How do you fight a bad review?
June 1, 1997 3 minutes read
How do you fight a bad review?
Accurate data save the day for Salinas Valley
Administrators at Salinas Valley Memorial Hospital knew something was wrong. A report by the California Office of Statewide Health Planning and Development (OSHPD) stated that the hospital’s cervical and lumbar diskectomy outcomes were "significantly worse than expected." The question was how to correct the record. The Salinas, CA, facility had the answer at its fingertips: its own up-to-date, severity-adjusted data.
"The problem was that the OSHPD data outcomes were old and non-severity adjusted," said Ralph H. Keill, MD, assistant administrator and medical director of Salinas Valley. "In studying our own severity-adjusted data, we determined that one physician whose length of stay [LOS] was above average was responsible. And that physician had retired after the period covered by OSHPD data." Salinas Valley uses severity-adjusted data from Iameter, a software company in San Mateo, CA.
"When we studied our own data for the most recent two-year period, it was obvious that improvements had been made in LOS and charges," Keill says. "And when we sent this information to OSHPD, we received a letter stating that the questionable portion of the report would not be published because [the state’s] data was flawed."
Keill praises a team effort at Salinas Valley for the successful fight against the bad review. But team spirit wasn’t always in evidence at the hospital. Many at the medical center credit Keill’s arrival three years ago with creating an environment of physician collaboration. They cite Keill’s ongoing letters to staff and informal meetings, along with his sharing doctors’ profiles with them to demonstrate that the purpose of data is to improve performance.
"There was the idea here when I arrived that data is used to get’ people, to punish them," Keill explains. "But my attitude is that the insurance companies already have the information and that we should use it to become better at what we do so we can provide an ever-improving level care for our patients. That’s what it’s all about."
Teamwork pays off
From the beginning, Keill focused on small groups and single diagnoses, sending out letters to individual physicians. After that, doctors began seeking him out to talk about their data. But Keill is quick to point out that successes have been a collaborative effort, particularly with Diane Elkins, director of quality management at Salinas Valley.
Elkins, who has been at the hospital for 10 years, says she has come to an important conclusion after years of assisting physicians with behavior change: "Physicians want reliable data they can use, not clinical decision making. They want to use that data to make important decisions on their own," she says.
Elkins gets no argument from Keill, who says, "Accurate data should be shared with physicians. It’s a tool to help them to improve their performance. In the past, hospitals had the data but held onto it, not sharing it with the people who really needed it the physicians."
Keill underscores his point with the example of a case in 1993 involving Salinas Valley’s urologists. That year, their profiles in transurethral resection on the prostate showed their charges to be $1,000 above the state average and $2,500 above their major local competitor. In addition, their LOS was 1.5 days higher than the state average and 2.6 days higher than the local competitor.
The physicians protested the figures, saying they believed one or two doctors were causing the data to be skewed. The urologists began to meet as peers, seeking to make significant improvements.
Three years later, the hospital’s urologists had managed to cut charges by more than $2,800 and LOS by 2.8 days. While costs had been nearly $2,000 above reimbursement in 1993, they were almost $1,000 below reimbursement by 1996. Readmission rates also decreased over the three-year period, indicating not only more efficient care for patients but more effective care.
"Obviously, no physician wants to be considered below average," says Keill. "Physicians want to be the best and to provide the best possible care to their patients. To that end, almost all of them will look for ways to improve their performance. Salinas Valley and its patients have been the beneficiaries of that attitude."
The hospital isn’t resting on its laurels. Recently, it presented profiles to the cardiology section for the most common cardiovascular DRGs in the first half of 1996. As a result, the cardiologists decided to seek further information on DRGs 141 and 122, where charges are nearly $2,000 above the state average.
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