Beyond OASIS: Consortium of agencies benchmarks nonclinical outcomes
Core areas: Intake, admission, caring for patient, payment collection
Trying to find good, scientific benchmarking data for nonclinical aspects of home care is like trying to find a needle in a haystack, according to David Baker, corporate director for home care services at OSF Healthcare System in Peoria, IL. It’s so hard that he formed a group of agencies about a year ago to share data, experiences, and best practices in several nonclinical areas.
"OASIS [Outcome and Assessment Information Set] will give you one set of data for the status of patients," says Baker. "But we want to look at financial data, performance data, cost data, outcomes data, and patient satisfaction data. These are other important elements of care."
Baker says his agency is under more and more pressure to benchmark such data sets against others because it’s hospital-based. "They’ve been doing this for years, and they would look at me like I was crazy when I said there was nothing out there for home care."
Although he was initially going to set up a benchmarking consortium on his own, Baker instead found a partner in the Healthcare Management Council (HMC), a Needham, MA-based company that has done benchmarking for hospitals for several years. "They had a good record, and they had the ability to interpret the numbers."
Martha Tecca, founding partner of HMC, helped Baker put together a group of seven agencies to participate in the benchmarking project. Aside from two organizations from Chicago, the seven were all from different geographic areas.
The first step was to determine what information would be worth collecting and sharing. Baker says he created a list of things he wanted to know. "In home health, we need to know the direct cost per visit for each discipline. We need to know what the labor, travel, and supply elements of those direct costs are. I did the same thing for other areas, such as hospice, DME, and IV." That was a starting point for discussions.
Over time, the list has grown to include:
• total cost comparisons;
• total direct cost comparisons;
• direct cost comparisons by discipline, including nursing, home health aides, physical, occupational, and speech therapy, and social work;
• performance by diagnosis, including diabetes, hypertension, coronary atherosclerosis, CHF, pneumonia, CVA, COPD, chronic skin ulcer, osteoarthrosis, and femur neck fracture;
• indirect service comparisons;
• practice comparisons.
Tecca says it was difficult to come up with appropriate questions. "In general, the interest in information is greater for most than their ability to provide it given their current systems," she says. "They filled out the questionnaires, and about half the items they had said they wanted information on, they couldn’t answer. We had to go in and extract it from whatever forms they had."
Even more challenging was putting together the data on indirect costs, says Tecca. "If you take the entire process from meeting the patient for the first time to meeting the patient’s needs, you have to break that down into core processes," she explains.
The group, which now numbers 12 organizations, came up with four of these core areas: intake, admission, caring for the patient, and collection of payment. "But within those four areas, there are a variety of functions in every organization," says Tecca. "You have to define the functions so each of the agencies can identify the costs associated with these processes. They can’t, in every case, give me functions that match one another. But there are clear sets of standard activities involved in each of these four areas. We are finalizing language now."
Growing and sharing
The goal is not just to share data, but to facilitate discussion among members, too. There have been three meetings so far one introductory meeting and two others. Tecca says there already have been "light bulb" incidents, where one participant has said something, and another has taken that comment and come up with a way to apply it in his or her own organization.
"There are broad and narrow goals," explains Baker. "I want to have a nationally accepted and credentialed service that provides good comparable data that is accepted by both the industry and payer sources as a barometer of our performance. I want behind-the-scenes networking so we can look at best practices and share information."
Tecca explains the more specific goals. "In the end, we hope they will be able to look at specific data points and have meaningful conversations about them," Tecca says. For instance, if 10% of Agency A’s staff is composed of home health aides compared to 27% of Agency B’s staff, the discussion can focus on how Agency B makes that number work. "It’s more meaningful than saying Agency B has a lower cost base. It shows a specific reason why it is lower. We want to help them get at the actual practices behind the numbers."
The group hopes to continue to grow. Tecca says the ideal situation would be to have several groups of 15 or so organizations that share data and information unreservedly. Right now, with two Chicago-based agencies, data must be doctored, she says Agency A does not get data for Agency B and vice versa. "They are willing to share experiences and best practices, but not specific data."
Spend a nickel to save a dime
The cost is $5,000 to $15,000, depending on the size of the organization, says Tecca.
That could be an impediment, Baker admits. "With the changes in the reimbursement system, people are getting more and more frugal," he says. "People may need the service, but they don’t want to spend the dollars."
Tecca agrees. But she says forward-looking organizations will be willing to spring for the money. "They understand that in a time when you have to make cuts, it’s important to know where to make the changes that will improve efficiency and cut costs, but not affect the quality of care."
She adds that in most cases, even the early data that the charter organizations have thus far provided and the discussions on best practices they have had should give the agencies information that can provide one full-time equivalent’s (FTE) worth of savings. "Half the cost of a visit is indirect costs," she says. "That provides a wealth of areas to save money. If you save one FTE, that’s three times the most expensive cost of becoming part of the partnership."
She is even more chagrined that organizations are willing to shell out millions of dollars to change systems to handle OASIS. "That will be helpful to them, but we are trying to help them use the systems they have now, to get real value out of them and help make decisions that will make them operate more efficiently."
Every organization has specific information needs, Tecca says. "They need to know clinical quality, they need to know functional outcomes, they need to know patient satisfaction. But they also need to have information from financial and administrative areas, and to integrate all the information together. Cost management is an issue for most organizations. The people who will participate in this have the quality issues down. But they are still learning about financial management. This enables them to enhance their cost and operations while maintaining quality."
(Editor’s note: Organizations interested in learning more about the partnership should contact Tecca, whose contact information is given in the source box above.)
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