Measurement, Cost, Compensation and Implants: The Train Is on the Tracks!
I was recently speaking with a colleague outside of my company about the new Inpatient Quality Reporting Program (IQRP) measurement requirements, and the challenges they pose for health plans, hospitals and just about anyone serving patients. And the fact that IQRP measurement requirements include “total hip and knee replacement unplanned readmissions,” which of course hits right in my company’s area of expertise. I’m more and more surprised (and alarmed) at how many players in the health care sector aren’t focusing on this, particularly given the growing expense, and potential revenue source, that implantable medical devices represent to health plans, hospitals and other providers.
Given that it’s all tied to quality and cost for health plans and compensation for providers, my team and I have already developed a three-pronged approach to ameliorate the risk of receiving negative IQRP scores that I thought I’d share here:
1. Proprietary algorithms for Severity of Illness Weights (SIW) based on national standards and approved by our National Physicians Board of Advisors. These weights predict the number of unanticipated inpatient admissions, emergency room visits, and unexpected outpatient visits directly attributed to the surgery. We define patients by four categories of SIW: Level 0 (normal risk) to Level IV (high risk).
2. Pay for Performance (P4P) program that measures quality and rewards healthcare providers who deliver exemplary quality of care to their patients, through attention to quality factors such as: “never” events (events that should never occur like working on the wrong leg); sentinel monitoring of the surgeons who know they are being graded and have to keep up quality scores in order to remain in the P4P program; following AMQ’s proprietary Clinical Guidelines; measuring outcomes for each surgeon and benchmarking against others in same region and same specialty, or nationally and same specialty; and requiring follow-up post-op from the surgeon’s office.
3. Post-op multi-pronged initiatives, including: (a) measuring outcomes for the first time in the industry through our Level 3 Registry; (b) requiring patient follow-up for 90 days and beyond as part of our P4P program, including measurements through standardized Brief Pain Index (BPI) questionnaires, and physician outcome reporting; and (c) measuring patient satisfaction that is directly related to surgeons and their staff. In addition, we have already developed algorithms on length of stay for inpatient and subacute rehab for knees and hips that will capture even more meaningful and actionable data going forward.
To date, our efforts have yielded impressive results in an area of increasing importance for every healthcare stakeholder — health care costs and compensation/reimbursement tied to sustainable quality outcomes. It’s possible to build capabilities and capacity to positively impact performance scores that ultimately help the patient!