Reducing Costs in Healthcare

Wallet Squeeze

One of the hottest topics in the business of today’s health care is cost containment. I believe that a vital component of that discussion surrounds that Purchasing Department within a facility or group of facilities. If a Purchasing Department can obtain supplies at a lower cost, without compromising quality, some of those savings can subsequently be passed along to the consumer; effectively lowering the cost associated with care as well as improves profitability. “Strategic supply management controls costs and protects assets — and that translates into a direct impact on a corporation’s bottom line” (Canadian Business, 2000). This objective can be accomplished in a number of different ways. Historically in most industries, purchasing in quantity reduces per unit costs of any supply because of negotiated breakpoints. The health care industry is no exception to this and has taken advantage of this aspect of purchasing by individual facilities, and small groups, joining group purchasing organizations (GPO). These consortiums have the large quantity purchasing power which allows them to contain cost of supplies on par with mega-infrastructure competitors in the market.

Market

Some traditional methods of minimizing supplies expense is via contract negotiations, competitive bidding amongst suppliers and adoption of just-in-time (JIT) inventory strategies. However, there are some limitations and potential pitfalls associated with these approaches that purchasing managers should remain cautious to avoid. For example, competitive bidding can only be utilized when there are multiple suppliers of the same (or comparable) product(s). An additional strategy for reducing cost is by streamlining product purchasing which effectively eliminates individual preference purchasing (such as individual physician). “Integrated systems bring about a radical shift in focus for materials management, from component prices to costs-per-procedure, enabling purchasing executives to achieve much more effective use of their group purchasing organizations and to eliminate hundreds of wasteful physician preference items” (Werner, 1993). Often quantity contracts for product require taking possession of specific amounts of product within a specified time frame…which may not coincide with rate of utilization. As a result, unused inventory ties up capitol which could be utilized elsewhere. And, finally, JIT inventory systems in a health care environment may not always be feasible due to the unpredictable nature of business. This is especially true in hospital areas such as Trauma Centers, Emergency Rooms and Intensive Care Units where readily available supplies are critical to life saving measures. That having been said, there are other facility areas where a JIT system could be utilized advantageously, such as; housekeeping, food services, and some areas of facilities maintenance.

The management of inventories in a healthcare environment is vital to reducing the over-all cost of care for the patient. However, it is not an easy undertaking and no singular approach is appropriate for every area within a facility or health care group. Due to the drastic needs variations in different departments, the tailoring of a mix of approaches is vital to maintaining cost containment, preserving high quality services and ultimately meeting the needs of patients.

References

Managing your bottom line: Purchasing and supply management advertising supplement]. (2000, Apr 17). Canadian Business, 73, 69-82.

Werner, C. (1993). Purchasing differs at veritically-integrated hospital system. Hospital Materials Management, 18(6), 14.

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Posted in Analysis, Change Management, consumer, Continuous Quality Improvement, Cost Containment, Costs, CQI, Economics, Healthcare, Healthcare Industry, Healthcare Management, Provider Profiling

Healthcare: One State Making Huge Improvements

Accomplishment Decision to Try

Improving our healthcare system continues to be a huge discussion, particularly with this being an election year. I think that few people would argue with the assertion that our system is far from perfect. We still have many areas where great improvements can be realized. I wanted to find out if there are states that seem to be making faster strides toward improvement and, after some research, I came across The New York State Department of Health. They are quickly improving their state system by trying new approaches to solve long existing challenges…and their results are impressive.

The New York State Department of Health has set the quality bar high both for themselves and other healthcare providers. With a state population of over 19 million people, New York State is the third most populated state in The United States according to the latest census reports from 2010. The Health Commissioner for New York State, Dr. Nirav R. Shah, has made it his mission to make his state the healthiest in the nation. With Dr. Shah leading the charge, The N.Y.D.H. is on the cutting edge in the effort to achieve transparency in; quality, cost effective treatment, education, sensible state regulation and accountability for consumers, regulatory agencies and clinicians. The N.Y.D.H. already has an impressively extensive website and databases replete with a broad spectrum of information all available at the click of a key. Information on Insurance Programs, Community/Family &  Minority Health, Education, Webcasts and even a section on a plethora of Diseases and Conditions from A to Z.

On December 3, 2013, the N.Y.D.H. sponsored the “Population Health Summit – Making New York the Healthiest State, Achieving the Triple Aim” (“Population health summit-making,” 2013). The goal of the summit was to bring together experts, including the Director of the CDC and the Executive Director of the Trust for America’s Health among others, to strategize on improve health care overall as well as reduce cost. Additionally, their mission was to foster collaboration between health departments, community groups, educational institutions and hospitals in order to achieve synergy for the good of all the citizens of New York State. Collaborations like these, as well as private businesses, is helping New York State to advance the way healthcare is delivered. “GE Healthcare announced, as part of its healthymagination initiative, a research collaboration with the Healthcare Association of New York State (HANYS) and Bassett Healthcare that will make hospitals safer for patients. GE’s Global Research Center (GRC) and its partners are developing technologies for use in hospitals to identify and mitigate patient safety risks, including the Smart Patient Room and the Patient-Safety Forecaster, a tool used to model effectiveness and savings associated with patient safety interventions” Medicine and Law Weekly (2009). It is impossible to currently value the future potential impact that these types of collaboration will have on tomorrow’s healthcare, we just know it will be positive.

In conclusion, I believe that the New York Department of Health is a model of healthcare because they are creating not only a system that works and has sharp focus, but they are more importantly building relationships between regulating agencies, clinicians, researchers, insurance providers and consumers. Furthermore, the hybrid environment they are fostering is based on quality, performance based incentive programs and evidence backed data incorporated into the latest and most technologically advanced system of medicine possible. The New York Department of Health may be setting the bar much higher than we have previously seen, but every state in the country is likely to be the beneficiary of their work.

What ways do you see your local healthcare providers collaborating with their communities? What are some other ways that your local hospital could improve in meeting the needs of the community?

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Thank you for taking the time to visit healthcarefully.wordpress.com

 

References

GE healthcare; GE healthcare, healthcare association of new york state and bassett healthcare collaborating to keep patients safe, enhance quality and lower cost of care. (2009). Medicine & Law Weekly, , 248.

Population health summit-making new york the healthiest state, achieving the triple aim. (2013, December 3). Retrieved from http://www.health.ny.gov/events/population_health_summit/

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Posted in Analysis, Benchmarking, Change Management, consumer, Continuous Quality Improvement, Costs, CQI, Diversity, Economics, Healthcare, Healthcare Industry, Healthcare Information, Healthcare Management, Provider Profiling

What is your job worth?

Money Clock

It is no secret that different positions within organizations come with different pay scales.  Determining how employees are paid can be a complicated task as many factors, some internal and some external, must be taken into consideration if accurate and justifiable pay rates are to be achieved.  Monetary compensation for a job is only part of the compensation equation.  There are other types of rewards, particularly in the healthcare industry, that are also of importance.  “Employee turnover is one of the major problems that organizations have to grapple with” (Singh & Selvarajan, 2013).  Compensation packages that include an array of benefits, perks, bonuses and ancillary rewards can all play a part in completing the compensation picture. The complete process of job evaluation can influence many facets of our healthcare institution, such as; turnover rate, employee morale, institution image, quality of services and our competitive advantage within our market, just to name a few.

The job evaluation process outlines the value of positions in our organization in financial terms.  Generally speaking, it is expected that positions that require higher skill levels; expertise, training and complexity in function and duties, will come with a higher rate of compensation.  In contrast, positions with lower value correspond to jobs with less complexity and fewer (if any) specialized skills or expertise.

Benchmarking, in terms of the job evaluation process, is the act of looking to existing comparable positions in other organizations and the compensation package for that position.  This facet of the job evaluation process is important because it translates to our organization remaining competitive particularly in areas of the market where the labor pool is shallow.  The scarcity of labor often drives the compensation rate up.  As with any other resources, when availability is low price is higher.  However, this can pose a unique problem in healthcare due to the fact that many organizations are impacted by reimbursement rates from third parties, such as insurance companies and Medicare.  An excellent source for benchmarking purposes is the Bureau of Labor Statistics as well as other professional associations, many of which conduct annual studies and surveys targeting wage and compensation by position and duties.

Internal to an organization, there are several ways to categorize jobs for the purposes of determining value to the organization.  “Job evaluation is part of the organization’s human resource planning process. It is a systematic method or process, as opposed to an approach that is random or non-systematic. This means that jobs are considered against the same criteria in each case, which should ensure consistency” (Chaneta, 2014).  These methods of valuation include; ranking, position classification, broad banding, point and factor comparison (a hybrid of ranking and the point method).  The ranking method is based on listing positions in the order of their importance to the organization; the job as a whole is considered rather than the individual responsibilities of the position.  The position classification approach is the method of grouping jobs into various categories (usually levels or grades) and is based upon position requirements, duties, skills, environment and any other number of factors deemed of significance to the category.  Broad banding is the method of categorizing positions based on ranges of pay, or bands.  These bands tend to differ from traditional, and narrow, ranges of pay which provides additional compensation flexibility for employers and employees.  The point method arranges compensation based on specific tasks.  The factor comparison approach blends the aspect of the point method for specific tasks by comparing them to industry benchmarks and developing compensation accordingly.

Hiring sign

Job evaluation procedures can be utilized to determine if adequate compensation is being offered to virtually any group by studying industry benchmarks as well as surveys and trends within the current employment pool of available workers.  For example, if we want to know if we are under-compensating our female employees we can seek statistical information from market research organizations as well as the Bureau of Labor Statistics to determine how women in comparable positions are being compensated in contrast to what we are paying females in our organization.

When discussing job evaluation in relation to compensation it is important to understand that market factors, particularly the availability of suitable candidates, plays a large role in determining pay.  It is also important to note that employers must remain vigilant to changes in the employment pool and the compensation rates that are current in order to reduce turnover, maintain skilled staff and team cohesion within our workforce.

Have you heard of or encountered a unique compensation approach, if so I would love to hear about it! Do you think that healthcare organizations are approaching compensation correctly? How do you see clinicians and other providers pay structure versus the value they provide to you? Do you believe that most people in healthcare are appropriately compensated, why or why not?

References

Chaneta, I. (2014). Effects of job evaluation on decisions involving pay equity. Asian Social Science, 10(4), 145-152. Retrieved from https://search.proquest.com/docview/1504090964?accountid=41759

Singh, B., & Selvarajan, T. T. (2013). Is it spillover or compensation? effects of community and organizational diversity climates on race differentiated employee intent to stay. Journal of Business Ethics, 115(2), 259-269. doi:http://dx.doi.org/10.1007/s10551-012-1392-5

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Posted in Analysis, Benchmarking, Change Management, Compensation, Costs, Economics, Employee, Healthcare, Healthcare Industry, Healthcare Management, Pay

Diversity in Healthcare

 

Successful Healthcare Organizations Embrace Diversity!

Diversity Face Profile

Diversity permeates the world we live in.  There is no aspect of life that is untouched by this fact.  In spite of the attempts of human beings to neatly categorize, label and implement uniformed conformity to our environment; diversity persists and is a fact of life itself.  In this regard, and ironically, the best definition of “normal” is diversity.  The variations that make a person who they are; are virtually endless and the combinations of variations yield even more diversity.  Healthcare institutions are comprised of people from all walks of life and many serve widely diverse community populations.  Those institutions that fail to embrace diversity place obstacles in front of many of their own employees.  “Employee career development issues include the barriers they regularly encounter, such as discrimination; inequitable access to resources; and language, religious, and cultural differences” (Pope, 2012).  It should serve as an easy litmus test for the average person that it is far easier to accurately define diversity than it is to define normal, particularly when it comes to patient populations and workers.

Although there are people who espouse that diversity can negatively affect business performance due to the propensity for internal conflict, dissension and turnover; these activities are going to happen even without diversity.  Internal conflict can, and will, happen for a plethora of reasons…most of which have nothing to do with traditionally defined diversity.  For example, individuals (employees) within any given population can have differing values, priorities, moral compasses, religious beliefs and attitudes; just to name a few.  When there is variation in alignment between the individual’s beliefs and others, including the employer itself, internal conflict can have the propensity to arise.  The same can be said for both dissension and turnover.

I believe that the ability to eliminate diversity is a delusion.  It has puzzled me for many years how so many people can, for example, walk through a garden in any park in America with amazement and awe at the beauty of what they encounter.  They stroll down the paths enjoying and relishing the feast for the senses that nature has provided in the garden.  However, many of those same people return to work the very next day and abhor the very diversity that brought them such joy in the garden the day before.  I do not understand why so many people choose to resist embracing the diversity that is so very clearly all around us.

Garden Path

Do We Ever Think “This Flower Isn’t As Good As It’s Neighbor”?

 

Healthcare organizations, at least all those that I am familiar with, are built to serve and improve the health of their surrounding communities.  Nearly every community includes; the very young and the very old, men, women and children, and many are ethnically diverse.  However, many healthcare providers still struggle with imbuing diversity in their workforce.  This places them at great disadvantage for serving minority patient populations within their own communities.  As a result, these minority populations suffer.  “Because the nursing profession itself is often mono-cultural and reflective of the dominant cultural institutions of society, it has only limited capability to meet the needs of people from minority cultures” (Southwick & Polaschek, 2014).  Many of today’s healthcare institutions employ very diverse teams both clinically and administratively.  Healthcare facilities today understand that diversity, when embraced, can be a very strong attribute that sets them apart from competitors.  Appealing to the widest audience possible entails embracing diversity not only in our workforce but, more importantly, in regard to attracting patient populations as well.  This stance ensures facility longevity, stability and future growth because diversity within communities is growing.  Healthcare facilities should reflect the diversity of the communities they serve. Healthcare organizations that actively pursue diversity as a core value, and do so with great zeal, will be among the most successful in the years to come.

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References

Pope, M. (2012). Embracing and harnessing diversity in the US workforce: What have we learned? International Journal for Educational and Vocational Guidance, 12(1), 17-30. doi:http://dx.doi.org/10.1007/s10775-012-9215-x

Southwick, Margaret,PhD., R.N., & Polaschek, Nick,PhD., R.N. (2014). Reconstructing marginality: A new model of cultural diversity in nursing. Journal of Nursing Education, 53(5), 249-55. doi:http://dx.doi.org/10.3928/01484834-20140415-01

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Posted in Analysis, Benchmarking, Change Management, consumer, Continuous Quality Improvement, CQI, Discrimination, Diversity, education, Global, Healthcare, Healthcare Industry, Healthcare Management, International, patient, Provider Profiling

Change Management in Healthcare

winds of change

Clinicians are often the last bastion that clings to the way things have always been done. As imperfect as the processes might be, they take comfort in what they know and fear what they do not. “Much of the record-keeping in hospitals and clinics in the US is still done on paper” (Box, Mcdonell & Helfrich, et. al., 2010). Clinicians are often creatures of habit, not easily swayed into a new way of conquering long fought problems. Many subscribe to the belief that “if it is not broken, do not fix it” type of mentality. “However, technologies such as computerized physician order entry (CPOE) systems, electronic health records (EHR), and electronic prescriptions are often strongly resisted by the same community that is expected to benefit from its use” (Bhattacherjee & Hikmet, 2007). I believe that this is an issue that is not limited to clinicians, but rather a general human tendency to abide with the familiar and shun the unknown.

This lack of enthusiasm to adopt new technologies and the associated improvements in process and resulting outcomes, is in stark contrast to the multitude of advantages which are well documented in the industry. However, there do seem to be specific reasons for the resistance to adopt these new tools and methodologies. The apparent inability to adapt to change can certainly be cited as one reason. An entire new cottage industry has blossomed around the concept of “Change Management” to deal with just such aversion to change, encouraging clinicians and administrators to adopt a more fluid approach to business evolution. Another dynamic that is a likely culprit is the factor of computer illiteracy. Many clinicians still practicing well and fondly remember a time when paper charts, prescription pads and verbal orders were commonplace in healthcare. Today many of those same clinicians are basically faced with learning a new “language”, that being technology, if they are to remain relevant in their field of expertise. There is also the issue of the power of knowledge. Knowledge is power and those that possess that knowledge preserve a higher degree of autonomy for themselves. This concept evaporates when we openly share knowledge in a collaborative environment. In spite of this notion being what is clearly best for both the organization and the patient; many clinicians are reluctant to surrender their power…even for the greater good. “They might not like performing the mandated behavior, but they do it anyway, because they are required to do so” (Brown, Massey & Montoya-Weiss, et. al., 2002). And, finally, many clinicians function somewhat isolated, or “siloed”, from other operational areas of the facilities in which they practice. This lack of exposure can easily translate into a perspective that is devoid of understanding the advantages and power of an integrated HMIS network, including CPOE.

In conclusion the marriage between business, healthcare and information technologies can be a very powerful cocktail for progress in medicine. Knowledge has always translated to power, from the time when books were only readable by very few. In order to overcome the obstacles of user resistance to technology implementation, we must be willing to openly discuss and address these issues and resolve them. Whether we like it or not, technology is a part of today’s healthcare and that role is going to grow exponentially as we progress forward. The medicine that we practice today is literally on the cusp of a new dawn, a new era…the techno-medical age has arrived.

 

Thank you for taking the time to read my post! I hope that you will follow my blog at heathcarefully.wordpress.com and invite your friends, family and colleagues to do the same. Please feel free to share my site. I am also available and happy to answer any questions you may have. I would also like to invite you to join in the conversation…what are your thoughts on the topic of Change Management in Healthcare?

 

References

Bhattacherjee, A., & Hikmet, N. (2007). Physicians’ resistance toward healthcare information technology: A theoretical model and empirical test. European Journal of Information Systems, 16(6), 725-737. doi:http://dx.doi.org/10.1057/palgrave.ejis.3000717

Box, T. L., Mcdonell, M., Helfrich, C. D., Jesse, R. L., Fihn, S. D., & Rumsfeld, J. S. (2010). Strategies from a nationwide health information technology implementation: The VA CART STORY. Journal of General Internal Medicine, 25, 72-6. doi:http://dx.doi.org/10.1007/s11606-009-1130-6

Brown, S. A., Massey, A. P., Montoya-Weiss, M., & Burkman, J. R. (2002). Do I really have to? user acceptance of mandated technology. European Journal of Information Systems, 11(4), 283-295.

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Posted in Analysis, Change Management, Continuous Quality Improvement, Costs, Economics, Healthcare, Healthcare Industry, Healthcare Information, Healthcare Management

Continuous Quality Improvement in Healthcare

Quality Improvement

In yesterday’s post, I talked about evaluating and profiling providers for the purposes of decision making. Effective benchmarking is a substantial part of that process. One of the ways that Provider Profiling and specifically Benchmarking are commonly used in the Healthcare Industry is to improve operations.

Continuous Quality Improvement (CQI) is the concept and reality of being in a perpetually active mode of development and enhancement of activities in order to meet or exceed the benchmarks of the Healthcare Industry. Furthermore, CQI is deliberate and proactive in a preventative posture that is inclusive of all aspects of the business, including both internal/external customers and stakeholders with primary focus on processes as they affect the organization as a whole. As a result, the responsibility of CQI within an organization is held by all members of the institution.

The process of Quality Assurance (QA) pertains to the measurement of compliance based on set forth industry standards. In this regard, QA is a direct comparison between quantifiable results of performance against benchmarks. This approach is a requirement of compliance to standardization rather than a choice. The responsibility for Quality Assurance typically rests with individuals or a single department specifically tasked with this focus as opposed to these duties being diffused throughout the organization.

These two approaches differ in some very distinct ways. In spite of the differences between CQI and QA, the added value to healthcare these processes provided cannot be overstated. “…conducting continuous improvement activities such as these, is an obligation of health systems and clinicians. We believe that rigorous, systematic evaluation should be considered part of normal, expected operations, rather than exceptional behavior that requires extraordinary regulatory control. (Platt, Grossmann and Selker, 2013)” The most fundamental variation is that CQI is a choice an organization makes rather than a requirement in order to provide proof of having met criteria of an outside source, as is normally the case with QA. For example, a CQI activity within Medical Records would be to examine the auditing process to streamline and make it more efficient. However, the actual act of auditing Medical Records for the purpose of finding and correcting errors is a QA function designed to demonstrate compliance of standards set forth by an outside accrediting agency. Another way that CQI and QA diverge is that the former is simultaneously a concept, or an ideal, as well as an activity. Yet another important variant is that CQI is an ever-present and ongoing activity that is constantly occurring and, in contrast, QA activities may be routine on a regular basis but they are not necessarily perpetually going on. Additionally, CQI is a diffused process that all members of an organization actively participate in while QA activities are usually participated in by only a few. Although these two processes are different in nature, scope, participation level and regularity of occurrence; they are both important and vital to improvement efforts in not only a healthcare setting but of industry in general.

In conclusion, CQI and QA are not perfect approaches and there are advantages and disadvantages to both. For example due to the all-encompassing and complex nature of CQI it can be daunting to implement within an organization that is accustomed to a more siloed QA approach to improvement. This is further compounded when applied to a healthcare setting due to the differing agendas of departments. For example, clinical practitioners inherently have a focus on patient care which has a high level of variety in protocols due to the differences in conditions and patients. “…physician training programs focus almost entirely on the knowledge and skills to manage clinical problems, with almost no training in skills related to healthcare management or effective quality improvement. (Bethune, Sue, Woodhead et al, 2013)” In contrast, other areas have extremely rigid functional process steps such as research and pharmacy arenas.

Both CQI and QA are invaluable methods and tools which empower healthcare providers to improve the quality, structure and ultimately added immeasurable value to both internal and external stakeholders. Quality Assurance measures provide us with invaluable data that helps in meeting required credentialing criteria. Adopting a posture and attitude of Continuous Quality Improvement allows healthcare providers to not only meet basic standards of what is acceptable but also paves the way for best possible outcomes even beyond industry benchmarks.

 

References

Bethune, R., Soo, E., Woodhead, P., Van Hamel, ,., & Watson, J. (2013). Engaging all doctors in continuous quality improvement: a structured, supported programme for first-year doctors across a training deanery in England. BMJ Quality & Safety, 22(8), 613-617. doi:10.1136/bmjqs-2013-001926

Platt, R., Grossmann, C., & Selker, H. P. (2013). Evaluation as Part of Operations: Reconciling the Common Rule and Continuous Improvement. Hastings Center Report, 43S37-9. doi:10.1002/hast.139

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Posted in Analysis, Benchmarking, Change Management, consumer, Continuous Quality Improvement, CQI, Economics, Global, Healthcare, Healthcare Industry, Healthcare Information, Healthcare Management, International, patient, Provider Profiling

Provider Profiling: Reliable Information Analysis For Decision Making

Oranges and Apples

Provider profiling has a wide range of applications in the Healthcare Industry. Prior to developing a Provider Profile it is vital to understand how the profile will be utilized because a wide array of criteria can be included in the effort to build an accurate portrayal of the provider. Successful development and implementation are completely dependent upon the inclusion of correctly chosen statistical data sets which, when combined appropriately, provide the end user valid, concrete and useable information for decision making purposes. Groups which routinely utilize Provider Profiles include Health Plans, consumers (and consumer groups), employers, and Providers themselves (for benchmarking and competitive assessment purposes). Conceptually, we want to be comparing apples to apples and oranges to oranges.

In the effort to provide a compelling profile, there are ten specific principles which should be included and considered, as outlined in Essentials of Managed care authored by Doctor Peter Kongstvedt (Kongstvedt, 2013). The first principle to include is the identification of high cost and high utilization clinical centers, which are of particular interest because this is vital in understanding where money is being spent (Cost Centers) as well as primary centers of demand and income (Utilization and Revenue Centers, respectively). The second principle to include is relative derivative information obtained from internal and external customers. The information they provide is critical in providing the profile a real market perspective. The third principle is the inclusion of the subject provider in the process of building and deployment of the profile, which ensures organization investment in the process. The fourth principle is (once the profile is completed) to establish industry benchmarks which are used to compare and contrast internal vs. external performance. The fifth principle is that all performance reporting should utilize uniform clinical data sets. This principle streamlines information so that accurate and direct comparisons can be made. The sixth principle is to utilize an outside source of data for validation of information collected from the provider when possible. This factor is key in determination of anomalies and incongruences in data in comparison to benchmarks. The seventh principle is to scrutinize data obtained directly from the provider’s onsite data collection system, which ensures accuracy, validity and dependability of information. The eighth principle is to tender performance comparatives utilizing clinically relevant risk stratification. This provides vitally useful statistical information for the purposes evaluating and mitigating the possibility of negative outcomes. The ninth principle is to insist upon dimensions of statistical importance for evaluation and create thresholds for minimum sample size, which provides for enough criteria in order to extrapolate substantive and qualitative results. The tenth and final principle is to redraft measurements of performance utilizing standardized severity adjustment protocols. Severity Adjustment is a means of demographically studying groups of patients by the seriousness of their condition(s). This is important because facilities that score high in this category of measurement are typically seeing patients with more chronic and acute conditions and, thus, are spending more to treat these additionally complex cases.

Some common problems associated with profiling include; data warehousing challenges, validity and reliability of claims data (the source for most profiling information), information omission, lack of standardization of terminology and adherence to Health Insurance Portability and Accountability Act (HIPAA) regulations during data collection. “Developing methods that can reliably distinguish among physicians’ performance is challenging because of small sample sizes, incomplete data, and physician panel differences” (Pelletier, Johnson, Westrick, Edward, Fontaine & Krinsky, 2014). In order to obtain the most complete and effective Provider Profile it is important to have as much information as possible. With the advent of Electronic Health Records (EHR) it is now possible to collect massive amounts of data, or mega-data. As such, Mega-Data Warehouses (commonly known as “The Cloud”) have been built. These warehouses are extremely expensive to both develop and maintain, which is a challenge for provider profiling. Due to the sheer size and scope of information obtained, it is vital that the information be accurate in order to produce valid, reliable and (most important) actionable information for health care institutions. The omission of information is an ongoing challenge for provider profiling because many times a patient may be treated for more than one issue so the main diagnosis cannot always be relied upon to provide a complete picture of everything that was done to treat them. For example, a patient may be in the hospital as a result of a fall which resulted in a broken hip. However, while they were in the hospital they also developed a Urinary Tract Infection (UTI). Their primary diagnosis would be the reason for admission, in this case a broken hip but this was not the only medical issue that was addressed. The lack of standardization of terminology speaks to the problem of language and clinical interpretation of diagnosis. HIPAA regulations are quite stringent and great care should be taken when collecting, storing and using data to ensure the privacy of individuals is maintained throughout the process.

In conclusion, the creative development and implementation of a Provider Profile can be useful in a variety of applications and by different groups for decision making purposes. Giving clinicians well-articulated demographic information regarding the patient populations they serve will empower patients by those clinicians passing that information along, effectively educating patients so that they may make informed health care decisions. ”Ours is an era in which patients seek greater engagement in health care choices, increasing the demand for high-quality information about clinical options” (Woolf, Chan, Harris & Sheridan, 2005). Overcoming the challenges to building a reliable, accurate depiction of a provider is of paramount importance in this process because it is necessary in order to yield clear direction for the user. As the industry moves forward, with both clinicians and patients expecting more from the provider system as a whole, these issues will likely grow in importance, gravity and scope.

How do you see benchmarking, provider profiling and the management of big data affecting your organization? Do you see different and more innovative ways that provider profiling could be used to improve the way we go about providing healthcare? What steps do you see the industry taking to ensure that patient information remains confidential in light of data warehousing and the emergence of “The Cloud”?

Thank you so much for visiting healthcarefully.wordpress.com, I hope that you will share this blog with your family, friends and colleagues…but most importantly, I hope you will join in the conversation!

All the best,

Michael

References

Kongstvedt, M.D., F.A.C.P., P. (2013). Essentials of managed care. (6th ed.). Burlingame, Massachusetts: Jones and Bartlett Learning.

Pelletier, L. R., PhD., Johnson, S. A., PhD., Westrick, E. R., M.D., Fontaine, E. R., Krinsky, A. D., PhD., Klugman, R. A., M.D., . . . Sax, Harry C, MD,F.A.C.H.E., F.A.C.S. (2014). Composite model for profiling physicians across domains of Care/PRACTITIONER APPLICATION. Journal of Healthcare Management, 59(3), 224-37.

Woolf, S., Chan, E., Harris, R., & Sheridan, S. (2005). Promoting informed choice: Transforming health care to dispense knowledge for decision making. (Master’s thesis).

 

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Posted in Analysis, Benchmarking, Change Management, Cloud, consumer, Continuous Quality Improvement, CQI, Diversity, Economics, education, Global, Healthcare, Healthcare Industry, Healthcare Information, Healthcare Management, HIPPA, International, patient, Provider Profiling
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