Patient safety has been a hot topic of conversation among healthcare organizations for some time and has recently picked up steam with the emerging push toward value-based care. Healthcare organizations are in a constant state of implementing or evolving their current practices to ensure the protection of their patients from preventable medical errors, infections and/or 30-day readmissions. According to Hospital Safety Grade, as many as 440,000 people die every year from hospital-related errors, injuries, accidents, and infections. By continually constructing a stronger culture of safety, clinicians can provide higher-quality care while eliminating the need for patients to receive additional, costly medical treatment.
Tracking Patient Safety Interventions Can Be an Administrative Burden
Patient safety is a complex topic, but is one that must be prioritized. The process to improve quality and perform the data analysis is continually evolving and requires access to both clinical and financial expertise. Some of the most talked about areas of patient safety include how to avoid 30-day readmissions, adverse drug events and Hospital Acquired Conditions (HAC) which include events such as sepsis, infections, catheter-associated UTIs, pressure ulcers and/or injuries from falls. By evaluating current behavior patterns within a healthcare system, healthcare leaders can encourage a safety shift that promotes a higher level of patient engagement, transparency and the elimination of avoidable medical errors which result in lower administrative functions of healthcare.
Even though implementing new intervention strategies on a consistent basis across an entire healthcare system can be difficult at times, another challenge providers face is being able to monitor and report the outcomes of the safety quality measures. Many healthcare teams can have a difficult time accurately gathering and interpreting data insights from the varying intervention strategies. Most of the time, this data collection from Electronic Health Records (EHR) is difficult to extract, can be manual process and is not integrated well with other sources such as the Social Determinant of Health, resulting in a broken approach to accurately measure and report quality improvement to the payer community, such as CMS. In addition, this approach complicates the process, driving up unnecessary healthcare administration costs. In order to determine the success of each intervention, it has to be made clear as to why a strategy may or may not be working. Is the intervention not working because of the provider execution? Or is there a problem within the integrity and collection of data itself? Is the intervention strategy not aligned with the patient population?
If the problem stems from the clinician’s team, the intervention strategy more than likely needs to be adjusted since each community and population varies and requires a unique approach to different safety concerns. If the quality of the data is a concern, a clinical documentation and medical coding audit followed by an education plan and continual monitoring may be necessary. Very rarely, if ever, does a one size fits all approach provide positive, long-term results.
Effective Patient Safety Practices Lower Healthcare Administrative Costs
Most recently, the focus of patient care and how an individual is billed after visiting their provider has been solely based on the volume of care a patient receives, also known as fee-for-service. With the implementation of the Alternative Payment Models (APMs) and value-driven care becoming more prevalent, the focus on improving patient safety outcomes play a bigger role than ever before. Federal policies from CMS and major payers are pushing APMs which are payment methods that rewards providers for delivering high-quality care at reduced costs. This model of payment can apply to a specific medical condition, a particular treatment, or population.
According to the Healthcare Payment Learning & Action Network, in 2018, 36 percent of total U.S. healthcare payments were tied to two alternative payment models. This is an increase from 34 percent in 2017 and is part of a much larger trend in healthcare payment reform since the Learning Action Network was first launched in 2015 when only 25 percent of healthcare payments used alternative payment models.
By implementing APM and having the patient’s outcome tied directly to a provider’s reimbursement, patients receive a higher quality of care and have a more positive experience. When both instances occur, patients typically see a stronger, long-term health outcome. According to the Agency for Healthcare Research and Quality, studies of patients hospitalized for a heart attack showed that patients with more positive reports about their experiences with care had better health outcomes a year after discharge. When patients receive customized care based on their needs, healthcare costs are lower because hospital readmissions, repetitive treatments and all of the expensive administrative tasks during the billing process can be avoided.
How Signature Performance Reduces Costs, Improves Quality
At Signature Performance, we are dedicated to making a lasting impact in the nexus of healthcare by inhabiting the payer, provider, federal and community sectors. Our team has the financial and clinical expertise combined with EHR optimization experience to access a healthcare systems readiness for this paradigm shift to value-driven care. With the proper planning, guidance, payer contract design and tools your healthcare system can thrive in this ever-changing landscape. Our unmatched experience on both the payer and provider side of the business allows our team the opportunity to evaluate some of healthcare’s largest challenges from a variety of perspectives and create custom solutions that get to the core of the problem.
We believe the healthcare industry in the United States deserves only the best, and that sentiment is what motivates our dedicated team to do our very best each and every day. It’s our calling to bend the curve of healthcare administration costs by improving the overall quality and experience while minimizing resources and cost.
Michelle Swertzic is the VP of Health Solutions & Strategy at Signature Performance Inc., in Omaha NE. Signature Performance is an industry leader in reducing healthcare administration costs for private and public healthcare sectors. Our unmatched experience in serving both the payer and provider side of healthcare financial management allows us to implement innovative solutions for every administrative demand.