A sophisticated performance measurement system can tell a provider a lot more about its clinical process than an indicator-based system can, but there's a trade-off in price.
The Maryland Quality Indicator Project's participation price is less than $3,000 a year. That includes data-collection software, comparative reports, training and support relating to 15 indicators of inpatient and ambulatory-care performance. Psychiatric and long-term-care indicators are another $500 each per year.
By contrast, highly computerized systems that lift patterns of care from clinical bits and pieces can start at $25,000 to $35,000 and top out at more than six figures.
The top of the line at Care Management Sciences Corp., CaduCIS Manager, costs more than $100,000 a year depending on the extent of analysis and hand-holding. The system takes data from clinical information systems and charge-capturing systems on tests, therapies and other events documented during a patient's stay.
The package also includes a heavy dose of physician training, steeping them in the potential of the system to consider a whole new range of information. And it sets up clinical departments to make queries and turn them into interventions, says David Brailer, M.D., president of the Philadelphia-based company.
Customers of the Quality Standards in Medicine system pay a one-time license fee of $25,000 to $80,000, plus installation and training fees, says William Munier, M.D., president of Boston-based QSM. The company also charges an annual maintenance fee of 17% of the initial license expense.
QSM offers discounts on its fees for multiple-hospital networks and works with small hospitals to bring the system within their price range, Munier says.
Other considerations in deciding on a performance measurement system include the costs of getting data into a system and the level of detail that's affordable.
At Lake Charles (La.) Hospital, two people work full time extracting items from paper charts of all discharged patients, says Brenda Hoppe, director of quality management.
Aided by a structured series of prompts dictated by the type of case being entered, the workers have become adept at the job, Hoppe says. In March, for example, they loaded data on a total of 1,135 discharges.
Providence Hospital in Washington also employs two full-timers to extract data on 35% to 40% of all admissions for its QSM database, says Robert Simmons, vice president for medical affairs. The hospital extracts 100% of discharges in some areas, such as obstetrics and invasive procedures, Simmons says.
At Graduate Health System, which helped test the CaduCIS Manager software, "there was no exotic data input," says Stanley Goldfarb, M.D., who oversaw the program as senior vice president for medical affairs. The system tapped into a Shared Medical Systems hospital information system and also took billing and pharmacy data from existing claims databases.
Data availability vs. timeliness is figuring into the cost of decision-support offerings.
Some companies use publicly available data from Medicare cost and clinical reports as well as state-sponsored data initiatives, which can be six months to a year old but ready for analysis, Brailer says.
Care Management Sciences recently created a scaled-down version of CaduCIS that's available over the Internet, working with a database of publicly available hospital data. The fee for that level of data is $5,000 a year.
A software and services package using more recent data from a provider's UB-92 claim forms sells for $35,000 to $40,000 a year, Brailer says.