VBP as a vehicle for comprehensive process improvement in the perioperative suite.

With the Hospital Value-Based Purchasing (VBP) Program now fully underway, the Centers for Medicare and Medicaid (CMS) is placing more pressure on hospitals to track and report VBP core measures. Hospitals are subsequently under additional financial burden, particularly in the cost-sensitive perioperative suite. This burden is especially challenging to the many hospitals that assert that Medicare is not covering the full cost of patient care.

However, the challenge of finding cost-effective solutions to improve VBP core measure results should lead hospitals to appropriate technology, significant process improvement and ultimately better, less expensive perioperative care. CMS expects the VBP program to stimulate not only implementation of the EHR, but also innovative technologies. The EHR provides an invaluable underlying database of patient information but requires additive technologies, such as software customizations or real-time overlay solutions, to make the data truly useful at the point of care for specific groups of caregivers and departments.

Most VBP core measures encapsulate evidence-based care practices shown to improve surgical outcomes and are directly relevant to workflow in the perioperative suite. VBP core measures, referred to as “clinical process of care measures,” are weighted 70 percent by CMS when calculating a hospital’s incentive payment; the remaining 30 percent is derived from “patient experience of care,” as reported from surveys. The core measures (and, indirectly, the patient experience measures) draw out two important points for hospitals to address when seeking cost-effective technology solutions:

  1. The need for accurate and timely documentation; and
  2. The high level of interdependencies among perioperative caregivers and units.

Hospitals that take both into consideration will focus on facilitating documentation practices as well as building up an infrastructure that links together the activities of all stakeholders in the surgical process: surgeons, nurses, anesthesiologists, OR administrators, compliance officers, pathologists, radiologists, phlebotomists and other technicians.

Given the complexity of the perioperative suite, improving documentation and overall coordination call for some level of process automation. As a first step, hospitals tend to look toward technology to help with documentation practices, particularly customization of the EHR. Studies indicate that hospitals are more successful at carrying out patient safety mandates than recording them. Since VBP core measure scores are a direct reflection of hospital documentation practices, aligning documentation to reflect actual performance is essential.

While failure to document accurately and on time is clearly less serious for the patient than failure to carry out the safety mandate itself, both typically point to the same source: process failure. The more complex the environment, the more it is subject to breakdowns in communication and coordination. The consequences associated with process failure in the highly complex perioperative suite, where patient safety has been under scrutiny for some time, are considerable. Successfully coordinating core measure activities across the continuum of care can serve as a blueprint for automating other processes to fit seamlessly into perioperative workflow.

Automated workflow tools that are already making their way into hospitals as they incorporate new strategies to improve compliance with CMS and other safety mandates include real-time reminders, real-time notifications, electronic checklists, automated scorecards and electronic whiteboards. The most effective solutions extend beyond core measure compliance, coordinating all hospital safety guidelines and other key activities to improve patient outcomes as well as efficiency objectives, such as better resource utilization and OR throughput. Along with promoting high compliance, the new solutions bolster an infrastructure that promotes effective communication and more consistent practices, as well as the use of monitoring and measurement to reduce variability – all critical factors for reducing errors and omissions, delivering care more efficiently and creating an optimal environment for staff and patients alike.

Over the next five years, scores for outcomes, hospital-acquired conditions (HACs) and efficiency with clinical are expected to factor in with clinical process and patient experience measures. A hospital that has aligned core measure compliance with perioperative workflow and developed a solid foundation for automating other crucial perioperative processes stands a much better chance of achieving and sustaining improvement in the VBP program, even – and especially – as the criteria for success shift.

About the author
Jeffrey Robbins is CEO of LiveData and has served as its technology visionary since the company's founding in 1991. He has served as co-chairman of the Medical Device Plug and Play (MD PnP) Communication Standards Working Group of the CIMIT Operating Room of the Future. He was also a member of the U.S. Advisory Board to the ISO & International Electrotechnical Commission, and Senior Technical Advisor to the National Rural Electric Cooperative Association. He may be contacted at jeffr@LiveData.com. Learn more at www.LiveData.com.