I read online that viewership of the 2016 Rio Olympics is down. That was news to me, since I have been glued to the television during all of the swimming, diving and gymnastics events. I don’t read the spoiler alerts on the news and in social media, because I want to watch each event with nervous anticipation and hopefulness. I love to be surprised by the results!
As you know, swimming is a favorite sport of mine – more so lately because my grandson, Jack, participates in the sport. In my last two Friday Flash reports, I told the story of his most recent meet, as I watched him swim in adversity and finish his first race with his goggles lodged between his nose and mouth; then, I had a chance to see him finish in fifth place for his 100-meter backstroke event. He had told me all about his strategy to improve his time, and in his last race, the 200-meter freestyle, I learned even more about Jack as he once again put his strategy to work—he shaved a full 15 seconds off his personal best time and finished in fourth place!
Last week, I used Jack’s story to talk about our own strategy for success when it comes to Best Care. Our vision is to not only deliver the safest care to every patient, every time, but we are also challenging ourselves to rank among the top 20 academic medical centers for quality and patient safety*. This week, something happened to reassure me that we can and will meet this very aggressive goal.
As a participant in the Medicaid program, which provides medical coverage for more than 4 million low-income Texans, UTMB takes part in its pay-for-performance program. Simply put, the program has two basic elements upon which we are rated: potentially preventable readmissions (PPR) and potentially preventable complications (PPC).
The penalties are not insignificant. When the program began three years ago, UTMB had $3.5 million of its Medicaid payments withheld due to unplanned readmissions and complications. We were astonished. But, as we looked into the data, it became clear that a good deal of the reimbursements were withheld not because of the quality of the care provided, but rather because our documentation and coding was not sufficient; therefore, it did not accurately reflect the degree of our patients’ illnesses or the specificity of their complications. In response, we set out on a mission to improve our documentation and coding, as well as to review every unplanned readmission.
The results the following year were incredible—instead of the $3.5 million figure being withheld, we had reduced the amount to a $2.5 million—all from readmissions. Following this significant improvement, we planned to further reduce this amount in FY16 by at least another million by sustaining our gains in reducing readmissions and focusing on preventing complications.
Because our Medicaid population is heavily represented by mothers and children, we talked to the department leaders, we rolled up our sleeves and reviewed OB charts with identified complications, brought in experts in the 3M PPR and PPC algorithms, and shared findings and recommendations with faculty and residents, informing them of the implications for their ongoing documentation. As a result of that work, a physician leader reviewed each case forwarded by hospital coders. The physician then communicated clarifications to the individuals involved in that patient’s care and medical record, and provided any overall messaging that would be useful in guiding the entire department.
While documentation and coding were certainly high contributors to the outcomes, there were also some process changes that helped us turn the information into actions that improved our overall care. The team engaged partners in Information Services to make changes in the Epic EMR infrastructure that would better facilitate the identification of the complexity and co-morbidity of OB patients, and to guide the assignment of observation status as appropriate (thereby avoiding an inpatient readmission).
The result? This week, we received our report from Medicaid outlining our results for the 2015 performance period, which go into effect September 1, 2016. We had zero deductions for unplanned readmissions and zero deductions for unplanned complications of care. That’s right—we exceeded our plan, and we did not incur ANY of the potential $2.5 million penalty!
This outcome reinforced several things for me:
- We need a plan that we follow without exception.
- We need people to be engaged in this effort to help us identify problem areas, develop solutions to those problem areas, and be willing to assist in teaching and educating our providers and staff to help us achieve our goal.
- We can achieve lofty, seemingly impossible goals, if we have a plan, execute it and stay singularly focused on achieving it.
While I would like to think that the large amount we retained will help our budget next year, we also learned that some of our funding from other various sources will be reduced more than we had anticipated. So while the latter is disheartening, it is another reason why we are so focused on Best Care—safer care is not only better for our patients, but it costs less, too.
If we remain focused on meeting the performance benchmarks for academic medical centers, increase our efficiency, reduce variation in care, and improve our quality, everyone wins. We lower our costs, see greater reimbursement, and most importantly, our patients get the best possible care—this is our ultimate goal.
We have a tremendous opportunity to showcase our talent and expertise through this endeavor. Thank you all for everything you are doing to help UTMB Health achieve Best Care for all of its patients!
*As measured by the Vizient Quality & Accountability Study.