Take next step in performance measurement
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in Oakbrook Terrace, IL, refers to its core measurements as the next step in the performance measurement evolution.
HIM professionals might agree that at the very least, core measures — which are used only by acute care hospitals — are an important quality assessment tool that provide standardization and the possibility of clean benchmarking data.
"Core measures make up the bulk of measures that have been recommended for use across the country," says Judy Finlan, RN, MBA, CPHQ, product manager of QuadraMed Corp. in Neptune, NJ. QuadraMed is an approved vendor for core measurements.
Although nursing staff will argue that only a nurse can obtain the core measure information, some facilities will rely on their most skilled coders to abstract the data, Finlan says.
"Coders would need to know a lot more detail with regard to drugs that are ordered and when they are administered," Finlan says. "They’ll be looking in more detail at the types of discharge instructions given to patients, and I do know of some hospitals where they’ve identified their very good coders and promoted them into this position."
Because hospitals are experiencing both nursing and coding staff shortages, each facility may have its own way of handling the data collection, but it is clear that someone’s workload will be increased as a result, Finlan adds.
Finlan is scheduled to speak about core measurements at the 74th National Convention and Exhibit of the Washington, DC-based American Health Information Management Association. The convention is Sept. 21-26 in San Francisco.
Here is what HIM professionals need to know about core measurements and collecting those data:
• What are core measurements?
The Joint Commission has created requirements, data elements, data definitions, and algorithms to calculate outcomes for a set of specific measures that are particularly important in quality improvement for acute care hospitals. These became effective for all patients discharged on or after July 1, 2002.
The four focus areas identified by the Joint Commission are:
— acute myocardial infarction;
— heart failure;
— community-acquired pneumonia;
— pregnancy and related obstetrical conditions.
Each measure set has about 15-20 standardized questions.
After establishing these core measurements, the Joint Commission tested more than 50 vendors to make certain they had standardized methods for compiling and reporting the data, Finlan says.
"What the Joint Commission did was give vendors specifications and then sent raw data to each of the vendors," Finlan explains. "They had 48 hours to run the data through their programs and get the results back to the Joint Commission."
The vendors whose answers passed the Joint Commission’s test were deemed ready to provide vending services to acute care hospitals, Finlan adds.
• Core measures are putting more emphasis on the importance of HIM departments.
"I think one of the things I have noticed is that there’s more emphasis and attention paid to the UB data by other departments within the hospital," Finlan says. "In a lot of institutions it has always been difficult for coders to get the respect they deserve because clinicians thought the data was not going to be used for anything except paying bills."
Now that coding data are being used to measure quality and this information is reported to the Joint Commission, there is a trend of clinicians beginning to listen more closely to what HIM professionals have to say, Finlan adds.
"HIM directors have to be involved in implementing core measures because it’s their data," Finlan says.
• The use of risk adjustment in core measurements levels the playing field.
To keep core measurements as fair as possible, there are risk adjustments added to the analysis. This way, a hospital’s data may actually reflect more positive or negative outcomes than the number alone would suggest.
For example, suppose Hospital A had 20% of its patients die from acute myocardial infarction, Finlan offers. On the surface, that percentage may sound high, but when risk-adjustment factors are included in the analysis, it may be that the hospital actually could have expected to see a 40% death rate among this same population, Finlan explains.
"And that is the information that is going to the Joint Commission and to hospitals, as well," Finlan says. "When you try to give [benchmark] results to doctors, the first thing they’ll say is, My patients are sicker,’ so risk adjustment takes into account which patients are sicker on a subjective basis."
All vendors supplying core measurement services will have the capability of doing risk adjustment, Finlan says.
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