What's The Value in Value Based Purchasing

Starting next October, CMS is going to reduce all discharge inpatient payments by 1% to create a VBP pool.  Over the next few years, that rate will increase until 2017 when the pool will hit a cap of 2%.  Based on a complicated calculation that includes scores on clinical outcomes and HCHAPS, an organization may receive their full payment back, may receive less than that amount or may receive more than that.

So what’s the point?

The goal is to move towards better consumer driven healthcare where outcomes and quality matter most.  It’s time to put away the phrases of “Well we’re a safety net provider” or “Our patients are just different” and move towards acknowledging this coming change and that we need to see this institution for what it is: a first rate hospital for all patients, not just those in need.

Maybe you think that’s not fair, that there should be a way to level the playing field between the top and the bottom, but to do so would mean we would have to acknowledge that we cannot compete with the “big boys” in terms of quality or outcomes, and that just isn’t the case.  We embrace this challenge to improve our HCHAPS scores and have publicly reported data that shows how great our institution is.

Everyone impacts the score.  From saying “Hello” to everyone in the halls to picking-up trash or helping a stranger find their way, it creates the kind of culture we need to succeed. 

While those are indirect influences, HIM has some direct:

·If we are behind on scanning and a doctor goes to access PowerChart and a note isn’t there and he gets mad and his frustrations may be visible to our patients who then have a bad experience

·If we don’t release the right records or release them timely, even though there isn’t an ROI question on the survey, our patients would score the hospital lower because they are going to dock us for that

Everyone plays a part.  From the top-executives to the front-line staff. 

There is value in VBP, it just is up to us demonstrate the highest values.

Healthcare Is More Than Healing

Been a while, my apologies...

Customer service and its relation to healthcare seem to be front and center these days (that is, if you happen to be a healthcare institution, the public probably couldn't care less right now).  The question needs to be asked, what does customer service mean in relation to treating someone?

For most people, we think of customer service when we go out to eat, stay at a hotel, get on an airplane or purchase something.  Those are generally positive experiences (we want something) and barring a problem, we expect to be treated with respect and from a personable employee.  But in healthcare, almost the opposite is true.

Even for the most mundane events, who really wants to go to the doctor.  Everything they do hurts.  Even a simply shot pierces the skin and can cause pain.  Think about that flu shot that made your arm hurt for days.  What about if you have surgery?  My wife has a heart condition and has had two open heart surgeries.  Each time they crack her body open and inflict pain in order to save her.  This is not an indictment of that process, but merely pointing out that after someone hurts your body, do you really want to then be asked to rank them on a scale of 1to 10?  Is that even fair?  Hospitals aren't hotels (as a New York Times op ed piece pointed out recently) and to think otherwise is unfair.

But having said that, organizations do need to remember that it's all about the patient and sometimes going the extra mile pays off.  Making people feel welcome is a huge point.  It's why Children Mercy hospitals are dolled up like play lands or why some hospitals include art in the hallways.  The hospital shouldn't be seen as a bad or scary place to be, but they aren't a week long vacation on the beach either.  Value Based Purchasing my do more harm that good for some institutions where they see sicker patients or perform more risky surgeries, because even under the best circumstance, the pain you feel can make you score them negatively, which can lead to lower payments.