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Patient Safety and Quality Phillip L. Coule, MD MBA FACEP FAEMS Associate CMO, Chief Patient Safety Officer

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Page 1: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Patient Safety and QualityPhillip L. Coule, MD MBA FACEP FAEMSAssociate CMO, Chief Patient Safety Officer

Page 2: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Overview

• Transition to Value based care• Patient Safety and Quality Measures• Population Health• Financial Impact of transition to Value Based

Purchasing

Page 3: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Results of Fee for Service Healthcare Business Model

• High Cost• High Chronic Illness

• Low Quality• Low Access

Page 4: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Medicare Spending Before 1984

4239 5290 6268 6572 7354 8019 925111238

1454917619

2047723543

27699

33725

39918

48134

53438

1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983

Total Medicare Payments ($M)

Page 5: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Medicare Spending After 1984

0

50000

100000

150000

200000

250000

300000

350000

400000

1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012

Total Medicare Spending($M)

Page 6: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Change is coming│IHI Triple Aim

Photo credit: http://bhmpc.com/wp-content/uploads/2014/05/timthumb.png

Page 7: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Better Health (Population)• Shift from

episodic to continuous

• Examples: % of Attributed patients with HbgA1c >9%

Page 8: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Population Health Maturity

Page 9: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Better Care (Experience)

Page 10: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Patient Experience

25% 75%

HCAHPS = Healthcare Consumer Assessment of Healthcare Providers and Systems

Page 11: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Lower Cost (MSPB)

MSPB = Medicare Spending per beneficiary

Page 12: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Measures of patient safety and Quality

Page 13: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Quality Measures

• CMS Core Measures• Patient Experience / Access

– Emergency Department Left Without Being Seen (LWOBS)

– ED LOS (Admitted and Discharged)

Page 14: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Safety

• Falls with Injury• Hospital Acquired Pressure Injury• Hospital Acquired Infections

– Catheter Associated Urinary Tract Infections (CAUTI)– Catheter Associated Blood Stream Infections (CLABSI)– Ventilator Associated Pneumonia (VAP)– Surgical Site Infections (SSI) – Clostridium Difficile (C.Diff)

Page 15: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Patient Safety Measures• CLABSI (Central Line Associated Blood Stream

Infections)– Central Line Bundle / “Certified” Lines– Reduce use and early removal– Scrub the hub / Sterile dressing changes– CLISA Score

Page 16: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

• CAUTI (Catheter Associated UTI)– Strict competency for insertion and maintenance– Early removal

Page 17: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Patient Safety Measures (Con‘t)

• Falls– Identify high risk patients / institute precautions– Responsiveness of staff to calls (No Pass Zone)– Intentional rounding– Beers List

Page 18: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Hospital Acquired Pressure Injury

• HAPI Hospital Acquired Pressure Injury– Intentional Rounding – Predicted high risk – proactive intervention– Proactive turning and positioning– Device positioning– EMS Spine Boards (Use selective spinal

immobilization)

Page 19: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Patient Satisfaction

• Patient Experience (HCAHPS)– Communication– Responsiveness of Staff– Cleanliness / quietness– Communication about Medicines– Discharge information– Overall rating– Recommendation

HCAHPS = Healthcare Consumer Assessment of Healthcare Providers and Systems

Page 20: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety
Page 21: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Transition to Value-Based Care Delivery

Page 22: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

∗

+

* A composite of patient outcomes, safety, and experiences+ The cost to all purchasers for purchasing care

The part of the above equation that has the greatest opportunity for influence in meeting the “value-based” requirement of any health system is Quality!

Page 23: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

THE TRANSITION: FROM FEE FORSERVICE TO VALUE-BASED PAYMENT

Source: Georgia Society of CPAs

Page 24: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Value-based payment models

• Shared savings• Bundles• Shared risk• Global capitation

Page 25: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

The Population Health Model

Content adapted from: http://www.mckesson.com/population-health-management/population-health/get-started/

5 Steps Toward Success in a Value-based Structure

Connect: Acquire, aggregate, and leverage your data to support clinical integrations

Analyze: Once connected, financial and clinical data must be translated in to actionable insight

Intervene: Use analysis to create care coordination and care management workflows which proactively drive interventions

Engage: 3 key levels of engagement- patient, physician, and stakeholder network

Support: Leverage advisory, operational, and care coordination tools and services to lay the foundation for organizational processes

Page 26: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

CMS Overall Star rating vs Value Based Purchasing

Page 27: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety
Page 28: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Image Credit: https://dag.advisory.com/2013_G_DAG_Gmap/Home/MapView?mapname=cms_hcahps_star_rating_july16

Page 29: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

What does it mean to be a 3 star hospital?

Page 30: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety
Page 31: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety
Page 32: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety
Page 33: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety
Page 34: Patient Safety and Quality - Augusta University Health Board... · 2017-06-01 · Patient Safety and Quality. Phillip L. Coule, MD MBA FACEP FAEMS. Associate CMO, Chief Patient Safety

Summary

• Transition to Value Based Model• Transition will create a straddle• Patient Safety Strategies• VBP Models combine Quality, Safety, Patient

Satisfaction


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