When it comes to healthcare, we all want quality over quantity. Put simply, no one wants to spend more time at the doctor’s office or in inpatient care. Value-based healthcare models aim to deliver on this goal by moving us beyond fee-for-services models—which by default encourage more tests, more procedures, and more follow up.
Instead, payers will reimburse providers not for quantity of care, but for clinical outcomes tied to cost containment. To succeed in the transition, healthcare organizations must implement strategies that effectively track quality metrics and improve care with the ability to demonstrate evidenced based outcomes.
Who’s officially tracking quality?
The Centers for Medicare and Medicaid Services (CMS) and commercial payers, as well as accrediting bodies (e.g., The Joint Commission), require health systems to report quality measures. Hospital quality metrics are a set of standards developed by CMS to quantify healthcare processes, patient outcomes, and organizational structures.
In value-based payment models, quality metrics are used to adjust provider reimbursement rates, offering a bonus for above-average ratings or a penalty for failing to meet standards. For example, CMS’ Merit-based Incentive Payment System (MIPS) adjusts providers’ payments based on their performance in four categories with varying weight: quality, cost, improvement activities, and promotion of interoperability. Quality makes up the biggest chunk (40%) of the MIPS Final Score, with improvement activities accounting for another 15%.
What is a healthcare quality management dashboard?
Healthcare organizations generate vast quantities of quality-related and other data. Interpreting (e.g., identifying trends) and managing that data are challenging when it’s stored in separate systems throughout an organization. Quality management dashboards increase the visibility and transparency of key quality data targets and measures, including:
- Structures—the characteristics of clinicians and facilities related to capacity and systems—for example provider-to-patient ratio
- Care processes, such as the percentage of patients who received immunizations or mammograms
- Outcomes variables, for example surgical complications and hospital-acquired infection rates
Like your car’s dashboard, healthcare quality management dashboards provide a visual representation of data that guides decision making. When you know how fast you’re driving, you can make informed decisions about altering your speed. Similarly, when you know how many adverse events the ICU had last month, you can decide what corrective actions to take.
Quality dashboards display countless metrics and other quality key performance indicators (KPIs) related to, for example:
- Adverse events (e.g., falls, infections, medication errors)
- Never and sentinel events (e.g., mortality)
- Clinical outcomes (e.g., readmission rates)
- Patient access (e.g., wait times, the number of patients who left the ED without being seen)
- Patient complaints and satisfaction scores
Nurse leaders and others compare this internal performance data with other departments, facilities in the system, and other healthcare organizations (via healthcare industry benchmarks), to identify areas for quality improvement. The visualizations that quality dashboards provide to administrators and managers help them identify previously hidden patterns in data, deviations from ideal care, and performance differences across units or organizations. Quality dashboards also allow leaders to track responses to operational changes and quality improvement initiatives.
Several studies show that use of hospital- or system-wide quality and patient safety dashboards improves patient safety by reducing infection rates, medication errors, and falls.
What are the challenges of measuring healthcare quality?
As quality-focused initiatives take center stage in value-based payment systems, unfortunately many healthcare organizations remain stymied about how to identify, monitor, and improve upon the appropriate quality metrics. Some of the overarching reasons follow.
There’s no universal definition of “quality”
To accurately measure healthcare quality, you have to know what you’re measuring—but there is no standard definition of quality. An Institute of Medicine (IOM) study found more than 100 definitions of quality of care. The IOM defines quality of care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
There are hundreds, if not thousands, of quality measures—standards for measuring the performance of healthcare providers to care for patients and populations. Each quality measure focuses on a different aspect of care delivery, including:
- Health outcomes
- Clinical processes (e.g., use of antibiotics)
- Patient safety
- Efficient use of healthcare resources
- Care coordination
- Patient engagement in their own care
- Patient perceptions of their care (e.g., patient experience and satisfaction)
- Population and public health
- Provider competencies (six standards)
Several organizations—including the Agency for Healthcare Research and Quality (AHRQ), the National Quality Forum (NQF) and CMS—provide sets of quality measures. CMS used 686 quality measures (including 92 patient safety measures) in its 26 quality programs in 2020, down from 905 in 2015. CMS’ MIPS program includes 209 quality measures for 2021. To meet the quality performance category requirements, providers must report on six quality measures (including one outcomes measure), or a defined specialty measure set, or all quality measures on the CMS Web interface (an application that is available for groups of at least 25 clinicians).
Data collection is difficult
Quality measurement and improvement efforts depend on the collection of accurate, timely data. But many data collection, monitoring, and analysis systems are poorly designed, misunderstood, and not used properly once implemented. Quality improvement staff may lack experience in collecting and interpreting data, or they may struggle with administrative or clinical data management systems that weren’t designed to monitor the quality data they track.
In addition, if clinicians don’t perceive quality measures to be credible, or if their collection is excessively burdensome, you’ll risk alienating providers instead of engaging them in quality improving initiatives.
What metrics should you include on a healthcare quality management dashboard?
You should choose quality and risk management metrics based on your organization’s needs, the specific reporting requirements of your payers (including CMS’ quality programs), and your accrediting body (e.g., The Joint Commission).
In 2021, CMS used quality measures in the five categories that follow to rate more than 4,500 hospitals from one to five stars. Although star ratings for hospitals are not directly related to financial reimbursement, many of the measures used to determine the star ratings are also used in other programs, such the Hospital Value-Based Purchasing Program, that directly affect reimbursement.
The patient mortality rate measures the percentage of patients who die in a hospital's care before being discharged. Mortality rate is a strong indicator of providers' ability to stabilize a patient's condition following surgery or another procedure.
2. Safety of care (medical incidents)
Safety metrics are related to medical incidents, including errors and adverse events. Hospital incidents include unintentional consequences or side effects of hospital procedures, including conditions like sepsis, postoperative respiratory failure, pulmonary embolisms, hemorrhages, and other reactions or infections.
This metric measures healthcare professionals’ ability to provide comprehensive, high-quality patient care without triggering an adverse reaction. The number of harm events per 1,000 patient days is one way to quantify this measure.
Two common patient safety measures are:
- Skin breakdown, which occurs when pressure decreases blood flow to the skin. Patients with skin breakdown have a higher risk of infection. Skin assessment tools can be used to reduce skin breakdown.
- Healthcare-acquired infections, which occur while patients are receiving treatment for medical or surgical conditions. These infections are caused by viral, bacterial, and fungal pathogens.
3. Hospital readmission rate
This metric refers to the percentage of patients who are admitted into the same or another hospital within 30 days of being discharged for the same condition or a complication from the original episode of care. High hospital readmission rates indicate that physicians and other care providers are not delivering the proper care to patients, perhaps because they are overlooking complications or relevant patient data. Lower hospital readmission rates indicate higher care quality. In 2018, the average readmission rate in the US was 14%, with an average readmission cost of $15,200 per patient.
Finding the optimal length of stay to prevent readmission is important for patient and hospital financial health. High readmission rates can decrease hospital revenue, since hospitals with the highest readmission rates may be penalized by not receiving full Medicare reimbursement payments. Hospital readmissions cost Medicare $26 billion annually, so it’s not surprising that Medicare is focused on reducing readmission rates. In 2019, 82% of hospitals in Medicare’s Hospital Readmissions Reduction Program received readmissions penalties.
4. Patient experience
Patient-reported outcome measures assess patients’ experiences and perceptions of their healthcare. You can evaluate these by tracking complaints and administering patient satisfaction surveys, including the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that measures 64 markers of patient satisfaction ranging from care quality to care facility cleanliness. HCAHPS scores provide important information about how hospitals can improve patient care and services.
5. Timeliness and effectiveness of care
Timeliness of care metrics (e.g., waiting times, such as the time from arrival at the ED until diagnostic evaluation) are related to patient access to care. Overcrowding in the ED has been associated with increased inpatient mortality, increased length of stay, and increased costs for admitted patients. After realizing that some 4,000 patients per year were leaving the ED without being seen, one community hospital analyzed its timely ED performance data to identify four improvement areas: staffing patterns, registration, triage assessment by the RN, and early access to a qualified medical provider. They achieved significant performance improvements, including an 89% relative reduction in the rate of patients that left without being seen.
Effectiveness of care outcomes measures evaluate two things: compliance with best practice care guidelines (e.g., the percentage of patients receiving recommended hospital care for specific conditions such as heart attack), and achieved outcomes (e.g., lower readmission rates for heart failure patients). Ensuring clinicians are following current best practice care guidelines is essential to improving clinical outcomes. Monitoring treatment outcomes and notifying clinicians when they need to review care guidelines are also important.
Quality management tips: Standardize processes and procedures
Standardization is essential for quality improvement and risk management. Standardizing clinical decision-making and procedures makes clinicians’ and staff members’ behavior systematic, so they respond consistently (and appropriately) to similar situations. When behavior aligns with clinical and safety evidence regarding sound practices, patient care improves. Likewise, standardizing structures and processes—via technology (e.g., electronic health records), leadership, and a safety culture—helps improve health outcomes.
- Notably, look at both standard operating procedures, and education and training of your healthcare workforce.
- Use value management software to standardize decision-making for new medical devices, med-surg supplies, and capital equipment. Making purchasing decisions based on an objective evaluation of clinical, safety, and financial data instead of subjective opinions leads to better clinical and financial outcomes.
- Use comprehensive quality and risk management software. Quality management software allows you to collect and analyze data (e.g., incidents and patient complaints), automate the follow-up process, monitor improvement actions, and share the results via reports and dashboards. Choose your quality measures carefully for clinical relevance as well as CMS program compliance.
- Design your quality management dashboard specifically for the outcomes your organization seeks to achieve, and ensure that it’s easy for staff to access and use. Choose a quality management system that is flexible and configurable, allowing you to customize workflow, forms, fields, reports, and dashboards.
- Incident management software simplifies the reporting of adverse events and near misses. Select incident management software that uses several proven methods (such as PRISMA, SIRE, and Ishikawa) to analyze root causes. Train staff on how to collect quality data and utilize quality management software to interpret that data and develop improvement initiatives.
- Use a structured approach for your quality improvement actions and follow up on data gathered. The Plan-Do-Check-Act (PDCA) cycle is one effective approach. Manage and monitor your improvement actions with a digital improvement tracking system.
If your organization needs help navigating the complexities of healthcare quality, risk management, and provider performance improvement, talk to us.