Community Hospitals

by James Markland

Value-Based Purchasing Achieves Positive Results
EMR News: Leveraging the Latest!
Teleradiology Service Boosts Productivity

Value-Based Purchasing Achieves Positive Results

In October 2003, Premier healthcare alliance, a network of more than 2,200 hospitals and 63,000-plus health care facilities, and the Centers for Medicare and Medicaid Services (CMS) set out to determine if economic incentives (pay-for-performance) to hospitals are effective at improving the quality of inpatient care. The project, called the Hospital Quality Incentive Demonstration (HQID), incorporates over 240 hospitals across 36 states. Hospitals in the project include small and large operations, urban and rural settings, and teaching and nonteaching facilities. These hospitals submitted data to Premier, which then submitted the data to CMS for validation and analysis.

For the first 3 years of the project, which were evaluated as part of this research, Premier collected from participants? outcome data based on adherence to a set of more than 30 evidence-based clinical quality measures developed by government and private organizations, including the National Quality Forum (NQF), the American Hospital Association (AHA), and the Leapfrog Group. The Composite Quality Score improved by an average of 15.8% during the project?s first 3 years.

According to Premier, improvements in quality of care have saved the lives of an estimated 2,500 heart attack patients in the first 3 years of the project, and patients received approximately 300,000 additional recommended evidence-based clinical quality treatments, such as smoking cessation, discharge instructions, and pneumococcal vaccination, during that same time frame. In the project?s first 3 years, CMS has awarded more than $24.5 million to top performers.

Performance Exceeds Expectations

Also known as value-based purchasing (VBP), the process has met with criticism that only the upscale hospitals with the most resources can succeed in such a format. The HQID project has largely dispelled this idea. Although hospitals serving a large percentage of disproportionate share patients performed below others at the outset of the project, differences in quality lessened after 3 years in the clinical areas of heart attack, heart failure, and hip/knee replacement.

?The program creates a dynamic where the work is never done?quality goals keep getting more aggressive because as a group, HQID hospitals are improving rapidly over time,? said Jack Garon, MD, chief medical officer at Sinai Health System of Chicago. ?We focus on current performance, and our goal remains staying in the top 10%, which means we must continually improve.?

Garon continued, ?This program gives everyone the clear goals and the focus they need to eliminate care variations so that all patients?no matter where they live or what hospital they visit?receive the same evidence-based, high-quality care.?

Cathy Robinson, vice president of HQID-participating Rush Foundation Hospital, Meridian, Miss, said, ?It has been suggested that rural or safety net hospitals will struggle as part of value-based purchasing or pay-for-performance programs. While we certainly face unique challenges as a rural, safety net facility and have needed time to effectively implement the evidence-based protocols required in HQID, our successes and those of the other safety net participants clearly show that any hospital can deliver high-quality care.?

Research from Premier seems to demonstrate that over time, any hospital, regardless of size, location, patient/payor mix, or system affiliation, involved in VBP can realize significant quality improvements.

EMR News: Leveraging the Latest!

GE Healthcare, a provider of health care information technology, announced that Community Hospital South in Indianapolis is now live with GE Centricity™ Enterprise 6.1 and Monitored Care, an integrated clinical, financial, and administrative system that helps streamline workflow and improve productivity across the continuum of care. The implementation of the two systems will help Community Hospital South capture clinical and medical device data in a patient?s electronic medical record (EMR), enabling health care providers to provide more comprehensive and efficient care.

Community Hospital South is a 200-bed licensed acute care facility serving south-central Indiana and is part of the Community Health Network, a health system nationally recognized for its quality of care and use of health care technology. GE Healthcare Centricity Enterprise will automate key clinical processes for lab orders, test results, and pharmacy and care documentation with administrative, financial, and billing processes throughout a comprehensive EMR system. By providing physicians with immediate access to medical data, the GE solutions help physicians make better-informed treatment decisions, allowing those physicians to decrease the potential for medication error while increasing the quality and safety of patient care. GE Healthcare Centricity EMR has been in place at the hospital since 2002.

Community Hospital South worked extensively with GE throughout the recent implementation of the latest version, offering thorough feedback along the way to ensure the final system, now in place, served their needs.

Highlights of the New System

According to GE Healthcare, Community Hospital South is the first hospital to go live with Centricity Enterprise Monitored Care, which integrates data from patient monitors, ventilators, and IVs in monitored environments such as intensive care, cardiac care, and emergency departments. This combines lab results, test orders, and patient histories in a single EMR accessible from anywhere, helping to reduce time spent by care providers on manual documentation. GE?s standards-based technology also allows third-party integration. Community Hospital South can seamlessly connect data from non-GE systems into the Centricity Enterprise EMR.

Teleradiology Service Boosts Productivity

Wayne Memorial Hospital (WMH), a 98-bed community hospital in Honesdale, Pa, has signed an exclusive imaging services contract with the Foundation Radiology Group (FRG). Wayne Memorial serves patients in the northeastern Pennsylvania region, including Wayne and Pike counties, as well as Sullivan County in New York.

Headquartered in Pittsburgh, FRG focuses on serving nonuniversity-affiliated health care institutions, with an emphasis on serving the rural and suburban hospital segment. With 60 on-staff radiologists, FRG seeks multiyear exclusive contracts for 7 x 24 x 365 radiology in full-service bureaus.

?Our partnership with Foundation Radiology Group will allow us to extend the level of radiological service that we can provide to our clients,? said David Hoff, executive director, Wayne Memorial Hospital. ?Improving patient care is our top priority at WMH, and we are confident that our contract with FRG will be key in reaching our patient service goals.?

?The FRG solution is a perfect fit for WMH at this time,? said Samuel Choi, MD, medical director at WMH. ?With FRG?s subspecialty expertise and timely read turnaround times, we become more well-rounded as a practice by offering a wider range of subspecialty interpretations. We expect this change to be a tremendous benefit to our patients.

?A major advantage of the relationship is the final reports they generate,? added Choi. ?Before FRG, I had to spend at least 2 hours a day dictating reports. Sometimes there would be no reports generated on weekends. Now FRG creates reports within 15 minutes to a half hour, any day of the week. This is an enormous improvement in turnaround time and a great benefit for a small community hospital like Wayne Memorial. We are very pleased with the service. It is excellent and delivers everything as promised.?

?FRG?s turnaround time on final diagnostic readings?not just preliminary reads?of our studies is exceptional,? said James Hockenbury, director of ancillary services at Wayne Memorial Hospital. ?It?s especially beneficial to our emergency department physicians who must often act quickly.?

FRG?s board-certified radiologists provide readings in neuroradiology, mammography, cardiac CT, brain perfusion, vascular ultrasound, and OB/GYN ultrasound, as well as musculoskeletal, interventional, pediatric, and general radiology. The FRG model allows suburban and community health care institutions and outpatient centers access to subspecialty services that they may otherwise not have access to, thus providing a broader service base for those institutions.

?Most doctors go home at 5 pm,? said Brandon Chan, MD, CEO, Foundation Radiology Group. ?A relationship with FRG means that the hospital is staffed 24 hours a day, 7 days a week, with radiologists.? In effect, with FRG, Wayne Memorial moves from a staff of two in-house radiologists to 60.

Speed of response is the essential benefit. According to FRG, their stat reports average 30 to 45 minutes; inpatient reports average less than 4 hours; and critical results notification averages less than 30 minutes for attending or referring physicians.

?At FRG, we provide cost-effective radiology solutions that help our clients extend the level of care they can provide to their patients,? said Chan. ?We?re proud to help WMH reach their goals, and to add them to our existing client network.?