Col­lab­o­ra­tion key for this year’s 100 Top Hos­pi­tals

This year’s 100 Top Hos­pi­tals use col­lab­o­ra­tion to boost per­for­mance across the board

Modern Healthcare - - NEWS - Mau­reen McKinney

DATA Down­load Web-ex­clu­sive charts at mod­ern­health­­pi­tals

In 2010, over­whelmed by a del­uge of per­for­mance data coming from both in­ter­nal and ex­ter­nal sources, of­fi­cials at the Univer­sity of Michi­gan Health Sys­tem formed a 25-mem­ber clin­i­cal qual­ity com­mit­tee charged with gath­er­ing all the in­for­ma­tion in one place and pars­ing out top pri­or­i­ties for the 919-bed med­i­cal cen­ter.

Made up of physi­cians, nurses and ad­min­is­tra­tors who meet monthly, the com­mit­tee col­lects and an­a­lyzes qual­ity data from the CMS’ Hospi­tal Com­pare, the state’s hospi­tal as­so­ci­a­tion, var­i­ous col­lab­o­ra­tive ini­tia­tives with Blue Cross and Blue Shield of Michi­gan and other sources.

“It’s a huge amount of data, and it can some­times feel like you’re drink­ing from a fire hose,” says Dr. Dar­rell Camp­bell, a pro­fes­sor of surgery and chief med­i­cal of­fi­cer at UMHS. “Be­fore we formed the com­mit­tee, we had well-mean­ing but re­dun­dant ef­forts in some ar­eas and we were miss­ing things in oth­ers. This gave us a way to cen­tral­ize the data and be­come much more ef­fec­tive and or­ga­nized.”

With the com­mit­tee in place, the health sys­tem was able to more ef­fi­ciently tar­get a num­ber of qual­ity and safety prob­lems, in­clud­ing high rates of ven­ti­la­tor-as­so­ci­ated pneu­mo­nia on a par­tic­u­lar unit or for­eign bod­ies re­tained af­ter surgery. The com­mit­tee formed teams tasked with an­a­lyz­ing data, iden­ti­fy­ing ev­i­dence-based strate­gies and eval­u­at­ing whether hospi­tal staff em­ploys best prac­tices in the prob­lem-plagued ar­eas.

A year later, the health sys­tem in­sti­tuted med­i­cal team train­ing in its op­er­at­ing rooms, pro­to­cols that in­clude the use of check­lists, ver­i­fi­ca­tion and im­proved com­mu­ni­ca­tion. Med­i­cal team train­ing, cur­rently in use by many hos­pi­tals across the coun­try, was shown in 2010 to have re­duced sur­gi­cal mor­tal­ity by 18% in a group of 108 Veter­ans Health Ad­min­is­tra­tion hos­pi­tals.

It’s those changes, among oth­ers, that Camp­bell cred­its with help­ing the health sys­tem se­cure a place for the eighth time on Tru­ven Health An­a­lyt­ics’ 100 Top Hos­pi­tals: Na­tional Bench­marks for Success.

Now in its 20th year, the list rec­og­nizes 100 high-scor­ing hos­pi­tals from a field of 2,922, based on per­for­mance across mor­tal­ity mea­sures, 30-day read­mis­sion rates, av­er­age length of stay and a num­ber of other mea­sures.

For­merly known as the health busi­ness of Thom­son Reuters, Tru­ven Health An­a­lyt­ics was formed in June 2012 when Thom­son Reuters sold its health di­vi­sion to Ver­i­tas Cap­i­tal, a New York pri­vate eq­uity firm, for $1.25 bil­lion.

Tru­ven re­leased its 100 Top Hos­pi­tals list for 2013 ex­clu­sively to Mod­ern Health­care.

Among this year’s hon­orees are sev­eral hos­pi­tals that have made the list re­peat­edly, such as 659-bed Baystate Med­i­cal Cen­ter, Spring­field, Mass., which has ap­peared 16

times; 395-bed St. Thomas Hospi­tal, Nashville, which made the list 12 time; and 199-bed Lick­ing Me­mo­rial Hospi­tal, Ne­wark, Ohio, which has made the list 11 times.

This year’s list also features 18 first-timers, in­clud­ing 409-bed Pres­by­te­rian In­ter­com­mu­nity Hospi­tal, Whit­tier, Calif., and 80-bed Lovelace West­side Hospi­tal, Al­bu­querque.

Tru­ven iden­ti­fies each year’s 100 Top Hos­pi­tals by an­a­lyz­ing pub­licly avail­able claims data from the Medi­care Provider Anal­y­sis and Re­view (MedPAR) dataset, the CMS’ Hospi­tal Com­pare data­base and Medi­care cost re­ports. El­i­gi­ble hos­pi­tals are di­vided by size into five cat­e­gories: ma­jor teach­ing hos­pi­tals, teach­ing hos­pi­tals, and large, medium and small com­mu­nity hos­pi­tals.

Within each of those five cat­e­gories, hos­pi­tals are eval­u­ated against their peers on 14 mea­sures, such as 30-day mor­tal­ity for heart fail­ure, in­pa­tient ex­pense per dis­charge, com­pli­ca­tions and pa­tient ex­pe­ri­ence. To make the 100 Top list, hos­pi­tals must rank above their peers on a com­pos­ite score of all 14 mea­sures and must also score above the me­dian for each mea­sure.

Any hospi­tal that lost money dur­ing the pre­ced­ing year, based on Tru­ven’s anal­y­sis of cost re­ports, is out of the run­ning, says Jean Chenoweth, Tru­ven’s se­nior vice pres­i­dent of per­for­mance im­prove­ment.

Ac­cord­ing to Tru­ven’s na­tional com­par­i­son data, the 100 Top out­per­formed peer hos­pi­tals across all 14 mea­sures. They had 7% fewer pa­tient deaths and 6% fewer com­pli­ca­tions than ex­pected, con­sid­er­ing the sever­ity of their pa­tients. On the other hand, peer hos­pi­tals not on the list, in the ag­gre­gate, had ex­pected rates of mor­tal­ity and only 1% fewer com­pli­ca­tions than ex­pected.

For the 100 Top, av­er­age length of stay was less than 4 1/

days, com­pared with nearly five

2 days among peers not on the list. Their in­pa­tient ex­pense per dis­charge to­taled $5,548, 10% lower than the peer group’s av­er­age of $6,172. Hos­pi­tals on this year’s list also out­per­formed on prof­its, with an av­er­age op­er­at­ing profit mar­gin of 14.2%, com­pared with 3.7% for hos­pi­tals not on the list.

In ad­di­tion to its 100 Top ros­ter, Tru­ven also com­piles an an­nual list of Ever­est Award win­ners, a sub­set of hos­pi­tals that are in­cluded in the 100 Top and have also met a na­tional tar­get for rate of im­prove­ment over five con­sec­u­tive years. “Th­ese hos­pi­tals have man­aged to reach bench­marks for achieve­ment and for sus­tained im­prove­ment,” Chenoweth says. “That’s not easy to do.”

This year’s list of Ever­est Award win­ners features 17 hos­pi­tals, rang­ing in size from large teach­ing hos­pi­tals such as 919-bed Uni-

ver­sity of Michi­gan Helth Sys­tem to small com­mu­nity hos­pi­tals such as 55-bed Mercy Hospi­tal Grayling (Mich.).

Ad­vo­cate Lutheran Gen­eral Hospi­tal, Park Ridge, Ill., also an Ever­est Award win­ner, makes its 14th ap­pear­ance on the 100 Top list this year. An­thony Ar­mada, pres­i­dent of the 624-bed hospi­tal, at­tributes Ad­vo­cate Lutheran’s success to a num­ber of fac­tors, in­clud­ing high scores on pa­tient ex­pe­ri­ence—as mea­sured by the Hospi­tal Con­sumer As­sess­ment of Health­care Providers and Sys­tems sur­vey, or HC­AHPS—physi­cian en­gage­ment, ef­fi­ciency and fi­nan­cial per­for­mance.

For in­stance, the hospi­tal’s costs per ad­justed dis­charge have fallen for four years run­ning, a trend that Ar­mada says aligns Ad­vo­cate Lutheran with one of the main drivers of the health­care re­form law.

“No one in our hospi­tal would say that we’re do­ing what we do to cut costs,” Ar­mada says. “But what we have found that im­prov­ing qual­ity is cost ef­fec­tive, and at the end of the day, we’ve also been able to in­crease our mar­ket share.”

Ad­vo­cate Lutheran’s em­pha­sis on care co­or­di­na­tion has also helped the hospi­tal to achieve a 30-day read­mis­sion rate of 8.2%, far be­low the na­tional av­er­age of roughly 19%. The hospi­tal has im­ple­mented a num­ber of strate­gies to im­prove tran­si­tions of care, such as the use of health coaches for tough-to-treat pa­tients with mul­ti­ple chronic ill­nesses.

The hospi­tal re­cently took its qual­ity-im­prove­ment ef­forts to the next step when it chose to par­tic­i­pate in the Mal­colm Baldrige Per­for­mance Ex­cel­lence Pro­gram, which re­lies on set cri­te­ria to spur in­no­va­tion and im­prove or­ga­ni­za­tional per­for­mance.

“We don’t get com­fort­able—we’re per­form­ing well on sev­eral fronts but we want to be a high- re­li­a­bil­ity or­ga­ni­za­tion,” Ar­mada says.

Wood­winds Health Cam­pus, an 86-bed hospi­tal in Wood­bury, Minn., made the 100 Top list for the third time this year.

Scott North, se­nior vice pres­i­dent and pres­i­dent of acute-care hos­pi­tals for four-hospi­tal Health­East Care Sys­tem, Wood­winds’ par­ent or­ga­ni­za­tion, says much of the credit for the hospi­tal’s high scores can be traced to a dom­i­nant cul­ture of con­tin­u­ous im­prove­ment and pa­tient-cen­tered­ness. The hospi­tal opened its doors in 2000, af­ford­ing hospi­tal lead­ers the op­por­tu­nity to plan out each de­tail of the new fa­cil­ity and seek out a staff that had a sim­i­lar vi­sion.

“There are not a lot of chances to build a brand new hospi­tal and de­fine the cul­ture and phi­los­o­phy you want from day one,” North says. “For us, it started with con­nect­ing with

the com­mu­nity and find­ing out what they wanted. That hap­pened be­fore any shov­els were put in the ground.”

The re­sult is a fa­cil­ity on 32 acres of wet­lands “that doesn’t look like a hospi­tal,” North says. Ap­pear­ance isn’t the only dif­fer­ence, he says, adding that Wood­winds em­pha­sizes health and well­ness as much as treat­ing acute con­di­tions.

“Health­East has tra­di­tion­ally been a hospi­tal-cen­tered or­ga­ni­za­tion and now we’re be­com­ing more of a con­ti­nu­ity-of-care provider,” North says. “It goes hand-in-hand with health re­form, but it’s also the right thing to do.”

Wood­winds also ap­pears for the first time on Tru­ven’s list of Ever­est Award win­ners, a des­ig­na­tion that North cred­its to rapid im­prove­ment in over­all fi­nan­cial per­for­mance and ef­fi­ciency, among other ar­eas.

This year also marked the first time that Mercy Hospi­tal Grayling made the 100 Top ros­ter. The 55-bed hospi­tal, lo­cated in a ru­ral Michi­gan town of just over 1,800 peo­ple, has balanced thin mar­gins com­mon to such hos­pi­tals with a se­ries of am­bi­tious im­prove­ment projects.

For in­stance, the hospi­tal cre­ated unit­based coun­cils that fo­cus on pa­tient en­gage­ment and im­proved care co­or­di­na­tion. Stephanie Riemer-Matuzak, the hospi­tal’s CEO, says the coun­cils’ work has led to more mul­tidis­ci­plinary round­ing and has en­sured that ev­ery pa­tient re­ceives a visit from a care man­ager be­fore dis­charge.

The hospi­tal has also ex­pe­ri­enced marked progress in obstetrics qual­ity af­ter par­tic­i­pat­ing in a peri­na­tal safety ini­tia­tive in 2012. Those im­proved out­comes are es­pe­cially im­por­tant, Riemer-Matuzak says, be­cause the hospi­tal’s num­ber of an­nual de­liv­er­ies spiked from 300 to 400 in re­cent years, af­ter the clo­sure of a nearby hospi­tal.

Mercy Hospi­tal Grayling was also rec­og­nized as an Ever­est Award win­ner for its fiveyear rate of im­prove­ment. Riemer-Matuzak says she was sur­prised to learn that the hospi­tal would ap­pear on both lists for 2013, but she saw the news as hard-won recog­ni­tion af­ter years of sus­tained ef­fort. She also at­trib­uted much of the hospi­tal’s success to the guid­ing ef­forts of its par­ent sys­tem, 35-hospi­tal Trin­ity Health, Livo­nia, Mich.

“I think for a small, ru­ral hospi­tal like ours, one prob­lem is man­ag­ing the num­ber of ini­tia­tives, be­cause there are al­ways new ones,” she says. “But if you have a great process in place for man­ag­ing those ini­tia­tives, if you’re mea­sur­ing those met­rics and if as­so­ci­ates un­der­stand the goals, it be­comes much eas­ier to achieve.”

Wil­liam Palaz­zolo, clinic di­rec­tor; Jen­nifer Tom­ford, clinic man­ager; and Linda Schaffier, med­i­cal as­sis­tant, use a vis­ual met­rics board to show process im­prove­ments at the Univer­sity of Michi­gan Health Sys­tem’s Pre-Op­er­a­tive Clinic, which treats com­plex pa­tients sched­uled for surgery at the med­i­cal cen­ter. UM is among Tru­ven Health An­a­lyt­ics’ 100 Top Hos­pi­tals for 2013.

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