Keeping Score

An Executive Interview with Healthcare Insights

Helping healthcare organizations quantify their services and provide the best care to consumers. By Steven Berger

EHM. The public needs to understand clinical and quality outcome metrics. Can you define what some of those are or should be?
Steven Berger. There are now hundreds of various clinical and quality metrics available to be used by the industry. For hospitals, this would start with the Joint Commission’s use of Core Metrics, typically defined as 17 process measures and one clinical outcome (mortality), now also being used by the Medicare program to determine hospital Pay for Performance. But it extends to the Leapfrog Group’s use of the National Quality Forum’s (NQF) 27 Endorsed Set of Safe Practices, the many clinical and quality metrics being reported by various States (see the Oregon PTCA Death Rates) and other governmental, quasi governmental (NQF) and professional associations.

EHM. Once these metrics are utilized by government and various clinical rating agencies, how can the public determine where they need to go for their medical and health care?
SB. Now that is a more difficult question. There are many ways to analyze health outcomes, and many ways to monitor the outcome data and many ways to act on the information. Each individual is likely to take action differently. For example, suppose you are a consumer about to have an elective surgery who learns, on a website, that your local hospital has received a median score on ‘complication’. A hospital located two hours away received a higher (better) score on complications. Do you go to your local hospital or opt to travel two hours? That’s the question. Now, based upon each consumer’s issues, such as transportation availability, costs, risk assessment, etc, the decision will be different. So scores, per se, are parts of a decision process, not the end point.

EHM. Isn’t there a best practice method for healthcare providers and healthcare consumers to understand if the healthcare organizations are producing high quality outcomes?
SB. Yes there is. Let’s call it the Scorecard method. It involves reporting specific metrics around various aggregated dimensions such as clinical, quality, patient satisfaction, growth, best people, community, financial and any other. These dimensions form a framework for utilizing specific metrics, or measures, in an effective way. The INSIGHTS software from Healthcare Insights (www.hcillc.com), permits a hospital to develop Scorecards for each major dimension and for sub-dimension beneath them. Scorecards can be used by hospital administrators and boards to make better decisions in a value-added way.

Even greater value is realized when the healthcare organization can drill-down into the aggregate results to review the detailed indicators. When information like this is available on demand and on time, decision makers have the information they need to make quick and reasonable decisions based on actual results. This information was not avaialble in a concise way before the Scorecard was developed.

Scorecards provide information is both useful and actionable, but some hospitals consider this information private or even secret and look for ways to secure it tightly within the organization. Government and consumer groups want to see much of information this made public. Hospitals that still believe their information should never leave their four walls should note that many hospitals and health systems post complete clinical and quality metrics on their websites. I would suggest that more and more hospitals will be doing this in the near future.

EHM. It sounds like there is still much that can be done in the preparation, implementation, reporting and monitoring around clinical (and financial) metrics.
SB. Much more. Goal setting is an important step toward achieving the outcomes the organization is looking for. I will be expanding on how to set effective goals within indicators in an accompanying article on the EHM website.

Steven Berger is President and Founder of Healthcare Insights (HCI). HCI provides the state-of-the-art INSIGHTS business intelligence software service and support tool plus training services to the healthcare industry. Berger, a hospital finance executive for several hospitals over a 20-year span, is the author of four books and several award-winning articles about healthcare general and financial management.