Complications following surgery can be the result of many factors. For Albany (N.Y.) Medical Center, identifying the cause of surgical site infections in patients after heart surgery was a problem area. A correctable problem – clinicians tracking the causes determined that more often than not the source of the staph bacteria responsible for the infection was not the hospital but rather the patient’s own nose.
“You’re carrying it but you have no signs or symptoms of any problem. But if that were to get into an open wound, it could easily infect that, and that’s what was happening,” says Louis Filhour, senior vice president for clinical quality at Albany (N.Y.) Medical Center.
Patients now get a swab and culture before surgery, and if they’re positive for the bacteria, it’s treated to eliminate possible infection. That new process has significantly reduced sternal wound infections, according to Filhour, who adds that the same pre-admission exam approach applies for detecting pressure ulcers in at-risk patients.
“They may be coming in for one thing, but we’re assessing their entire body, because they may already have a small wound or something starting,” says Filhour. “If we don’t capture that on day one, and then it develops further while the patient is here, then that also counts against us.”
Albany Medical Center is a great example of how to effectively measure value, particularly important in today’s healthcare landscape. Value these days is moving from concept to practice in healthcare as it becomes the foundation of the way health plans pay providers for the care they deliver to patients. This means that the ability to measure value must move beyond generally accepted proxies to exacting metrics that accurately measure provider performance.
Metrics need to identify the root causes of adverse patient outcomes that have a direct bearing on how much providers are paid based on the value they provide to covered lives. The metrics must be sensitive enough to determine whether providers were responsible for the adverse outcomes or whether factors outside of the providers’ control were the culprits.
“We are spending time double-reviewing anything that would be impacting a value measure, to make sure if we’re saying it’s a problem, that it really is a problem,” says Filhour. “We’ll fess up and accept it, but we need to make sure that it’s also correct.”
A study published earlier this month in the New England Journal of Medicine demonstrated the power of advanced analytics to identify patterns of patient readmissions after surgery — and, by extension, value of the care provided. The study by health services researchers at the Harvard University School of Public Health found that 13.1 percent of surgery patients were readmitted to the hospital.
More importantly, they found that surgical readmission rates varied by volume: Hospitals that performed more surgeries generally had lower readmission rates than hospitals that performed fewer surgeries. That finding suggests that the high-volume surgical hospitals are doing something different in terms of process that leads to better outcomes — and fewer financial penalties from payers.
For hospitals and health systems to cope with the move from the traditional volume-of-care payment model to one based on value, the measuring and assessment must begin internally with regular tracking and reporting of all relevant safety and quality measures, according to the American Hospital Association in its April 2013 strategy report, Metrics for the Second Curve of Health Care. Central to such objectives as reducing preventable emergency and inpatient visits are data commonly used to improve patient safety and quality.
Absent the ability to collect and analyze data, the move from volume to value for all industry stakeholders will be little more than rhetoric. Providers that are able to collect and analyze data and subsequently develop meaningful measures of value will be in the best position to collaborate with patients and payers to improve care and reduce unnecessary healthcare costs.