Article Published: Healthcare Financial Management, June 2015
To Increase Efficiency, Decode Medicare Spending per Beneficiary (MSPB)
By Dale N. Schumacher, M.D., Len Felgner, Eric D. Dobkin, M.D., Fern E. Nerhood, Margaret W. Paroski, M.D.
A hospital can achieve both clinical and financial performance improvements by decoding its data on Medicare Spending per Beneficiary (MSPB) and creating a multidisciplinary team to identify episode variations and opportunities.
AT A GLANCE
Hospitals can use the 2014 MSPB data provided to them by the Centers for Medicare & Medicaid Services to improve their performance. The process of decoding and analyzing MSPB data involves:
- Analyzing MSPB measures by patient, major diagnostic category, and physician
- Understanding the technical aspects of the data
- Creating MSPB 30-day care pathways to identify episode variations and opportunities for joint clinical and financial scrutiny
Article Published: January 27, 2015
Analysis of How Evidence-based Clinical Information Software Products Used at the Bedside Affects Patient Outcomes
By Dale Schumacher, M.D., President, Rockburn Institute
Rockburn Institute was commissioned by Wolters Kluwer to determine if the nursing-based Lippincott Solutions’ products positively affect Clinical Outcomes, and subsequently could have a positive effect on the finances of a health care organization. After understanding that the two main applications in the suite – Lippincott Procedures and Lippincott Advisor – are geared towards providing the latest evidence-based information that helps clinicians with both care processes and answers to clinical questions, we decided to use the Centers for Medicare and Medicaid Services (CMS) Value-based Purchasing program as a basis to perform the study.
The Medicare Value-based Purchasing (VBP) program is a budget neutral program that rewards higher performing acute-care hospitals with incentive payments while penalizing lower performing hospitals. The program is funded by calculating from the base operating Diagnosis Related Group (DRG) payment of each hospital and reducing the initial payment by 1.0% for Fiscal Year (FY) 2013, 1.25% for FY2014, 1.5% for FY2015, 1.75% for FY2016, and 2.0% for FY2017 and all subsequent years. The program assesses a hospital’s performance on each VBP measure (Process of Care, Patient Experience of Care, and Patient Outcomes) using an achievement threshold and a benchmark. The performance baseline began in 2010 and, for this study, ended in 2013, using the most recently reported national Medicare data at the time of the research.
In the study, we compared Value-based Purchasing, Readmissions and Financial data from the Centers for Medicare and Medicaid Services (CMS) and the results of 2,728 eligible U.S. hospitals. The CMS data was matched with selected Wolters Kluwer internal database information that identified Lippincott Solutions customers.
This enumeration compared 252 hospitals using Lippincott Procedures with non-user hospitals, 93 hospitals using Lippincott Advisor with non-user hospitals, and 166 hospitals identified on the American Nurses Credentialing Center (ANCC) as Magnet designated vs. non-designated hospitals. We rank ordered the hospital cohorts and compared both their average and median ranks and their decile distributions.
In the study, we found that in all three situations, there was a higher Total Performance Score overall in each of the three cohorts.
Enhancing Clinical Process Improves Patient Outcomes
After understanding that Lippincott Procedures was specifically designed to help at the point-of-care with clinical care processes, a priori we expected was that these customers should have a higher clinical process of care score within the VBP model that would correlate to improved patient outcomes, based on related studies that show enhancing nursing practice and clinical process improves hospital performance and patient outcomes.
We analyzed each of the domain components (Clinical Process of Care, Patient Experience of Care, and Outcomes) average value within the VBP calculation against the Procedures cohort. In this analysis, there was a higher clinical process of care score (60.43 vs. 48.94) for hospitals using Procedures than for non-users, and also a higher Outcomes score (54.20 vs. 49.57). Thus on Total Performance, Procedures was 12.5% better (55.59 – 49.43, divided by the base 49.43) and on Process of Care 23.4% better (60.43 – 48.94 divided by the base 48.94). These scores showcase the link between best practice clinical process and patient care.
These findings relate to other recent studies documenting that enhancing nursing practice and clinical process improves hospital performance and patient outcomes. One such review, “Baccalaureate Nurses and Hospital Outcomes: More Evidence,” frames nurses’ education as a “modifiable property” with the responsibility for improvement being on healthcare organizations. This analysis, by Linda Aiken, PhD, FAAN, FRCN, RN, University of Pennsylvania School of Nursing, supports enhancing organizational performance through higher nurse educational levels and targeted nurse training, which includes access to evidence-based practice information. The onus for this improvement rests with the organization.
Another study from Martsolf and colleagues examined data from 421 hospitals from 2008-2011 with the patient as the unit of analysis determined that “…increases in staff number and skill mix can lead to improved quality and reduced length of stay at no additional cost.” Studies such as Martsolf and Aiken help make the connection between improved clinical process of care and patient outcomes, which in turn correlates to our study where using Lippincott Procedures positively affected Clinical Process of Care and Outcomes scores.
Lippincott Procedures Users That Are Also Magnet Hospitals
The study also compared ANCC Magnet-designated hospitals published on the ANCC website. On average, the 166 Magnet hospitals found in the VBP database had a greater effect in Patient Experience of Care and Patient Outcomes scores than in Clinical Process of Care. The overall Total Performance Score comparison was 58.34 (Magnet designated hospitals) vs. 49.46. The Total Performance Score rank was comparable to and slightly above the Procedures hospitals.
Twenty-one hospitals were both Magnet and Procedures hospitals. Because this is only an 8% overlap, it is too small to draw conclusions as to the interactions that occur between the two programs. However, interestingly and anecdotally, the hospitals that were both Procedures and Magnet hospitals had an average weighted Patient Outcome rank of 71.50 placing them among the top 28% of U.S. hospitals.
Lippincott Advisor Results
The study also looked at hospitals using Lippincott Advisor, a decision-support software application from Wolters Kluwer meant to provide quick and immediate answers and clinical information to clinicians at the point-of-care. These results showed that Lippincott Advisor users also scored higher than hospitals that did not. In our analysis, there were 45 hospitals in the VBP program that were using Lippincott Advisor for the entire period between 2010 and 2013, with 2010 being the year Lippincott Advisor was launched as a product for purchase. Thus, we added another 48 hospitals that used Lippincott Advisor starting in 2011 or 2012 to the study. From a total of 93 Lippincott Advisor customers, these users had a median VBP percent rank of 55.10 vs. a non-user score of 49.98 and an average VBP percent rank score of 53.78 (Advisor customers) vs. 49.99 (non-customers).
Lippincott Procedures and Lippincott Advisor hospitals score higher on VBP verses hospitals not using Procedures or Advisor during the study period. Given the measurement complexities, these are impressive findings.
Our findings are consistent with and supportive of Aiken’s “…reconceptualization of nurses’ education as a modifiable property (emphasis added) of a health care organization, much like the Institute of Medicine’s redefinition of patient safety as a property of an organization.” That is, an organization’s performance can be improved by improving its modifiable properties. Dr. Aiken notes that this puts “…the onus on health care organizations to respond.” The data from our analyses suggest that Lippincott Procedures and Lippincott Advisor are elements for enhancing nursing education and contributing to evidence-based practice at the beside, which would both improve organizational performance.
The full study is published by Wolters Kluwer. To download a copy, visit www.LippincottSolutions.com/ValueBasedPurchasingWhitePaper.
For additional information, contact Jean James at Rockburn Institute, 410-796-4554, email@example.com.
About Dale Schumacher
President of Rockburn Institute, Dale N. Schumacher M.D., MPH, has 25 years of healthcare system governance experience. He chaired the Mercy Health Care System Board (Scranton, PA) and was a member of the Kaleida Health Board (2003-2011) and the Catholic Healthcare Partners Board (Cincinnati). From 2003 until 2013 he has served Long Island Health Network, as a consultant and as the external Quality Compliance Officer. For the past decade he has supported Crozer Keystone Health System as its consulting Clinical Informatics Officer.
Dr. Schumacher has extensive experience in developing and implementing strategic quality plans for health systems, measuring change in practice patterns after information feedback and implementation of prospective payment risk adjusters. He has published over 40 articles in medical education, medical care, quality of care assessment, healthcare data analysis, and reliability of chart-review data; he was on the editorial board of the JCAHO Quality Review Bulletin. He was the lead author on the Institute’s study for the National Association of Private Psychiatric Hospitals measuring the impact of prospective payment on psychiatric hospitals that was published in the New England Journal of Medicine and altered the federal government approach to hospital payment. In 2003, he was designated a “Quality Leader” by the Journal for Healthcare Quality.
 Aiken LH. Baccalaureate nurses and hospital outcomes: more evidence. Med Care. 2014. Oct:52(10):861-3. Linda H. Aiken, PhD, RN, FAAN. School of Nursing, Center for Health Outcomes and Policy Research; Department of Sociology; and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Rockburn Institute 410-796-4554 firstname.lastname@example.org