Nina M' Antoniotti, RN, MBA, Ph'D' Marshfield Clinic TeleHealth Marshfield, Wisconsin - PowerPoint PPT Presentation

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Nina M' Antoniotti, RN, MBA, Ph'D' Marshfield Clinic TeleHealth Marshfield, Wisconsin

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Collaboration between organizations. Pay-for- Performance ... Promotes using utilization and clinical data for improving quality. ... – PowerPoint PPT presentation

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Title: Nina M' Antoniotti, RN, MBA, Ph'D' Marshfield Clinic TeleHealth Marshfield, Wisconsin


1
Nina M. Antoniotti, RN, MBA, Ph.D. Marshfield
Clinic TeleHealth Marshfield, Wisconsin
  • Tying TeleHealth to Quality
  • Where is Your Chasm?
  • American Telemedicine Association Annual Meeting
  • Nashville, Tennessee
  • May 2007

2
TeleHealth/Telemedicine
  • Telemedicine
  • The use of medical information exchanged from one
    site to another via electronic communications to
    improve patients health status.
  • telehealth, which is often used to encompass a
    broader definition of remote healthcare that does
    not always involve clinical services.
  • Videoconferencing, transmission of still images,
    e-health including patient portals, remote
    monitoring of vital signs, continuing medical
    education and nursing call centers.
    (Retrieved 04-23-07 www.americantelemed.org)

3
Quality
4
  • Quality can refer to
  • Technical interpretation - A specific
    characteristic of an object (the qualities of ice
    - i.e. its properties)
  • Philosophical interpretation - The essence of an
    object (the quality of ice - i.e. "iceness")
  • Practical interpretation - The achievement or
    excellence of an object (good quality ice - i.e.
    not of inferior grade)
  • Metaphysical interpretation - The meaning of
    excellence itself
  • Scientific interpretation In physics, the range
    of frequencies over which something will
    characteristically respond. (www.wikepedia.com,
    accessed 5-07)

5
Quality
  • Not limited by sector, form of payment,
    organizational type, or clinical discipline
  • Two fundamental components
  • Technical, scientific appropriateness,
    competency, and accuracy of care (Five Rs).
  • Delivered in a safe and technically competent
    manner that is acceptable to the patient.

6
Definition of Health Care Quality
  • The degree to which
  • Health services for individuals and populations
    increase the likelihood of desired health
    outcomes and are consistent with current
    professional knowledge (Lohr, 1990)

7
  • Evaluation of Quality
  • Structure
  • Provides the setting, credentialing standards and
    infrastructure to support good care
  • Process
  • Appropriate evidence-based care as a key
    component in achieving good outcomes for patients
  • Outcome
  • Considers the appropriateness, efficiency, and
    variation of care creating value-added and
    meaningful care

8
Determinants of Quality
9
Chasm
  • The Gap between
    average care…
  • … and the best care

10
IOM Six Chasms
  • Safe avoiding injuries to patients from the
    care that is intended to help them.
  • Effective providing services based on
    scientific knowledge to all who could benefit and
    refraining from providing services to those not
    likely to benefit (avoiding underuse and overuse).

11
Six Chasms
  • Patient Centered providing care that is
    respectful of and responsible to individual
    patient preferences, needs, and values, and
    ensuring that patient values guide all clinical
    decisions.
  • Timely reducing waits and sometimes harmful
    delays for both those who receive and those who
    give care.

12
Six Chasms
  • Efficient avoiding waste, in particular, waste
    of equipment, supplies, ideas, and energy
  • Equitable providing care that does not vary in
    quality because of personal characteristics such
    as gender, ethnicity, geographic location, and
    socio-economic status (IOM, 2001, p. 39-40)

13
  • …a health care system that achieved major gains
    in these six dimensions would be far better at
    meeting patient needs. Patients would experience
    care that was safer, more reliable, more
    responsive, more integrated, and more available.
    Patients could count on receiving the full array
    of preventive, acute, and chronic services from
    which they are likely to benefit.
    Such a system would also be better for
    clinicians and others who would experience the
    satisfaction of providing care that was more
    reliable, more responsive to patients, and
    more coordinated than is the case today. (IOM,
    2001, p.6)

14
Where Does TeleHealth Fit?
  • Interactive video consultations
  • Safe, patient-centered, timely, efficient,
    effective, equitable
  • Store-and-forward
  • Safe, timely, efficient, effective
  • Remote monitoring
  • Safe, patient-centered, timely, efficient,
    effective

15
IOMs Six Chasms of Quality
  • Patient Centered
  • Reduces the burden of access to health care
  • Provides necessary services in underserved,
    disparate areas
  • Safe
  • Diagnostic accuracy, technical superiority
  • Better patient compliance
  • Timely
  • Reduces time from referral to appointment
  • Introduces specialist earlier in the process of
    care
  • Early symptom management for chronic conditions

16
IOMs Six Chasms of Quality
  • Efficient
  • Time neutral or less time for providers
  • Patient is better prepared
  • No duplication of services
  • Higher productivity for providers especially
    for health professions shortages
  • Increased collaboration/communication between
    providers
  • Lower no-show rate

17
IOMs Six Chasms of Quality
  • Effective
  • Quality, cost, outcomes studies
  • Stabilization of rural practices
  • Reduction in the number of ED visits, unnecessary
    physician office visits, unnecessary care
  • Reduction in the total number of visits
  • Equitable
  • Reimbursement
  • Transmission costs

18
Quality Management
  • Training
  • Operational Systems
  • Scheduling and Appointing
  • Billing and Coding
  • Patient Satisfaction
  • Provider Satisfaction
  • Monthly Management Reporting
  • Evidenced-based Practice
  • Clinical Outcomes

19
What TeleHealth Can Mean to Strategic Management
  • Outpatient Specialty Clinics
  • In-patient assessment and support
  • Decision Analysis model for transfers
  • Disease Management, Remote Monitoring
  • Email consultations
  • Practitioner Support
  • Practice Support
  • CME, CEU, ancillary staff education
  • Collaboration between organizations

20
Pay-for- Performance
  • The use of incentives to
    encourage evidence-based
    practices that promote better outcomes and
    ultimately may result in a
    transformation of the healthcare
    system.

21
Objectives of
Pay-for-Performance
  • Align payment and quality
  • Facilitate adoption of HIT
  • Reduce clinical practice variability
  • Creation of infrastructure

22
Objectives
  • Decreased hospitalizations
  • Decreased re-hospitalizations
  • Decreased days of stay per episode
  • Improvement in health status towards specific
    indicators
  • Decreased use of medications, treatments driven
    by health status indicators
  • Increase in patient/family satisfaction
  • Quality and patient safety

23
  • Combination of
  • Practice guidelines
  • Disease management
  • Decision support systems
  • Historically paid for
  • Units of service
  • per person

24
Pay for Performance
  • Setting performance expectations
  • Measuring performance
  • Rewarding results through financial and incentive
    systems
  • Measured expectations

25
  • Facets of Pay-for-Performance
  • Structure
  • Provides the setting, credentialing standards and
    infrastructure to support good care
  • Process
  • Appropriate evidence-based care as a key
    component in achieving good outcomes for patients
  • Outcome
  • Considers the appropriateness, efficiency, and
    variation of care creating value-added and
    meaningful care

26
Is this an Idea of the Week?
  • Rising cost of health care
  • No accountability for outcomes
  • No payment for higher quality of care
  • When patients are kept healthy, doctors and
    organizations lose money
  • 66 of persons are served by federal health care
    programs
  • National Academy of Sciences IOM study
    proposing federal govt link payments to
    performance

27
Where Does TeleHealth Fit?
  • Improved access
  • More timely access
  • More timely introduction of specialist into the
    process of care
  • Early symptom management
  • Involves the patient in the process of care
  • Decreased hospitalizations, days of care, repeat
    hospitalizations, use of medications

28
  • In a pay-for-performance strategy, TeleHealth is
    not the solution, but a tool that augments the
    delivery of care and transfer of information in a
    pay-for-performance strategy. The technology
    adoption currently present in TeleHealth may
    facilitate the adoption of other technologies
    that support pay-for-performance.

29
Tying the Knots
  • Tying TeleHealth/Telemedicine Quality
    Pay for Performance
  • together in a strategic management philosophy.

30
TeleHealth and Rural Health
  • Improves Access
  • Provides Accurate and Available Information
  • Assists in the deployment of Electronic Medical
    Records
  • Provides Necessary Specialty Services
  • Provides Chronic Disease Management (Care
    Management)
  • Provides Health Services for the Elderly,
    Disabled, Home Bound

31
What TeleHealth Can Mean to Rural Providers
  • Outpatient Specialty Clinics
  • In-patient assessment and support
  • Decision Analysis model for transfers
  • Disease Management, Remote Monitoring
  • Email consultations
  • Practitioner Support
  • Practice Support
  • CME, CEU, ancillary staff education
  • Collaboration between organizations

32
TeleHealth and their networks are uniquely
positioned for the assessment, evaluation,
implementation, and deployment of electronic
medical records.
33
  • Soon, physicians may be looking for something
    that helps them prepare for a new reimbursement
    environment, one that requires that they measure
    and report on quality and safety indicators for
    their practice.

34
  • CCHIT Certified EHRs are tested against criteria
    that include the ability to monitor quality
    indicators. And as CCHITs certification criteria
    roadmap matures, product testing criteria will
    likely become more rigorous to keep pace with the
    growing requirement for quality monitoring.

35
  • With the introduction of future interoperability
    criteria, certification will help physicians and
    other providers choose products that have the
    ability to report across care settings and
    coordinate care between the patient and the
    physician.

36
Centers for Medicare Medicaid Services
(CMS) Physician Group Practice (PGP) Demonstration
  • The first value-based purchasing demonstration
    applied to providers.

37
PGP Objectives
  • Align reimbursement with quality.
  • Promotes using utilization and clinical data for
    improving quality.
  • Encourage coordination of Part A and B services.
  • Promote efficiency in administrative structures
    and care processes.
  • Reward for improving health outcomes.

38
To CMS, ? Quality
  • The higher of 75 compliance, or the Medicare
    mean, or …
  • ? 10 reduction in gap between administrative
    baseline and 100 compliance, or…
  • 70th percentile of Medicare HEDIS

39
What were the stated goals?
  • Encourage coordination of Part A and Part B
    services
  • Promote efficiency by investment in
    administrative structures and care processes
  • Reward physicians for improving health outcomes
  • In other words . . . . .

40
CMS wants to avoid this!
41
Bottom Lines
  • Improving quality without improving efficiency
    results in
  • Improving efficiency without improving quality
    results in
  • Our challenge is to improve quality and
    efficiency, simultaneously

and fast.
42
Starting Points
  • Primary Prevention Avoid disease
  • Secondary Prevention Early detection
  • Tertiary Prevention Chronic disease
  • Diabetes
  • Anticoagulation
  • CHF
  • Hypertension
  • CAD
  • Dementia
  • Depression
  • COPD
  • Frail Elderly

43
Fundamental Truth
  • Every system is designed perfectly for the
    results it achieves

- Paul Bataldan, IHI
44
Qualitys Impact on TeleHealth
  • Formalizes an informal initiative
  • Creates expectations for service
  • Allows wider distribution of evidence-based
    practice
  • Assists in attainment of benchmarks, goals
  • Moves TH out of the grant-funded arena

45
Qualitys Impact on TeleHealth
  • Creates expectations
  • Demands attention to detail, performance,
    satisfaction
  • Pulls in strategic initiatives
  • Requires benchmarks
  • Proof of clinical outcomes, cost savings,
    increased value to the customer

46
Strategic Management for TeleHealth and Quality
  • Ensure that Strategic Management is the
    foundation for TH/TM initiatives
  • Identify TH/TM initiatives within the strategic
    plan
  • Culture change to a way of doing business
  • Become a TH/TM organization

47
  • Leaving out one small detail can
    make all the difference in the world.
  • Make TeleHealth a part of your
    quality initiatives and quality a part of
    TeleHealth!
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