Fourth, hospitals are struggling with significant reporting requirements including Surgical Care Improvement Project scores, the Inpatient Quality Reporting Program to the National Committee for Quality Assurance and reporting to insurers. This increased transparency is sparking competition and creating an empowered army of patient consumers willing and able to make informed decisions about where and how their healthcare is delivered.
Consequently, hospitals need the structures and processes in place for constant quality improvement, data capture and analytics. On a macro level, the challenge is that many hospital records are still paper-based, making the aggregation and dissemination of well-organized information nearly impossible in an age when hospitals are paid based on highly specific quality measures (antibiotics, patient temperature, etc.).
Hospitals need to commit to an in-house or outsourced IT infrastructure that delivers quarterly reports that lead to better care decisions and reporting, lower administrative costs and stronger reimbursements. These reports must be usable for hospital staff so they can understand their performance, how they impact overall outcomes and how they can improve.
Fifth, healthcare reform has tied hospital compensation to quality outcomes. If a hospital wants to function in an incentive-driven environment, there needs to be a data-powered dashboard of quality measures that holds individuals accountable for the patient experience every step of the way.
Finally, if hospitals really want to pursue quality and make it part of their cultural fiber, they need to motivate staff (both clinical and administrative) to be thought leaders. It should become a part of their core job responsibilities and they should be compensated for it. Hospital staff should teach, do research, and serve on local, state, regional and national professional boards and committees. Having an army of motivated thought leaders in the community delivers tangible and intangible benefits to the hospital.
The development of accountable care organizations make these changes mandatory. The ACOs will redistribute hospital priorities and investment from traditional fee-for-service activities to prevention, evidence-based medicine and outcomes for a defined population. As the host in the patients' surgical home, the perioperative leader should triage patients by using data to identify the right solution in the hospital (the main or non-main OR, for instance) or in another more suitable setting (an ambulatory surgical center perhaps).
Effective ACOs will lead to the migration of care from acute to outpatient settings, which if done well can improve outcomes, improve reimbursement rates and lower the cost of care. By going through these steps, the pieces of the puzzle—quality, sustainable outcomes, cost, reimbursements and overall financial performance—will all fit together and everybody wins.
Dr. John Di Capua is a practicing anesthesiologist and interim managing partner at North American Partners in Anesthesia in Melville, N.Y.