A Balanced Approach to CMS Core Measures for Healthcare Providers

June 11, 2014  |  Delia Caldwell

In 2013, CMS made reporting of certain emergency department statistics mandatory. In 2014 those reportable statistics were broadened. These ED core measures are reported as part of the Hospital Compare initiative that allows healthcare consumers to compare services and metrics among hospitals. Currently, CMS takes a small patient sample from EDs for reporting; hospitals do not lose funding if these ED core measures are too high.

CMS has also made mandatory the tracking of inpatient readmissions due to the same problem. Hospitals who readmit too many patients lose some of their Medicare reimbursement. With margins slim to none, hospitals cannot afford penalties. The focus on reducing readmissions has become a primary strategy for most hospitals, as stakes are high.

Benchmark or best practice?

Not so — not yet — in EDs. Many of our ED clients want some understanding of how they stack up in the ED core measures, in HCAHPS scores against their competitors, or against other institutions with similar programs and patient types. Their desire to benchmark is understandable: it gives an institutional sense of where they stand. But this is a less than ideal way for our clients to frame goals and current challenges. Even when they are pushed to increase patient satisfaction reflected in HCAHPS scores, sometimes they set the bar too low.

If one simply tracks one’s performance with reference to a low- or average-performing group of institutions, it’s easy to develop a false sense of security (and lose some sense of urgency). It’s not particularly helpful and it’s not enough to be “better than the other guys.” Instead, a department should be focused on getting better period – making the most of your own capabilities within your particular context. It’s important to identify and follow through on your unique opportunities for improvement, whether you meet, exceed, or sit below the statistical average.

This is the difference between benchmarks and best practices. A benchmark tells you whether you’re “better than the next guy,” while a best practice helps you identify and implement ways to be as successful as possible. So what do these best practices look like?

The moving target

The act of measuring performance places a laser focus on how much you’re spending, as well as the quality of care you’re delivering. When implemented effectively, your tracking should help you balance these twin imperatives, ensuring that your hospital is able to serve the community and that the care you deliver is of the highest possible quality.

Take, for example, older patients who are statistically likelier to be readmitted, driving up readmittance percentages, creating more volume in the ED, and protracting a difficult situation for the patient. Observing simple best practices can reduce the rate at which these patients return:

  • Making certain inpatients are truly ambulatory with stable vitals, no ileus, and no present drug-resistant infection before release
  • Confirming that other infections are treated
  • Ensuring there is a post-discharge plan in place, including follow-up care and checks for adherence to discharge instructions

These are obvious steps, yet they may extend a patient’s initial stay, making them costly obvious steps, so they are sometimes rushed through. But the up-front cost of higher quality care may save them from being readmitted in the future, which is advantageous to both the patient and the hospital.

Becoming a more effective healthcare provider is a continuous process. It takes constant dedication. The target is always moving, and no institution will ever be perfect. But by framing this process in terms of best practices, a hospital can improve steadily, continuously working to be as successful as possible.

 ABOUT THE AUTHOR     Delia Caldwell MBAoutcome_swarming_Delia Caldwell
Delia Caldwell works with clinical staff to put the systems and processes in place they need to improve care and save lives. Through simulation modeling, process mapping, and dashboard tools she helps departments reduce LOS, improve patient outcomes, and streamline operations. A skilled facilitator, Delia guides organizations through change, using data to demonstrate that her recommendations will improve productivity and efficiency. With more than 85 operational studies completed, her efforts have redefined the way that providers deliver care. Read more from Delia.



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