new trend report discover the tactics for tough times resource...

August 2009

This is the 18th edition of the semiannual Adult ICU Update, a newsletter provided as a benefit to UHC Benchmarking & Improvement Services participants. The e-mail in which you received the link to this Update also includes a link to your organization’s customized Performance Opportunity Summary. If you have any comments or questions, contact Cathy Krsek at (630) 954-4799.

Trend Report

The Trend Report is not included in this edition of the newsletter. It will return in the next edition.

Discover the Tactics for Tough Times Resource Center

Because of the growing financial pressures facing academic medical centers, UHC offers the Tactics for Tough Times Resource Center, which features cost- and time-saving strategies used successfully by your peer organizations. Review a complete list of the 2008-2009 tactics briefings developed for UHC members.

Send us your feedback about this initiative as well as topics for future briefings at [email protected].

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https://www.uhc.edu/tactics.htm

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Better Performers in Management of Ventilator-Dependent Patients

One of the benefits of UHC membership is the opportunity to network with experts at other academic medical centers. To help foster that collaboration, this newsletter will now list the top 10 organizations for each of the risk-adjusted metrics in the Adult ICU Performance Opportunity Summary reports—length of stay observed-to-expected (LOS O/E), cost O/E, and mortality O/E—for a specific area or aspect of care.

This month, the newsletter features better performers in the management of ventilator-dependent patients because that area is where most of the improvement opportunity is. The following tables include the better-performing organizations’ abbreviated names and their O/E ratios. Please contact Cathy Krsek at (630) 954-4799 to request contact information for any of these organizations.

UHC is following up with Vanderbilt University Medical Center (the only organization in the top 10 for all 6 metrics) and will share information about how the organization achieves such outstanding results.

Top 10 Performance for 9671 (Ventilator < 96 hours)

LOS O/E Cost O/E Mortality O/E

Maryland 0.667 UConn 0.6907 Hennepin 0.9735

Vanderbilt 0.7312 UTMB 0.8401 UC Irvine 1.028

UConn 0.7494 Fletcher Allen 0.8565 Vanderbilt 1.0556

Shands Jacksonville 0.785 Hennepin 0.8652 Fletcher Allen 1.0718

New Mexico 0.8014 Shands Jacksonville 0.8677 Oregon 1.0825

UTMB 0.8363 Vanderbilt 0.8884 Utah 1.089

Wisconsin 0.8414 Loyola 0.9256 Denver Health 1.0906

Wishard 0.8437 Oregon 0. 9445 Arizona 1.0952

Colorado 0.8468 Nevada 0.9997 Harborview 1.1078

UC Irvine 0.8492 MC Georgia 1.0182 Ohio State 1.1413

Top 10 Performance for 9672 (Ventilator > 96 hours)

LOS O/E Cost O/E Mortality O/E

Vanderbilt 0.8851 Vanderbilt 0.9445 Vanderbilt 0.7745

Cleveland 0.8961 Hennepin 0.9732 Kansas 0.777

Methodist 1.029 Fletcher Allen 1.0641 Arizona 0.7783

Rush 1.0587 Shands Jacksonville 1.0765 Iowa 0.8015

Hennepin 1.0865 UTMB 1.1301 Colorado 0.8056

Ohio State 1.0968 Loyola 1.1453 Oregon 0.8059

Denver Health 1.0977 UConn 1.1696 UConn 0.808

UMDNJ 1.1025 Barnes-Jewish 1.1807 Wisconsin 0.8139

Wisconsin 1.1442 Methodist 1.2052 Methodist (IN) 0.8169

Maryland 1.1494 Mass Gen 1.2091 MC Georgia 0.8309

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How to Interpret the Adult ICU Performance Opportunity Summary Reports

A guide to help you interpret the reports is available online. Each report is discussed separately, column by column. To navigate to the guide on the UHC Web site, go to the Semiannual Updates section of the Adult ICU 2003 page.

Custom Compare Groups

A member told UHC that the report would be more useful for specific diagnoses if it were possible to create a custom compare group. The instructions are somewhat involved, but your Clinical Data Base experts can help you use the instructions to run the reports you want. The instructions are located in the Semiannual Updates section of the Adult ICU 2003 page.

Database Coordinators

If you are not sure who your database coordinators are, here’s how to identify them. For a list of Operational Data Base coordinators, click here. To find out who your Clinical Data Base coordinator is, contact CDP Member Support Services at [email protected] or (630) 954-3792.

UHC Staff Contact

Cathy Krsek Director Operational Benchmarking and Nursing Leadership (630) 954-4799 [email protected]

© 2009 University Health System Consortium. All rights reserved.

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https://www.uhc.edu/docs/003684687_AdultICUPerformOppSummRept.pdf

http://www.uhc.edu/

http://www.uhc.edu/results_list.asp?folder=WEB/IE/BenchNew/All/AdultICU_03

https://www.uhc.edu/docs/003684683_AdultICUInstructForCDPOnline.pdf

http://www.uhc.edu/results_list.asp?folder=WEB/IE/BenchNew/All/AdultICU_03

http://www.uhc.edu/cps/rde/xchg/wwwuhc/hs.xsl/MemberPart.htm/papp/MemberParticipation/http:/webapp.uhc.edu/product_info/product_detail.asp?prod_id=1%2D5E%2D268

mailto:[email protected]?subject=CDB%20Coordinator%20(August%202009%20Adult%20ICU%20Update)

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Per Case Annual TotalTotal Cases

1st–2nd Quarter 2008

Savings Opportunity if Top Quartile Cost O/E Achieved

1st–2nd

Qtr 2008

Cost O/E

1st–2nd

Qtr 2008

The purpose of this report is to give an overview of your organization’s progress in reducing costs for the selected patient groups. The report also indicates the potential additional cost

savings opportunities for the selected patient groups. This information can be used to identify performance improvement initiatives and stimulate further investigation of the data. All

information was taken from the UHC Clinical Data Base on 12/31/08.


3rd–4th Quarter 2008


3rd–4th

Qtr 2008

Cost O/E

3rd–4th

Qtr 2008

University HealthSystem ConsortiumUHC Adult ICU Clinical Executive Summary Report

The University of Connecticut Health Center, John Dempsey Hospital

Long-term ICU Patients Cases

Better than the Top Quartile210 Better than the Top Quartile0.62 Better than the Top Quartile151 Better than the Top Quartile0.56Respiratory patients

$659209 $275,3480.97 Better than the Top Quartile214 Better than the Top Quartile0.95Cardiac patients

Better than the Top Quartile13 Better than the Top Quartile0.57 Better than the Top Quartile6 Better than the Top Quartile0.55Neurological patients

$3,7862 $15,1461.17 Better than the Top Quartile3 Better than the Top Quartile0.75Alcoholic Cirrhosis patients

Better than the Top Quartile9 Better than the Top Quartile0.54 Better than the Top Quartile3 Better than the Top Quartile0.81AIDS patients

Better than the Top Quartile36 Better than the Top Quartile0.99 Better than the Top Quartile31 Better than the Top Quartile1.17Vent > 96 Hours

Better than the Top Quartile40 Better than the Top Quartile0.82 Better than the Top Quartile43 Better than the Top Quartile0.69Vent < 96 Hours

Better than the Top Quartile66 Better than the Top Quartile1.01 Better than the Top Quartile73 Better than the Top Quartile0.87Dialysis

Better than the Top Quartile19 Better than the Top Quartile0.73 Better than the Top Quartile41 Better than the Top Quartile1.21PEG Hyperal

Low Acuity Cases

Better than the Top Quartile42 Better than the Top Quartile0.57 Better than the Top Quartile25 Better than the Top Quartile0.71Upper GI Bleeding

Better than the Top Quartile18 Better than the Top Quartile0.67 Better than the Top Quartile20 Better than the Top Quartile0.77Unspecified Chest Pain

Better than the Top Quartile25 Better than the Top Quartile0.40 Better than the Top Quartile18 Better than the Top Quartile0.50Self Inflicted Overdose

Better than the Top Quartile14 Better than the Top Quartile0.44 Better than the Top Quartile7 Better than the Top Quartile0.47Carotid Endarterectomy

Summary

604Long-term ICU Total Cases $290,494 $0565

99Low-Acuity Cases $0 $070

© 2009 University HealthSystem Consortium — printed August 19, 2009 —

Annual Savings Opportunity: Savings = (Annualized Cases * (Mean Cost per Case – ((75th Cost O/E) * (Mean Expected Cost)))).

Note: Quarters reported are calendar quarters. If only one quarter is reported, case volumes are doubled. If you have questions, please contact your CDB coordinator or Cathy Krsek ([email protected]).

All Rights Reserved. NOTICE: This document contains proprietary information that is confidential and protected by state and federal privacy and peer review laws.

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1st–2nd Quarter 2008


1st–2nd

Qtr 2008

Cost O/E

1st–2nd

Qtr 2008

The purpose of this report is to give an overview of your organization’s progress in reducing costs for the selected patient groups. The report also indicates the potential additional cost

savings opportunities for the selected patient groups. This information can be used to identify performance improvement initiatives and stimulate further investigation of the data. All

information was taken from the UHC Clinical Data Base on 12/31/08.


3rd–4th Quarter 2008


3rd–4th

Qtr 2008

Cost O/E

3rd–4th

Qtr 2008

University HealthSystem ConsortiumUHC Adult ICU Clinical Executive Summary Report


All patients 16 and older with the following

disease or procedure codes.

Long-term ICU patients:

Principle Disease Codes

Reported as ―Cardiac Patients‖

HF (428.0)

Coronary Atherosclerosis (414.01)

Subendocardial MI (410.71)

Reported as ―Respiratory Patients‖

Acute Respiratory Failure (518.81)

Pneumonia (486)

Aspiration Pneumonia (507.0)

Reported as ―Neurological Patients‖

Intracerebral Hemorrhage (431)

Subarachnoid Hemorrhage (430)

Alcoholic Cirrhosis (571.2)

AIDS (042)

Procedure Codes

(Any procedure, not just principle)

Ventilator > 96 hours (96.72)

Ventilator < 96 hours (96.71)

Dialysis (39.95)

PEG or hyperalimentation (43.11 or 99.15)

If a patient had one of the long-term primary

disease codes and a procedure code, the patient

was included in the data in only the primary

disease code group, and eliminated from the

data set for the procedure. This prevents the

patient from being counted twice.

Low-acuity ICU patients:

Primary Disease Codes

Upper GI Bleeding (530.82, 531.00, 531.01,

531.20, 531.21, 531.40, 531.41, 531.60,

531.61, 532.00, 532.01, 532.20, 532.21,

532.40, 532.41, 532.60, 532.61, 533.00,

533.01, 533.20, 533.21, 533.40, 533.41,

533.60, 533.61, 534.00, 534.01, 534.20,

534.21, 534.40, 534.41, 534.60, 534.61,

578.0-578.9)

Self-inflicted Overdose (at least one

diagnosis code from 960.0-979.9 and one

from E950.0-E950.9)

Carotid Endarterectomy (procedure code

38.12)

Pain, chest, unspecified (786.59)


Annual Savings Opportunity: Savings = (Annualized Cases * (Mean Cost per Case – ((75th Cost O/E) * (Mean Expected Cost)))).

Note: Quarters reported are calendar quarters. If only one quarter is reported, case volumes are doubled. If you have questions, please contact your CDB coordinator or Cathy Krsek ([email protected]).


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Total

Cases

% ICU

LOS>0 Days¹

Mean

ICU

LOS

Mean

LOS²

Mean

Exp.

LOS

LOS

O/E¹

Mean

Cost²

Mean

Exp. Cost

Cost

O/E¹

Mortality

Rate²

Mean Exp.

Mortality Rate

Mortality

O/E¹

% ICU

LOS>7 Days¹Type

Annual Savings

Opportunity if Top

Quartile Cost O/E

Achieved

UHC Adult ICU Performance Opportunity Summary–Clinical


Performance Summary: Performance Measures

The purpose of this document is to provide a comparison of your organization's performance to other participants in the UHC Benchmarking program. The information is

intended to create internal discussions about improvement possibilities. All information was taken from the UHC Clinical Data Base on 12/31/08.

University HealthSystem Consortium

Reporting Period: 07/01/2008–12/31/2008

Long-term ICU Patients: Diagnosis Groups

151 29.8% 4.0% 4.6 5.1 6.5 0.79 $7,176 $12,728 0.56 9.9% 7.5% 1.32Respiratory

patients

Better than the

Top Quartile

– + + + – * *

10th /25th /50th 20.8% /24.3% /30.3% 4.2% /6.4% /7.9% 0.79 /0.83 /0.92 0.82 /0.96 /1.10 0.66 /0.77 /0.89

214 97.2% 4.7% 2.2 2.5 2.9 0.87 $15,815 $16,608 0.95 2.3% 2.1% 1.11Cardiac patients Better than the

Top Quartile

– + + + –

10th /25th /50th 17.8% /25.9% /34.0% 1.4% /2.1% /3.4% 0.86 /0.94 /1.00 0.88 /1.01 /1.10 0.41 /0.65 /0.84

6 33.3% 16.7% 5.0 5.2 7.1 0.73 $8,199 $14,940 0.55 16.7% 12.9% 1.29Neurological

patients

Better than the

Top Quartile

– + + + –

10th /25th /50th 64.2% /75.8% /86.4% 20.0% /25.6% /33.3% 0.73 /0.77 /0.87 0.75 /0.88 /1.03 0.58 /0.74 /0.81

3 33.3% 2.0 4.7 4.6 1.02 $6,413 $8,587 0.75 0.0% 0.7% 0.00Alcoholic

Cirrhosis patients

Better than the

Top Quartile

+ +

10th /25th /50th 18.2% /25.0% /35.0% 0.73 /0.76 /0.94 0.75 /0.92 /1.11 0.00 /0.40 /0.79

3 33.3% 6.0 27.3 15.7 1.74 $26,706 $33,065 0.81 0.0% 1.5% 0.00AIDS patients Better than the

Top Quartile

– –

10th /25th /50th 8.0% /11.8% /15.2% 0.69 /0.76 /0.97 0.79 /0.91 /1.18 0.00 /0.43 /0.82

Long-term ICU Patients: Other Diagnoses With Specific Procedures

31 100.0% 87.1% 21.6 31.4 20.2 1.56 $69,150 $59,126 1.17 25.8% 31.9% 0.81Vent > 96 Hours Better than the

Top Quartile

– + – – + *

10th /25th /50th 89.5% /96.3% /98.7% 65.6% /72.5% /79.9% 1.10 /1.19 /1.27 1.17 /1.37 /1.56 0.81 /0.94 /1.10

43 90.7% 20.9% 6.2 8.6 11.4 0.75 $22,454 $32,511 0.69 37.2% 25.7% 1.45Vent < 96 Hours Better than the

Top Quartile

– + + + + *

10th /25th /50th 78.2% /88.7% /92.2% 10.6% /13.3% /16.3% 0.84 /0.91 /1.02 0.93 /1.12 /1.28 1.10 /1.23 /1.43


¹Percentile rankings are included for these measures. The actual percentile values are listed on the line below the hospital-specific data for each diagnosis.

²Significance indicator is included for these measures. An asterisk (*) to the right of the value denotes a significant difference between the observed and expected values at the .05 level of significance. No

test is performed when there are less than 10 cases for LOS and Cost, or less than 25 cases for Mortality.

Performance qualifiers: Two bold arrows () are more favorable than the top decile of project participants; two arrows () are more favorable than the top quartile of project participants; one arrow

() is more favorable than 50% of project participants; and a blank is less favorable than 50% of project participants.

Note: A (+) indicates a positive trend from the previous two quarters of data and (-) indicates a negative trend from the previous two quarters.

ICU Days: The CDB contains two data sources for ICU information: the ICU Days field from the abstract data file and the line item charge units with ICU revenue codes from the detail charges data file.

Based on a review of the consistency of information within institutions for these two data sources, UHC found some institutions are inconsistent with providing this ICU information. Use this data point for

comparison purposes with caution. To discuss data quality concerns in more detail, please contact the UHC Member Support Help Line at 630/954-3792.

For additional information on the Clinical Data Base, please contact your CDB coordinator.

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Total

Cases

% ICU

LOS>0 Days¹

Mean

ICU

LOS

Mean

LOS²

Mean

Exp.

LOS

LOS

O/E¹

Mean

Cost²

Mean

Exp. Cost

Cost

O/E¹

Mortality

Rate²

Mean Exp.

Mortality Rate

Mortality

O/E¹

% ICU

LOS>7 Days¹Type

Annual Savings

Opportunity if Top

Quartile Cost O/E

Achieved








73 39.7% 6.9% 5.1 8.3 7.3 1.14 $14,087 $16,154 0.87 6.9% 4.3% 1.60Dialysis Better than the

Top Quartile

– + + + –

10th /25th /50th 22.3% /28.6% /34.3% 7.8% /10.2% /13.3% 1.10 /1.17 /1.24 1.25 /1.39 /1.58 1.01 /1.12 /1.34

41 56.1% 31.7% 16.3 26.9 15.8 1.70 $46,732 $38,696 1.21 4.9% 14.4% 0.34PEG Hyperal Better than the

Top Quartile

– – – – + *

10th /25th /50th 41.2% /48.6% /56.8% 19.7% /27.1% /34.1% 1.19 /1.31 /1.46 1.21 /1.32 /1.61 0.46 /0.63 /0.76

Low-acuity Patients

25 72.0% 2.5 4.8 4.6 1.04 $7,697 $10,918 0.71 0.0% 4.2% 0.00Upper GI Bleeding Better than the

Top Quartile

– – – + *

10th /25th /50th 17.0% /22.8% /31.1% 0.80 /0.87 /1.00 0.86 /1.03 /1.19 0.24 /0.60 /0.84

20 85.0% 1.4 1.4 2.0 0.67 $4,267 $5,554 0.77 0.0% 0.0% 0.00Unspecified Chest

Pain

Better than the

Top Quartile

– + –

10th /25th /50th 0.9% /1.8% /5.7% 0.76 /0.80 /0.92 0.81 /0.93 /1.03 0.00 /0.00 /0.00

18 55.6% 1.4 2.2 2.9 0.75 $2,779 $5,595 0.50 0.0% 0.1% 0.00Self Inflicted

Overdose

Better than the

Top Quartile

– – –

10th /25th /50th 15.6% /25.7% /35.2% 0.67 /0.80 /0.94 0.76 /0.86 /1.10 0.00 /0.00 /0.00

7 71.4% 1.2 2.0 1.6 1.29 $3,987 $8,556 0.47 0.0% 0.0% 0.00Carotid

Endarterectomy

Better than the

Top Quartile

+ – –

10th /25th /50th 16.1% /28.6% /71.4% 0.86 /1.01 /1.17 0.91 /1.10 /1.28 0.00 /0.00 /0.00












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Total

Cases

% ICU

LOS>0 Days¹

Mean

ICU

LOS

Mean

LOS²

Mean

Exp.

LOS

LOS

O/E¹

Mean

Cost²

Mean

Exp. Cost

Cost

O/E¹

Mortality

Rate²

Mean Exp.

Mortality Rate

Mortality

O/E¹

% ICU

LOS>7 Days¹Type

Annual Savings

Opportunity if Top

Quartile Cost O/E

Achieved








All patients 16 and older with the following

disease or procedure codes.

Long-term ICU patients:

Principle Disease Codes

Reported as “Cardiac Patients”

HF (428.0)

Coronary Atherosclerosis (414.01)

Subendocardial MI (410.71)

Reported as “Respiratory Patients”

Acute Respiratory Failure (518.81)

Pneumonia (486)

Aspiration Pneumonia (507.0)

Reported as “Neurological Patients”

Intracerebral Hemorrhage (431)

Subarachnoid Hemorrhage (430)

Alcoholic Cirrhosis (571.2)

AIDS (042)

Procedure Codes

(Any procedure, not just principle)

Ventilator > 96 hours (96.72)

Ventilator < 96 hours (96.71)

Dialysis (39.95)

PEG or hyperalimentation (43.11 or 99.15)

If a patient had one of the long-term primary

disease codes and a procedure code, the patient

was included in the data in only the primary

disease code group, and eliminated from the

data set for the procedure. This prevents the

patient from being counted twice.

Low-acuity ICU patients:

Primary Disease Codes

Upper GI Bleeding (530.82, 531.00, 531.01,

531.20, 531.21, 531.40, 531.41, 531.60,

531.61, 532.00, 532.01, 532.20, 532.21,

532.40, 532.41, 532.60, 532.61, 533.00,

533.01, 533.20, 533.21, 533.40, 533.41,

533.60, 533.61, 534.00, 534.01, 534.20,

534.21, 534.40, 534.41, 534.60, 534.61,

578.0-578.9)

Self-inflicted Overdose (at least one

diagnosis code from 960.0-979.9 and one

from E950.0-E950.9)

Carotid Endarterectomy (procedure code

38.12)

Pain, chest, unspecified (786.59)












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UHC Adult ICU Operational Executive Summary Report


1st–2nd Quarter 2008 Annual

Savings Opportunity if Top Quartile Achieved

Total Salary Cost per Nursing Equivalent Patient Day

1st–2nd Qtr

2008

3rd–4th Quarter 2008 Annual

Savings Opportunity if Top Quartile Achieved

3rd–4th Qtr

2008


intended to create internal discussions about improvement possibilities. All information was taken from the UHC Operational Data Base on 12/31/08.


Cardiac Intermediate Unit n: 89 n:

070036 - UCONN - 815450, CSD $385 Better than the Top Quartile

Med/Surg/Card ICU n: 11 n: 13

070036 - UCONN - 814610, ICU $736 Better than the Top Quartile $743 Better than the Top Quartile

Med/Surg/Card Intermed Unit n: n: 47

070036 - UCONN - 815450 CSD $430 Better than the Top Quartile

Summary $0 $0


Note: Quarters reported are calendar quarters. Insufficient Data means that Nursing Days per Equivalent Discharge were not supplied. If you have questions, please contact your ODB

coordinator or Cathy Krsek ([email protected]).

Annual Savings Opportunity: Savings = (((Total Salary Cost per Nursing Equivalent Patient Day – 75th Total Salary Cost per Nursing Equivalent Patient Day) * Average Wage

Index)*Annualized Nursing Equivalent Patient Day).

Note: The ―n‖ next to the unit represents the number of institutions that submitted data for that specific unit. If an institution reports more than one unit to the Operational Data Base in the same

category, they are listed separately under the name of the unit. For additional information on the Operational Data Base, please contact your ODB coordinator.


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UHC Adult ICU Performance Opportunity Summary–Operational


Top

Quartile

50th

PercentilePerformance Measures

Top

Decile

Performance Summary UCONN Annual Savings Opportunity

if Top Quartile Performance Achieved


n


intended to create internal discussions about improvement possibilities. All information was taken from the UHC Operational Data Base on 12/31/08.

UCONN


ICU

Med/Surg/Card ICU

1.

2.

3.

4.

$2,944

$743

76.6

19.3

$1,535

$743

49.3

18.4

$2,428

$825

61.3

19.3

$2,944

$944

75.0

23.4

$704,562 savings

Better than the Top Quartile

9.6 FTE reduction


n: 6

n: 13

n: 6

n: 13

Total Salary Cost per Nursing

Equivalent Discharge


Equivalent Patient Day

Total Worked Hours per

Nursing Equivalent Discharge


Nursing Equivalent Patient Day

–

–

–

–

Intermediate

Med/Surg/Card Intermed Unit

1.

2.

3.

4.

$430

11.5

$1,140

$392

37.5

11.5

$1,165

$431

38.8

13.6

$2,729

$609

88.1

17.4

Insufficient Data


Insufficient Data


n: 24

n: 47

n: 24

n: 47


Equivalent Discharge


Equivalent Patient Day


Nursing Equivalent Discharge


Nursing Equivalent Patient Day


A (+) indicates a positive trend from the previous two quarters of data and (–) indicates a negative trend from the previous two quarters.

Annual Savings Opportunity: Total Salary Cost per Equivalent Nursing Discharge = (((Total Salary Cost per Equivalent Nursing Discharge – 75th Total Salary Cost per Equivalent

Nursing Discharge) * Average Wage Index) * Annualized Equivalent Nursing Discharge) Total Salary Cost per Nursing Equivalent Patient Day = (((Total Salary Cost per Nursing

Equivalent Patient Day – 75th Total Salary Cost per Nursing Equivalent Patient Day) * Average Wage Index) * Annualized Equivalent Nursing Patient Days) Total Worked Hours per

Equivalent Nursing Discharge = (((Total Worked Hours per Equivalent Nursing Discharge – 75th Total Worked Hours per Equivalent Nursing Discharge) * Annualized Equivalent

Nursing Discharge) / (Hours Paid %) * 2080 paid hours/FTE)) Total Worked Hours per Nursing Equivalent Patient Day = (((Total Worked Hours per Nursing Equivalent Patient Day –

75th Total Worked Hours per Nursing Equivalent Patient Day) * Annualized Nursing Equivalent Patient Day) / (Hours Paid %) * 2080 paid hours/FTE)).

Note: The ―n‖ next to the unit represents the number of institutions that submitted data for that specific measure. If an institution reports more than one unit to the Operational Data Base in the same

category, they are listed separately under the name of the unit. For additional information on the Operational Data Base, please contact your ODB coordinator.


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How to Interpret the Adult ICU Performance Opportunity Summary Reports

These reports are sent every six months with the most recent two quarters of data available reported. We include all benchmarking participants that are in the UHC Clinical Data Base (CDB) or Operational Data Base (ODB) in this report, even organizations that did not participate in the 2000 project. We have done this in order to make the reports as meaningful as possible by providing larger comparison groups, and to provide important information and value to all benchmarking participants. The purpose of the report is to indicate potential areas of improvement. Annual possible savings in dollars or days or FTEs are meant as an indicator, and should be used to drive additional evaluation. They should not be used as specific budget targets without additional in-depth analysis. If you have any questions about the report, please contact Cathy Krsek at [email protected] or 630/954-4799.

Reports

Five separate reports are prepared. The first is the Clinical Executive Summary Report that includes clinical cost savings opportunities by diagnosis. The Operational Executive Summary Report includes potential operational salary cost savings opportunities by intensive and intermediate care units. The executive summary reports are intended to assist senior leadership with identification of potential opportunities that can then lead to improvement activities. A Trend Report shows the organization’s trend on cost, LOS and mortality for the last 10 quarters. Once a year the trend report includes the long-term ICU diagnoses and once a year it includes the low acuity diagnoses. The detailed reports include the Performance Opportunity Summary – Clinical with patient level data elements, including total cases, ICU LOS, overall LOS, cost, and mortality, O/E ratios for LOS, cost and mortality and annualized savings opportunity. The Performance Opportunity Summary – Operational has additional productivity data elements, including salary cost and worked hours per nursing equivalent discharge and nursing equivalent patient day.

Clinical Data Base Reports

New Clinical Data Base Risk Adjustment Methodology Release

On March 27, 2007 UHC released to Clinical Data Base (CDB) participants a completely revised risk adjustment methodology applied to CDB data that includes many additional

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custom models. The new release includes:

• More than 3 years of remodeled data with revised length of stay, cost, and mortality models

• Models specific to certain clinical populations such as pediatrics and oncology • New 2004 RCC source files employed to generate the observed cost

The new risk model and other online documentation for risk adjustment updates are available for members on UHC’s Web site under Management Information Tools; select Clinical Performance, then Clinical Data Base and then click on "Documents and Data Loading Status" in the left menu bar. The “Risk and Cost Methodologies” section of this page includes both an executive and a more detailed summary of the new risk adjustment methodology and frequently asked questions about risk adjustment. The documentation for the UHC Complication Profiler that is used to identify complications is also found in this section (“Complication Algorithms and Risk Pool Definitions”). In the next section, items 1, 2, 3, 6, and 8 are related to risk adjustment. Item 7 in this section explains how the severity of illness value is assigned by the APR-DRG grouper, which is also relevant to risk adjustment since the severity of illness is usually one of the most important predictors in the models. The “Risk Model Summary” section includes all of the model results files with the coefficients for all the significant variables for each DRG. The data in the Adult ICU Performance Opportunity Summary have had the new methodology applied,so the observed to expected ratios for length of stay, cost, and mortality for Q1 and Q2 2006 in the report may be different from the Q1 and Q2 2006 data reported in the last summary. For more information about the risk adjustment methodology contact Steve Meurer at 630/954-6677, Jodi Neikirk at 630/954-2462, Julie Cerese at 630/954-3796, or Susan Bellile at 630/954-1724.

Important Note Regarding the Recent Updates to CDB Data

Members may notice some significant changes in observed costs after the most recent risk methodology updates. These changes are not due to the new severity adjustment models, which will, in many cases, change the expected values for outcomes – cost, length of stay and mortality. Rather, the changes in observed costs are a result of individual hospital updates to their ratio of costs to charges (RCC) between the years of 2002 and 2004. Previous to the most recent updates UHC was using hospital’s 2002 RCCs and the data that was unveiled on March 27, 2007 uses the RCCs from 2004. The following provides a quick tutorial on the cost to charge ratio and how it is used in the CDB.

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• Each hospital is required every year to provide CMS with their charges and costs separated into a number of service lines (e.g. drugs, laboratory, ICU).

• When CMS makes these available, UHC uses the hospital-specific RCCs for each cost center to estimate cost from the charges submitted by the hospital to UHC.

• The latest available CMS report is for 2004 (UHC did not update the CDB with the 2003 RCCs).

• Actual CDB costs are affected when a hospital has changes to their RCC which could occur as a result of:

o a change in hospital’s costs; o a change in hospital’s charge structure; and / or o a change in hospital’s service line utilization.

• There are specific standards that CMS requires of hospitals when reporting their costs and charges; however, a wide variation still exists in terms of the mapping of specific costs and charges to the cost centers on these annual reports to CMS.

It is, therefore, easy to imagine how a hospital can incur a wide swing in their observed costs as presented in the CDB from one year to the other. For more detailed information, please see the cost methodology document in the Clinical Data Products web site under Documents and Data Loading Status/CDB Docs/Cost Estimation Methodology or contact Jodi Neikirk at [email protected].

Diagnosis and Procedure Codes

The diagnosis and procedure codes that are included were selected in several ways. First, the Low Acuity Cases were selected during the Adult ICU (1997) project. They were identified in collaboration with APACHE as patients that were frequently cared for in ICU, but probably didn’t require that intensity of care. We chose to use the same codes for Adult ICU (2000). The Long-term ICU Patients: Diagnosis Groups were selected by using the CDB to identify patients that tended to have long ICU LOS. We took the top ten diagnosis codes as listed in the report footnote. Diagnoses that would probably be cared for in the same unit were grouped together (cardiac, respiratory and neurological patients) to increase the N and help to focus improvement efforts. The Long-term ICU Patients: Other Diagnosis with Specific Procedures were identified by the Adult ICU (2000) steering committee as additional patients that would probably have long stays in ICU and have high resource utilization. Patients that are found in both the long-term diagnosis group and the

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long-term procedure group are counted only in the diagnosis group so that they are only counted once.

Clinical Executive Summary Report:

Column 1 includes the list of the diagnosis and procedures that are included. Specific diagnosis and procedure codes used are listed on page 2.

Columns 2 - 5 include your organization’s data from the previous report: total cases, cost O/E, savings opportunity if the top quartile cost O/E achieved, per case and annualized. This is presented to serve as a comparison for your current data.

Columns 6 and 7 include the most recent two quarters of data available for total cases and Cost O/E. The O/E results from the application of a risk adjustment methodology to determine the expected value and expresses the observed to expected as a ratio. If the observed value is exactly as expected, the O/E will equal 1.0. If the O/E is 1.2, that indicates that the observed value is 20% higher than expected. Each case is considered individually. In other words, it is possible that every organization’s O/E for a particular measure could be greater than 1.0.

Column 8 and 9 (Savings Opportunity):

Column 8 includes potential savings per case. Column 9 includes the annualized potential savings opportunities. As stated earlier, annual potential savings in dollars is meant as an indicator, and should be used to drive additional evaluation. It should not be used as specific budget targets without additional in-depth analysis. The calculation of the opportunity is described in a footnote, but essentially, it is based on your organization reaching the level of performance defined as the top quartile.

Performance Opportunity Summary – Clinical

This report includes the diagnosis and procedure-specific data for LOS, cost, and mortality and includes annual savings opportunities. The 6-month (two quarter) time period included in the report is noted in the upper right hand part of the page.

Column 1 (Diagnoses and Procedures):

The diagnoses and procedures are grouped into three categories as described above under CLINICAL DATA BASE REPORTS, Diagnosis and Procedure Codes. The specific diagnosis and procedure codes used for this report are listed in a footnote on page three of the report. Only patients 18 years and older are included.

Column 2 (Total Cases):

This includes the number of cases in each diagnosis or procedure group for the reporting period. If only one quarter of data has been reported, the number of cases

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is doubled in order to calculate an appropriate Savings Opportunity (discussed later). An arrow to the right of the number indicates how your volume of cases ranks with the other UHC members. Two bold arrows (↑↑) indicates that you have more cases than 90% of the participants, two arrows (↑↑) indicates more cases than 75%, and one arrow (↑) indicates more cases than 50% of the participants. A blank indicates performance below the 50th percentile. These symbols are used in each column of data for which we have calculated the percentile rankings.

Because we wanted to give a complete picture of these patient populations, all outliers (LOS and Cost) have been left in the reports. If your organization has determined that further investigation should be done to further quantify an improvement opportunity, the first step should be to identify outliers and determine if they are the driver of the improvement opportunity. If so, those cases can be examined. If not, the remainder of the cases can be examined more closely for opportunity.

Column 3 (% ICU LOS>0 Days)

The percentage listed here is the percentage of patients in that diagnosis or procedure code that were admitted to ICU at any time during their stay. Just below the percentage, the 90th/75th/50th percentile values are listed as a reference. A (+) to the right of the percentage indicates an improvement since the last report. A (–) to the right, indicates a decline in performance since the last report. Just to the right of that symbol, arrows (as described above) are used to represent position among the participants.

Column 4 (% ICU LOS > 7 Days)

This column shows the percentage of patients that had ICU LOS more than 7 days. The flaw in this data point is that we cannot distinguish exact dates of ICU days from the CDB. Therefore, a patient may have actually had two 4-day stays and it will show up in the data as an 8-day stay.

Column 5 ( Mean ICU LOS)

This is the mean ICU LOS for patients who were admitted to ICU.

Column 6 (Mean LOS):

This is the mean hospital LOS for the entire population included in the diagnosis. Because this is a much larger N, it is possible that the mean LOS in this column is actually shorter than the mean ICU LOS reported in the previous column.

Column 7 (Mean Expected LOS):

A risk adjustment methodology is applied to the patient level data to determine the expected value for LOS. Separate models are generated for each adjacent DRG

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(ADRG) grouping in the CDB. Then each case in the CDB has its own expected values based on the model that was generated on patients in the same ADRG. The aggregate expected value is the average of the individual case-level expected values that have been determined by models generated on groups of patients with similar characteristics.

Column 8 (LOS O/E):

The O/E is the observed and expected values from the previous columns expressed as a ratio. If the observed value is exactly as expected, the O/E will equal 1.0. If the O/E is 1.2, that indicates that the observed value is 20% higher than expected. Each case is considered individually. In other words, it is possible that every organization’s O/E for a particular measure could be greater than 1.0.

If an asterisk (*) is shown to the right of the value, that denotes a significant difference between the observed and expected values at the .05 level of significance. No test is performed when there are < 10 cases for LOS.

Columns 9, 10, and 11 (Case Costs):

The next three columns include information on case costs. Expected costs and O/E are arrived at in the same manner as LOS, as described above. If an asterisk (*) is shown to the right of the observed value, that denotes a significant difference between the observed and expected values at the .05 level of significance. No test is performed when there are < 10 cases cost.

Columns 12, 13, and 14 (Mortality):

The next three columns include information on mortality. Expected mortality rates and O/E are arrived at in the same manner as LOS, as described above. If an asterisk (*) is shown to the right of the observed value, that denotes a significant difference between the observed and expected values at the .05 level of significance. No test is performed when there are < 25 cases for mortality.

Column 15 (Annual Savings):

The figure in this column is the potential annualized savings opportunity if your organization performed at the same Cost O/E that defines the top quartile. Please remember that this figure is meant as an indicator to be used to drive further investigation and help prioritize your activities, not as a specific budget target. If your organization’s costs are in the top quartile, this will be shown in this column instead of a savings opportunity.

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Operational Executive Summary Report

The data included in this report is from the Operational Data Base (HBSI Action). If your organization does not participate, you will not receive this part of the report. As with the Clinical reports, the opportunities identified in this report are meant to serve as an indicator to drive further investigation and help prioritize your activities, not as specific budget targets.

Column 1 (ICUs and Intermediate Units)

This lists the intensive and intermediate care units that your organization reports to the ODB.

Column 2 (1st-2nd Qtr 2002):

This time period is reported for comparison to the most recent time period.

The “n” is the number of other organizations reporting the same unit.

Below the n is the Total Salary Cost per Nursing Equivalent Patient Day:

Salary cost is defined by HBSI Action as “the dollar amount corresponding to the paid hours reported for the patient care unit. Salary cost includes monies paid for on-call hours not actually worked on site. Salary Cost also includes any premium overtime paid, such as for 12-hour shifts. Salary Costs excludes all benefit costs such as FICA, health insurance, pension plan premiums and unemployment/workers compensation.” Nursing Equivalent discharges is the total number of patients (inpatient and outpatient) discharged from the cost center during the reporting period. It includes an observation factor that takes into account outpatient, observation and short stay patients. Units with longer lengths of stay will have higher salary costs per discharge.

Column 3 (Annual Savings Opportunity)

This column shows the annualized savings opportunity if your organization performed at the level of the Top Quartile. If your organization is above the Top Quartile, the column will read “Better than the Top Quartile.”

Columns 4 and 5 (3rd-4th Qtr 2002)

This is the most recent Salary Cost per Nursing Equivalent Patient Day data and the annualized savings opportunity. The calculation uses a wage-index adjustment to factor in regional differences in salaries. (The formula is included in a footnote to the report.)

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Performance Opportunity Summary – Operational

This report includes additional performance measures for unit productivity and also includes annual savings opportunities. The 6-month (two quarter) time period included in the report is noted in the upper right hand part of the page.

Column 1 (ICUs and Intermediate Care Units: Performance Measures)

The four performance measures included in this report are listed in this column. These measures are defined as:

Total Salary Cost per Nursing Equivalent Patient Discharge: (Salary Cost defined above.)

Total Salary Cost per Nursing Equivalent Patient Day: Nursing equivalent patient days is the total number of patient days provided by the cost center during the reporting period. It also includes an observation factor.

Total Worked Hours (per Nursing Equivalent Patient Discharge and per Nursing Equivalent Patient Day): Worked hours are the total hours worked by personnel assigned to the unit and involved in its daily activities. Worked hours include: regular hours, actual overtime hours, actual hours worked by on-call staff (when called in), educational hours, both on and off the hospital premises, and orientation hours. Worked hours exclude: on-call standby hours, physician hours, and volunteer hours.

Column 2 (n):

The “n” represents the number of units reported in the category.

Column 3 (Organization Name)

This is the value for your organization for each performance measure. A positive trend (decreasing costs and hours worked) is indicated by a (+). A negative trend (rising costs and hours worked) is indicated by a (-).

Columns 4, 5, and 6 (90th, 75th and 50th percentiles):

The 90th percentile represents the top decile of performance. Organizations at this level have salary costs and worked hours less than 90% of the organizations reporting. The 75th percentile is considered the top quartile and is used to calculate savings opportunities. The 50th percentile indicates the top half in performance on these measures.

Column 7 (Annual Savings Opportunity)

This column shows the annualized savings opportunity if your organization performed at the level of the Top Quartile. If your organization is above the Top Quartile, the column will read “Better than the Top Quartile.” The calculation uses a

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wage-index adjustment to factor in regional differences in salaries. (The formula used to calculate the savings is included in the report footnote.) If there is a significant discrepancy between savings opportunity for hours worked per nursing equivalent patient day and hours worked per nursing equivalent patient discharge, it is usually a function of a significantly longer length of stay in the unit compared to the other reporting organizations.

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