NAPH-UHC Clinical Improvement Tools NAPH Annual Conference June 20, 2002 David Burnett, MD, MPH

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NAPH-UHC Clinical Improvement ToolsNAPH Annual
ConferenceJune 20, 2002David Burnett, MD, MPH
NAPH Annual ConferenceJune 19-22, 2002
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UHC Information Tools to Support Quality, Safety,
and Efficiency Improvement

• Clinical Data Products
• Patient Safety Net
• Faculty Practice Solutions Center
• Operational Data Base
• Benchmarking

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Comparative Clinical Data OfferingsA Source of
Descriptive Data
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Clinical Information Management Provides a Suite
of Services

• Clinical Data Base (CDB)
• JCAHO ORYX Reporting
• CDB-Pharmacy
• State Databases
• MEDPAR Analyses
• Custom Analytic Services

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The UHC Clinical Data Base Provides Comparative
Data on Peer Academic Medical Centers

• CDB pools clinical and financial data using
  discharge abstract summaries and UB-92 data
• Key Outcomes Cost, LOS, Mortality,
  Complications, Components of Cost
• CDB data is fully risk-adjusted
• CDB provides cost estimates, not charges

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The UHC Clinical Data Base Provides Comparative
Data on Peer Academic Medical Centers

• CDB contains all-payer discharges
• CDB allows open comparisons
• institutions compared by name
• CDB data is updated quarterly
• CDB data is fully risk/cost adjusted
• Detailed information on components of costs is
  available

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UHC Product Lines
The 500 DRGs have been assigned to 36 product
lines

• BMT
• BURNS
• CARDIOLOGY
• CARDIOTHORACIC SURGERY
• DENTAL/ORAL SURGERY
• DERMATOLOGY
• GASTROENTEROLOGY
• GYNECOLOGY
• HEART TRANSPLANT

• HIV
• KIDNEY TRANSPLANT
• LIVER TRANSPLANT
• LUNG TRANSPLANT
• MED ONCOLOGY
• MEDICINE GENERAL
• NEONATOLOGY
• NEUROLOGY
• NEUROSURGERY

RHEUMATOLOGY SUBSTANCE ABUSE SURG
ONCOLOGY SURGERY GENERAL TRAUMA UNGROUP/INV UROLOG
Y VASCULAR SURGERY VENTILATOR SUPPORT
NORMAL NEWBORNS OBSTETRICS OPHTHALMOLOGY ORTHOPEDI
CS OTOLARYNGOLOGY PEDIATRICS PLASTIC
SURGERY PSYCHIATRY REHABILITATION
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Web interface allows wide access throughout the
institution
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UHC Clinical Data Base ORYX Core Measure Service
Online data entry tool or data upload
capability Online reporting tool for
Quality/Performance Improvement reviews Control
chart creation for easy review of case data points
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CDB-Pharmacy Report Generation (Examples)

1. What are my top generic drugs within a product
   line or DRG?
2. Where is Drug A being used most in the hospital?
3. What of my CABG pts receive albumin compared to
   other HCOs?
4. Which glycoprotein iib/iiia inhibitors are other
   HCOs using in the cardiology product line?
5. What anticoagulants (DVT prophyx) are other HCOs
   using in pts undergoing total hip replacement
   (THR)?
6. Which physicians are using more antifungals in
   the BMT pt group?

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The UHC Patient Safety Net
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Toward an Epidemiology of Safety

• Focus on actual or potential harm to patients,
  not error
• Approaches tailored to the problem
• Root cause analysis for rare, serious events
• Data analysis for more common, less serious
  events
• Measurement is the beginning of management
• Establishing run rates for most common events
• Identifying areas for more focused process
  improvement efforts

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Design of the Patient Safety Net

• Internet based (server at UHC in Chicago)
• Point of care data entry for adverse events
  near misses
• Simple common classification system
• Rapid event reporting
• Fields for medication errors, ADRs, falls,
  transfusion events, procedural events,
  complications, equipment issues, behavioral
  events, skin integrity, other
• Secondary (password protected) fields for
  analysis of events by nursing, pharmacy,
  quality/risk management

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Special Features of the Database

• Patient, visitor, staff and other events captured
• Close call or near miss reporting
• Anonymous reporting an option
• Customized site of care fields
• Customized e-mail alert functions
• Standardized and custom reports
• Field for legal disclaimer
• Comparative data for benchmarking, detecting
  trends

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UHC-AAMC Faculty Practice Solutions Center
Introduction and Overview
May 21, 2002
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Objectives of the Faculty Practice Solutions
Center

• Facilitate the open sharing of practice
  management and physician productivity data across
  institutions
• Develop and provide access to statistically valid
  and stable comparative benchmarking data
  (physician productivity, departmental finance and
  operations, billing office performance)
• Provide easy to use tools for clinical activity
  reporting and analysis
• Facilitate knowledge transfer and experience
  sharing among academic practice managers
• Provide access to UHC, AAMC, and third-party
  content on practice management issues

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FPSC Features and Attributes

• 50 participating organizations (30,000 MDs)
• 5 consecutive years of MD-level CPT billing data
• Menu of routine and custom comparative
  reports/analyses, provided on a quarterly basis
• Custom benchmarking
• On-site training/implementation assistance
• UHC, AAMC, and syndicated content for MD and
  practice management education
• Community of users on line

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Design of the FPSC

• Member Concern
• existing comparative data not reflective of AHC
  faculty groups
• inaccuracies of survey data
• missing or misclassified data
• significant year to year variability in existing
  comparative data

• FPSC Approach
• numerous faculty groups participating
• broad scope of specialties
• continuous feedback and refinement through member
  involvement
• data submitted electronically
• consistent methodology in RVU calculation
• individual MD detail allows exclusion of outliers
  and analysis of coding behaviors

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UHC-AAMC FPSC Participants

• Alabama
• Albert Einstein/Montefiore
• Arizona
• Arkansas
• Baystate/Tufts
• Chicago
• Cincinnati
• Cleveland Clinic
• Colorado
• Connecticut
• Duke
• East Carolina
• Emory
• Florida
• George Washington
• Georgia
• Harlem Hospital
• Harvard/Beth Israel-Deaconess
• Harvard/Brigham and Women's

• Iowa
• Johns Hopkins
• Kansas
• Kentucky
• Loyola-Stritch
• Maryland
• UMass
• Med University of So Carolina
• Medical College of Wisconsin
• Michigan
• Missouri-Columbia
• Missouri-Kansas City
• Mt Sinai (NYC)
• Nebraska
• New Mexico
• North Carolina
• Northwestern
• Ohio State
• Oklahoma

• Sinai of Baltimore
• South Florida
• Stanford
• SUNY-Stony Brook
• Tufts (NEMC)
• UC-Los Angeles
• UC-San Diego
• USAF Surgeon General
• Utah
• UT-Galveston
• Vanderbilt
• Vermont
• Virginia
• Virginia Commonwealth
• Wake Forest
• Washington University-St Louis
• West Virginia
• Wisconsin
• Yale

department-level participant
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Automated Electronic Transfer Allows Efficient
Data Capture
FPSC participants send physician-level billing
data to UHC. Data is electronically extracted
and sent from the billing office.
Data In (at the procedure-level)
Total Billings for ea. Procedure
Site of Service for ea. Procedure
CPT Code for the Procedure
Payer Class for ea. Procedure
CPT Code Modifiers
ICD-9 Codes (first four)
Frequency of Billed Procedure
Service Data Posting Date
Patient Demographics Data age, sex, race, zip
code
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Converting Data to Management Support
Data Out
Total and Work RVUs
UHC Processes, Validates, and Converts the Data
into Practice Management Measurements
Billed Charges
Productivity by Service Mix Payer Class
Physician Department-Level Productivity
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Benchmark Specialties

• Physical Medicine
• Physical Therapy
• Psychiatry
• Radiology
• Diagnostic
• Interventional
• Nuclear Medicine
• Radiology Oncology
• Surgery
• Cardiovascular
• Colon/Rectal
• General
• Hand
• Neurological
• Oral
• Orthopedic
• Plastic
• Sports Medicine
• Vascular/Thoracic

• Anesthesiology
• Dermatology
• General Dermatology
• MOHS Surgery
• Emergency Medicine
• Family Practice
• Human Genetics
• Internal Medicine
• General
• Allergy/Immunology
• Bone Marrow Transplant
• Cardiology
• Invasive
• Non-invasive
• Critical Care
• Endocrinology/ Metabolism
• Gastroenterology
• Geriatrics
• Hematology/ Oncology

• OB/GYN
• General
• Gynecological Oncology
• Maternal and Fetal Medicine
• Reproductive Endocrinology
• Urogynecology
• Ophthalmology
• Otorhinolaryngology
• Pathology
• Anatomic
• Clinical
• Surgical
• Pediatrics
• General
• Allergy/Immunology
• Cardiology
• Critical Care
• Endocrinology
• Gastroenterology

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Web-based tool provides flexible and interactive
reporting.
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What Other Measures Does the FPSC Provide?

• Evaluation and Management (EM) Coding
  Distribution
• Scope and Mix of Services (Clinical Fingerprint)
• Charge Lag Analysis
• Charge Summary Statistics
• Revenue Forecasting
• Custom Peer Cohort Benchmarking
• Others

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FPSC Use in Safety Net Institutions Dealing with
Similar Issues

• Harlem physician staffing assessment
• Developed safety net benchmark group
• Assessed clinical workload/productivity
• Evaluated barriers to enhanced productivity
• Recommended system for ongoing management of
  physician productivity

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Barriers to Realizing Productivity Enhancement
Opportunities

• Barriers common in Safety Net institutions
• Variable operational support and resources
• Shortage of nursing and clinical support staff
• Legacy information systems
• Lack of clinical and operational integration
• High patient no-show rates

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FPSC Provides Tool to Help Inform Practice
Management

• Data and reports useful input to
• measure and manage productivity
• monitor coding compliance
• evaluate physician workforce sizing
• Can be used in conjunction with other UHC tools
  to address/overcome identified productivity
  barriers

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Operational Data Base Program Overview
University HealthSystem Consortium
THE POWER OF COLLABORATION
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Operational Data Base Program

• A data base reporting system and related services
  designed to provide UHC members and associate
  members with comparative operational data.
• Focuses on operational characteristics of
  hospital departments (i.e., hours worked/unit of
  service, skill mix, labor and supply expense/unit
  of service, and operational practices).
• Provides information for analyses to support
  performance improvement, budgeting, cost
  reduction, and identification of best performers
• Creates direct networking opportunities among UHC
  participants and between UHC participants and
  non-UHC participants
• Facilitates the tracking of key performance
  measures resulting from UHC operational
  benchmarking projects

There are 59 UHC members and approximately 450
non-UHC participants in the data base.
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Program Participants

• UAB Health System
• University Hospital of Arkansas
• UCLA Healthcare
• UCSF
• Stanford Health Care
• UC San Diego Medical Center (2)
• San Joaquin General Hospital
• Santa Clara County
• Denver Health
• Georgetown University Hospital
• Shands HealthCare
• Tampa General
• Crawford Long Hospital of Emory University
• Emory University Hospital
• Medical College of Georgia
• Grady Health System
• University of Iowa Hospitals and Clinics
• University of Chicago Hospitals
• University of Illinois at Chicago Medical Center

• Loyola University Medical Center
• Wishard Health Services
• University of Kansas Hospital
• Brigham and Womens Hospital
• UMass Memorial Health Care
• University of Michigan Health System
• Hennepin County Medical Center
• Fairview University (MN) Medical Center
• University of Missouri Health Care
• University Medical Center of Southern Nevada
• University for Medicine and Dentistry of New
  Jersey
• University of New Mexico Hospital
• SUNY Health Science Center at Syracuse
• University Hospital and Medical Center at Stony
  Brook
• New York Presbyterian (3)
• University Health Systems of Eastern Carolina
• University of North Carolina Hospitals

• Wake Forest Baptist Medical Center
• Medical College of Ohio
• UHHS University Hospitals of Cleveland
• Oregon Health Sciences
• Thomas Jefferson
• Methodist Hospital Division, TJUH
• University of Pennsylvania Health System (4)
• Penn State Hershey Medical Center
• Medical University of South Carolina
• Vanderbilt Medical Center
• Methodist Hospital (Houston)
• University of Texas Medical Branch, Galveston
• University of Virginia Health System
• VCU Health System Authority
• Harborview Medical Center
• Froedtert Memorial Lutheran Hospital
• University of Wisconsin Hospital and Clinics

NAPH members
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HBSI ACTION Highlights

• PC based software to support on-site data
  collection, reporting and analysis migrating to
  web in 2003
• Quarterly staff and expense performance
  information using standardized data collection
  instruments
• Up to nine quarters of data from over 500
  institutions including more than 50 UHC members
• Standard and user-defined cost center and
  facility reports which enable the user to
  customize analyses
• Quarterly enhancements of methodologies, software
  and/or product documentation
• Includes UHC data starting first quarter 1998

The HBSI ACTION and PEERnext products will be
combined in 2003 resulting in more data
collection tools and greater participation.
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Functional Areas within HBSI ACTION

• Admitting/Patient Care Registration
• AM Admission
• Ambulatory Surgery
• Anesthesia Department
• Biomedical Engineering
• Cardiology-Invasive
• Cardiovascular Non-Invasive Diag
• Community Education
• Dental Clinic
• Education Services
• Electrodiagnostics
• Emergency Department
• Endoscopy/G.I. Lab
• Environmental Services
• Facility Information
• Financial Information
• Food Nutritional Services

• General Accounting
• Health Information/Medical Records
• Home Health Care (4 departments)
• Hospital Administration
• Human Resources
• Imaging Services (six modalities)
• Information Systems
• Labor and Delivery
• Laboratory
• Laundry/Linen
• Marketing/Planning/Public Relations
• Materials Management
• Neurodiagnostics
• Nursing Administration
• Operating Room
• Orthotics Prosthetics Services
• Outpatient Clinics (32 clinics)

• Outpatient Observation Unit
• Partial Hospitalization Unit
• Patient Accounting
• Patient Care Units (70 units)
• Pharmacy
• Physician Practice
• Plant Operations/Maintenance
• Post Anesthesia Care Unit
• Radiation Oncology
• Rehab (5 departments)
• Respiratory Care
• Security
• Sleep Lab
• Social Services
• Sterile Processing
• Telecommunications
• Utilization Review

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Standard Elements Reported at the Department Level

• Statistics
• Worked Hours
• Paid Hours
• Overtime
• Paid Time Off Percentage
• Salary Cost (including skill mix)
• Supply Cost
• Direct Cost
• Workload (I.e., Patient Days, LOS, Billed Tests,
  OR Hours, ED Visits, Adjusted Discharges, etc.)

• Characteristics
• Do you send staff home when the census is low?
• Are ED observation patients held in the ED or
  sent to an observation unit?
• What percentage of your Neonates are born lt1,500
  grams
• What is your level of product standardization for
  select cases?
• Do you utilize protocols?

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Use of ODB Data By UHC Members

• Majority of members are using data for
  budgeting/cost reduction
• Fifty-two percent will use the data for FY2003
  budgeting
• Ninety-one percent will use the data for
  budgeting and/or targeting areas for cost
  reduction
• A variety of methods have been used
• The 25th or 50th percentile across the board for
  all departments
• Target the 10 departments with the largest
  opportunities each quarter
• Sliding targets based on the respective
  departments performance (i.e., 40th percentile
  if at the 50th percentile, 60th percentile if at
  the 70th percentile, etc.)

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UHC Makes Extensive Use of ODB Data in Support
of Members Improvement Initiatives

• Key Indicator Report
• Integrated Report
• Operational Benchmarking
• Department specific analyses
• Value Analysis Program
• Novation Participation
• Member Specific Engagements Related to Supply
  Chain Management
• Member Advocate Program

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UHC Benchmarking Program Overview
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UHC Benchmarking
Operational Benchmarking
Clinical Benchmarking

• Care delivery and support
• Process-focused
• Unit cost management
• Elimination of process defects
• Efficiency optimization

• Clinical decision making
• Procedure/condition focused
• Utilization management
• Variation minimized
• Clinical practice advancement

High-QualityEfficientPatient Care
Do Things Right
Do the Right Thing
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UHC Model for Managing Value
Value Quality, Cost
Operational
Clinical
Womens Health Pediatrics Complementary
Medicine Performance Improvement Models
Medical Records Follow-up Cardiology Suppl
y Cost Management Claims Denials Imaging
Services Clinics Billing and Coding
Managing Patient Flow Blood and Blood
Products IP Charge Capture, Bill.and
Collect. Leadership and Mgmt Dev. Use of
Decision Support Tools
Patient Accounting Laboratory Surgical
Services Employee Benefits Imaging
Emergency Department Adult ICU Phases I and
II Purchasing Process Ambulatory Clinics
Medication Use Process Medical Records
Trauma Health Info. Technology Inpatient
Admitting Customer Service Clinics
Organization and Registration
Kidney Transplant CABG PTCA Hip
Replacement Bone Marrow Transplant Stroke Cong
estive Heart Failure Trauma AMI Core Measure
Integration Diabetes Heart Transplant Pediatri
c Asthma Adult Asthma
Community-Acquired Pneumonia Acute
MI Neonatology HIV/AIDS Cardiology
Implementation Adult ICU Follow-up Small
Large Bowel Transplant Services


Completed Future Joint
clinical/operational benchmarking project

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Benchmarking Process
Regularly monitor performance
Determineprocess(es)to be studied
Adopt/adaptselected enablers
Identifyrelevantperformancedata
Compare/discoverbest-in-classenablers
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Benchmarking Project Outputs

• Project Summary (web and written)
• Performance Opportunity Summaries
• Knowledge Transfer Meeting Materials
• Survey Results
• Customized Satisfaction Survey Results (select
  projects)
• Case Studies
• Implementation Strategies and Support
• Information is accessible through the UHC Web
  Site (www.uhc.edu under Improvement and
  Effectiveness)