What a difference less than a point makes.
University of Colorado Hospital finished with 71.5 percent on the 2015 “Quality and Accountability Performance Scorecard” compiled by the University Health System Consortium (UHC), the organization of academic medical centers. The score, which measures hospitals’ performance in a variety of quality, safety, and patient experience measures, was only fractionally higher than the 71.1 percent UCH posted in 2014. Yet the hospital’s ranking rose to sixth in 2015 from 14th the year before. The award was made at UHC’s Annual Conference Oct. 1-2 in Orlando, Fla.
It says a lot about the importance of a hospital holding the line on effective patient care in an era in which the challenges of doing so – and having the data to support it – intensify every year. For example, New York University (NYU) Medical Center held the top spot on the UHC scorecard for a third straight year in 2015, but the institution’s overall score fell more than four percentage points, from 76.9 percent to 72.6 percent.
“It’s a very tight race, and even small changes make a huge difference in the rankings,” said Jean Kutner, MD, MSPH, chief medical officer for UCH. Kutner said the hospital’s performance is bolstered by a focus on quality and safety metrics across the organization, from the UCHealth and UCH boards of directors to leaders of individual units and clinics.
Newly arrived UCH President and CEO Will Cook noted the success in an email to staff Oct. 2. The hospital has been among the top 10 UHC performers five of the past six years, including consecutive number-one spots in 2011 and 2012.
“The fact that UCH has been repeatedly ranked among the nation’s top 10 academic medical centers shows your constant dedication to putting patients first,” Cook said. “This award also speaks to the quality of the faculty and research at the University of Colorado School of Medicine, because it is through their partnership that, together, we’re able to provide such a high level of care for patients.”
Stability in a time of change
The UHC scorecard measures the performance of its roughly 130 hospital members in six domains (see box). The organization compiles the data from measures developed by national organizations, such as the Joint Commission, and federal agencies, such as the Centers for Medicare and Medicaid Services (CMS). The measures include observed versus expected mortality rates, hospital-acquired infections, 30-day readmission rates, patient experience scores, and many more.
Many of the measures are used in the calculation of what, if any, annual performance bonus UCHealth employees receive.
A look at the top 10 performers in 2015 underscores the increasing degree of difficulty in meeting these standards and the intensity of organizational competitiveness. Of the 10, only UCH and Froedtert Hospital in Wisconsin improved on their 2014 scores.
The success came in the face of significant change the past year, said Sue West, RN, director of Clinical Excellence and Patient Safety for UCH.
“We sustained our performance despite capacity challenges and tremendous growth,” West said. “Staff hung in.”
She pointed to double-digit growth the past year across UCHealth in the number of outpatient visits and new patients, and 9 percent growth in the number of inpatient admissions. During the same time, UCH added 60 new inpatient beds, opened two floors in Anschutz Inpatient Pavilion 2, completed four new inpatient ORs, and built a new OR suite in the UCHealth Eye Center.
Across UCHealth, Poudre Valley Hospital and Medical Center of the Rockies also rank among the top community hospitals in the nation, and Memorial Hospital has made significant improvements in quality and safety. Look for more information in a future Insider.
Partnering with physicians
West credited the hospital’s UHC scorecard success in large part to its ongoing partnership with faculty of the CU School of Medicine. She cited as examples the leadership of Robert Meguid, MD, and Natalia Glebova, MD, PhD, in spearheading NSQIP (National Surgical Quality Improvement Project) initiatives; and Heidi Wald, MD, MSPH, who has focused on reducing rates of CAUTIs (catheter-associated urinary tract infections).
In addition, a new Quality and Safety Council co-chaired by UCH Chief Operating Officer Tom Gronow and UCHealth’s Executive Director of Emergency Services Richard Zane, MD, brings together the hospital, the School of Medicine, and University Physicians, Inc. to review data and assess the hospital’s performance in meeting standards of care, West said.
Kutner said those and other initiatives reflect an effort to bring the physician perspective into ever-broader discussions of improving patient care across the board, and a growing recognition patient care is a “team sport that we all do together.”
She noted the hospital’s recent additions of quality- and safety-focused positions, with Jeff Glasheen, MD, and Debra Anoff, MD, now serving as chief quality officer and physician advisor, respectively. Among other duties, Anoff is working with the hospital to increase communication between physicians who document the medical record, coders, and clinical documentation improvement (CDI) specialists, said Holly Saratella.
Docs and documenting
Saratella, a longtime data analyst with Clinical Excellence and Patient Safety, will manage a team of CDI specialists who will work with physicians and coders to ensure the medical record accurately reflects the care patients received while hospitalized. That means, for example, clearly documenting comorbidities present on admission, which are factors that could determine whether a patient’s death was expected or not, or length of stay – factors that are measured in the UHC scorecard. The hospital’s ultimate goal, Saratella said, is to code patients’ diagnoses and procedures while they are in the hospital rather than after discharge.
That’s an important clinical goal, and it is also important to improve the hospital’s efficiency in submitting data that show it meets CMS standards of care for infection rates and other measures that affect reimbursement.
“By the time the patient is ready to leave the hospital, we should have an accurate picture of their clinical condition, and the claim can go out the next day.”
Vigilant review of the medical record will also be necessary if UCH is to improve its ranking in the Safety category, which includes a collection of measures such as rates for CLABSIs (central line-associated bloodstream infections), pressure ulcers, and post-operative respiratory failure, which are grouped under Patient Safety Indicator 90. The hospital’s ranking in that category in 2015 rose from 49th to 37th, but Saratella said there are many opportunities for improvement.
“We’re still looking at the whole picture and reviewing opportunities to improve the integrity of the data,” she said.
Kutner stressed that the goal of complete documentation is less about jumping through regulatory hoops than in making sure the hospital and physicians get proper credit for caring for acutely ill, complex patients. That, in turn, will help to ensure that the hospital’s UHC ranking is an accurate representation of the work its providers do, she said.
“The more we understand about how to capture how sick our patients are, the better our ratings will be,” Kutner said.
As demanding as the pressures on hospitals are today, they are only going to increase, Kutner concluded. The ambulatory setting is also now subject to various quality and safety measures, and outpatient providers will be evaluated as their inpatient counterparts are.
“We’ve identified that as an institutional priority across the system,” Kutner said.
The Six Domains
UHC applies the following weights to the six categories of its Quality and Accountability Performance Scorecard:
- Mortality: 25 percent
- Safety: 25 percent
- Effectiveness: 20 percent
- Patient Centeredness: 15 percent
- Efficiency: 10 percent
- Equity: 5 percent