practices and guidelines. We take waste out of system using Lean techniques, and we redesign for cost, quality, safety, and patient satisfaction. So we have regular meetings, which we call decision accelerators, which bring people together from across the system to learn from each other and continuously redesign."
Asked how he hopes to improve Spectrum's quality reports, Byrnes says he hopes to add more metrics and more conditions. Specifically, he's hoping to beef up Spectrum's heart surgery quality report with additional metrics from cardiac specialty organizations as a way of drawing more attention to the health system's center of excellence. "When I looked at how well our vascular surgeons are performing compared to others, I'm excited to share this data with patients."
Spectrum sees its quality reports as part of its brand, says Byrnes. "Quality is a leading factor in our strategic plan-and it is central to a lot of the work we do in our primary and secondary service areas. We lead on quality and cost, and those are the main messages of our marketing plan."
Hachten believes more work is needed on a national level to develop and report on quality metrics that matter more to patients. "When I think about what patients really care about, I think they want to know if they will get better quicker, how much discomfort they are going to have after surgery, or what level of health they can reasonably expect to attain as a result of a surgery, procedure, or a therapy."
The National Quality Forum and others are beginning to develop these types of patient-centered measures. For instance, an Apr. 9, 2012 post on the Health Affairs blog highlights efforts in Sweden and the United Kingdom to collect data on health gain and patient satisfaction after orthopedic surgery (Lansky, D., Public Reporting Of Health Care Quality: Principles For Moving Forward).
However, it may be years before providers can report on these types of measures. "Collecting this type of data is very dependent on the IT systems we have," says Hachten. "Today, we don't have the ability to track patient-centered outcomes, but as we get more clinical data systems, better electronic health records, we will be able to report on metrics that are much more meaningful to patients."
Another challenge is getting more patients to use quality reports to make healthcare provider choices. "Many patients don't even know these reports are out there," says Hachten. "The more we report these scores and expose patients to them, the more familiar they will become with them."
He urges other hospitals and health systems to post their quality metrics. "You need to get over your fear of putting your information out there-even if it's not good. Posting your scores demonstrates to your patients that you really care enough to tell them what they need to know-and that you are willing to work to improve quality."
Access a related article on how Alegent and Spectrum are communicating prices: Lessons Learned from Hospital Transparency Pioneers
Maggie Van Dyke is managing editor of HFMA's Leadership publication (email@example.com).
Interviewed for this article:
John Byrnes, MD, senior vice president of quality, Spectrum Health, Grand Rapids, Mich. (John.Byrnes@spectrumhealth.org).
Richard A. Hachten II, FACHE, is president & CEO, Alegent Health, Omaha, Neb.
Rick Miller, DO, is senior vice president & chief quality officer, Alegent Health.
Angela Ward, FACHE, is quality and ancillary services executive, Alegent Health.
ClearBalance: Boosting Patient Payment through Consumer-Friendly Loan Programs
In this Business Profile, Bruce Haupt, president and CEO of ClearBalance, discusses how a patient loan program can increase patient collections, reduce bad debt, and speed cash flow.
6 Patient Revenue Cycle Metrics You Should Be Tracking (and How to Improve Your Results)
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
Deloitte Consulting LLP: Employing Innovative Solutions to Optimize Revenue Cycle Performance
In this Business Profile, Jerry Bruno, principal with Deloitte Consulting LLP, discusses the importance of choosing revenue cycle solutions that help an organization meet the challenges of a quickly evolving healthcare environment.
10 Ways to Reduce Patient Statement Volume (and Reduce Costs)
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Grant Thornton LLP: Maintaining and Improving Collections During an EMR Implementation
In this business profile, Lane Jackson, a partner in the Grant Thornton LLP Health Care Advisory Services practice, with extensive experience in overseeing system implementations and revenue cycle reorganizations, discusses best practices for elevating revenue cycle performance during an EMR implementation. Grant Thornton LLP is a sponsor of the Large System Controllers Council Affinity Group.
Reduce Patient Balances Sent to Collection Agencies: Approaching New Problems with New Approaches
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
KeyBank: Offering Expertise in Tax-Exempt Financing to Give Health Systems Flexible Options for Growth
In this business profile, Amy Gross, senior vice president of Key Government Finance, discusses the benefits of private placement transactions to support large-scale financing projects.
The Future of Online Patient Billing Portals
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Xtend Healthcare: Enabling Efficient Business Office Workflow
In this business profile, Doug Polasky, executive vice president at Xtend Healthcare, explains the importance of having sound workflow processes in a consolidated business office to ensure optimal performance and reduce costs.
Payment Portals Can Improve Self-Pay Collections and Support Meaningful Use
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
SSI: Bringing Patient Access to the Next Level
In this business profile, sponsored by SSI, Jay Colfer, vice president of sales and marketing, shares how patient access solutions are reversing the trend toward increased bad debt resulting from the rise in high-deductible consumer health plans.
Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
Deloitte: Helping Organizations Elevate the Healthcare Consumer Experience
In this business profile of Deloitte Consulting, Matthew Hitch and David Betts explore the potential benefits of elevating the customer experience and outline strategies to change service delivery.
ICD-10: Managing Performance
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
TriMedx: Elevating and Streamlining Clinical Engineering
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
Clarity Drives Collections
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Orlando Health Gains Insight into Denials, Reduces A/R Days with RelayAnalytics Acuity
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
Revenue Cycle Payment Clarity
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Streamlining the Patient Billing Process
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Wallace Thomson Hospital Automates to Maximize Limited Resources
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
7 Steps for Building and Funding Sustainability Projects
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Key Capital Considerations for Mergers and Acquisitions
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
Key Capital Considerations for Mergers and Acquisitions
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Trend Watch: Providers adapt as value-based care moves from hype to reality
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center case study
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Reforming with a New 50-Bed Acute Care Facility
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
5-Minute Briefing on Revenue Integrity Through HIM WhitePaper Hospitals FS
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
Providers Focus Too Much On Revenue Cycle Management
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
Lucille Packard Children’s Hospital Stanford Case Study
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
Using Predictive Modeling To Detect Meaningful Correlations Across Claims Denials Data
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
ZOLL and Emergency Mobile Health Care Case Study
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Maximizing Medicare Reimbursements White Paper
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Denials Deconstructed: Getting Your Claims Paid
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Automation and Operational Improvement Drive Sustainable Results
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Revenue Cycle Management Resolves Migration Implementation Issues
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
Partnering For Success – Provider Achieves Strength in Stability
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.