Outcomes measurement is all in the numbers
Outcomes partnerships provide perspective
It’s clear that with all the challenges facing hospices today, including rising pharmacy costs, there is a need to begin measuring outcomes and comparing those outcomes to the methods of care that produced them. But as hospices become managers of their data, what is to be gleaned from the fruits of their labors?
Certainly monitoring data over time and tracking improvements is valuable. Even more valuable would be the ability to compare similar data with other hospices.
"There are different ways of benchmarking administrative and financial data, but I recommend doing it within the context of a partnership," says Martha Tecca, MBA, founder of Healthcare Management Council (HMC), a Needham, MA-based outcomes consulting firm. "The reason you’re interested in the data is so that you can get access to the practices and understand the practices that generate the good data."
HMC has established outcomes partnerships for various segments of the health care industry including hospitals and home health. The partner organizations collect data individually but store their data in a central system where each organization has access to the data. HMC is working with 40 hospices in collecting data that will be shared among the group.
Tecca says hospices bring the right frame of mind to the data-sharing table. Unlike other segments of the industry in which agencies and facilities view each other as competition, hospices have long had the reputation of sharing experiences.
"Hospice [leaders] are fabulous networkers," she says. "They are very used to sharing with one another."
While hospices may be predisposed to networking, they are still far from being able to share usable data. The first challenge is finding partners willing to embark on such an ambitious project. Providers should approach these partnerships with an open mind, Tecca says. Do not limit your outcomes project partners to like agencies or facilities, or facilities just in your market or region. The most important criteria, she says, is to find providers that are leaders and forward-thinkers.
While logic may dictate that larger agencies have a distinct advantage over smaller agencies because of available resources, that’s not the case. Large or small, each agency has something to teach the other.
"Our original fear was that the best organizations aren’t going to want to join," she says. "The fact of the matter is the best organizations self-select the participators. We only have organizations that feel it’s important to share and learn from others."
Once providers identify others to share their data with, three points become very important:
1. Agree on important data. The partner providers must agree on which data is worth collecting and sharing. Generally, providers will want to focus on quality of death issues such as effective pain management, closure issues, grieving, and bereavement. While hospices are reasonably concerned about quality of care, costs should also be measured.
This is not to say that cost should be the central concern, but that cost can be controlled while still focusing on quality of care. "Pain management is obviously a large part of what hospices do," Tecca says. "It’s a strategic goal of a hospice to provide good pain management. With that goal in mind, they have to manage cost. Cost is not the driver. Good outcomes is the driver."
2. Agree on definitions for each statistic. In order for the data to be useful, they must be comparable from one facility to the next. The benchmarking exercise would be severely flawed if providers simply agreed to gather data on specific topics without agreeing to measurement criteria.
"You’re not just spitting data into some blind database, you’re working with other human beings to make sure the data are being input in the correct way," Tecca says.
3. Agree to share more than data. Providers must agree to share their experiences behind the data. "In other words, I want to know more than your length of stay," Tecca says. "I want to know what you are doing if your lengths of stay are longer than mine."
The data should prompt discussion among participating providers. Tecca says that agencies in the benchmark consortium have become so enthusiastic about contacting each other that her company has ceased having them go through HMC first and now allows them to contact each other directly.
Start simply
But what data should providers focus upon? Providers want to get as broad a picture of their business performance as possible, everything between clinical and financial. To start, providers should focus on data they are already collecting.
Many hospices may not realize it, but many useful outcome data already exist in their organizations. Most hospices, for example, track their length of stay and have anecdotal evidence of which referral sources invoke patients’ hospice benefits sooner than others.
"They are predisposed to benchmarking, but they are not predisposed to measuring things in this industry," Tecca says.
In order to link clinical outcomes with cost outcomes, hospices must be collecting cost data. They should already be collecting cost data for their first cost report to be filed later this year. Cost accounting system should be able to break down costs at various levels, such as cost by discipline or by department.
"I believe pretty strongly in a balanced scorecard approach or a multidimensional view of the organization," Tecca says. "You need to be managing your finances while you’re managing your quality, while you’re managing your customer base. Therefore, in order to make management business decisions, in general, you need to be able to understand financial data — where you stand, what are your costs, your utilization, as well as quality and patient satisfaction."
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