By Tod Baker
Principal, Vizient Advisory Solutions
Public scrutiny of hospital performance is not a new phenomenon. However, the increased use of public quality scorecards by government, healthcare consumers and payers continue to grow each year increasing the strategic risk for hospitals in competitive markets. In addition to the Centers for Medicare & Medicaid Services' (CMS) Star and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) ratings, U.S. News & World Report's hospital rankings, Leapfrog Hospital Safety Grade, Healthgrades and other consumer-facing ratings systems, private payers increasingly are developing their own ratings systems. Many payer-based ratings systems are utilized to financially incentivize hospitals based upon their quality performance. As the largest payer in American healthcare, the CMS has assigned hospital penalties for poor quality performance in readmissions, value-based care (cost and quality) and hospital acquired conditions since 2015.
Hospital teams attempting to manage this process can be overwhelmed by the task. Consider when all the metrics that feed the major, non-payer-based ratings systems are cataloged, hospitals are faced with more than 500 metrics to manage. Combine that with the challenge that all ratings systems use more than two-year-old data, and this year's work won't meaningfully impact hospital scores until 2026. Also, it can be difficult to understand how and why a hospital's scores are what they are and even more challenging to forecast future performance. So, when the board comes to the executive team and asks how the hospital received these scores and when they will improve, the team charged with 'boiling the ocean' can understandably be stressed.
But, with any complicated process, this challenge can be broken down into manageable steps:
- Focus on improving quality of care: Scorecards are designed to incentivize hospitals to improve and maintain high quality and efficient delivery of care. Hospitals that are successful in transforming and maintaining their scorecard performance focus this effort to drive improved outcomes for their patients. This strategy can be useful in creating a manageable list of major quality improvement initiatives (15-30 metrics of focus). These initiatives can serve as an internal template for improved processes and replicated across the hospital or health system. Remember, any efforts that are structured to 'play the game' is not sustainable. Hospitals cannot 'game' these scorecard methodologies at any level.
- Know your ratings and rankings: Empower a team (typically in the quality improvement department) to understand your scores, report the methodologies to the clinicians, executives and board and make scorecard performance a part of the culture. Internally prioritize your top two or three most important scorecards for improvement (i.e., CMS Stars, Leapfrog Group, U.S. News & World Report, etc.).
- Prioritize issues to measure: Identify the top 5-10 issues you need to address in each scorecard and determine how you can capture the data internally so you can measure and monitor recent progress. Many of the metrics in Leapfrog, U.S. News, Healthgrades and payer-based systems use CMS measures or data so it may be worth starting with CMS Stars and HCAPHS data. Prioritize the items are most impactful across your top two or three scorecards. Develop a list of 15-30 metrics that will improve quality and your scorecard performance across multiple ratings systems.
- Seek clinical and physician support: Share your list with your clinical leaders to gain understanding of scorecard methodologies and gather buy-in to your process. Gather input on how to develop an action plan and improve each metric. Measure the ongoing clinical impact (i.e., reduced readmission rates, reduced infection rates, etc.) to understand how your ratings may change in the future.
- Create an action plan: Form teams to address each issue. Consider forming teams in major domains such as infection prevention, readmissions, mortality, HCAHPS/PX and time and effectiveness. Empower these groups by focusing on only two to three metrics from your list. Ensure you have physician leadership on each team. Many organizations have these teams report their progress to a global quality committee that oversees overall hospital quality performance.
- Make improvements and sustain efforts: Integrate the work into your management systems and High Reliability Organization efforts and standard work. Build these measures into organizational analytics and KPI reporting and cascade transparency of performance from the board to the management teams to the bedside clinical teams. Measure current performance against metric improvement targets quarterly or semi-annually.
The utilization of scorecards and hospital rankings will continue to grow as a strategic challenge for hospitals. Investing in these processes today will pay multiple dividends in the future in improved quality of care, improved efficiency, enhanced negotiating leverage with payers, and scorecard rankings the hospital understands and is proud to have published.
About the author
As a member of Vizient’s Advisory Solutions quality improvement consulting team, Tod Baker focuses on leading health systems through quality improvement initiatives that include comprehensive quality transformation, national quality scorecard optimization and readmission reduction. Baker has 25 years of experience in creating and delivering consulting and analytics solutions within the healthcare industry. He has led hundreds of teams through successful health system and physician-focused projects designed to reduce costs and improve both quality of care and patient experience.