Hospital quality measures need to be overhauled, execs say

The quality measures hospitals use to gauge processes of care, clinical outcomes and patient experience are in need of serious restructuring.

That was the message delivered by leaders from Memorial Health System during a session at the American College of Healthcare Executives meeting in Chicago.

One hospital might be rated the best by one rating system but receive the worst rating from another, said Charles Callahan, senior vice president and chief quality officer at Memorial, based in Springfield, Ill. “There's no uniform definition of what is quality and what is high performance.”

Relying too heavily on federal measures to gauge quality isn't advisable, either, he said, adding that the CMS recently had to release multiple corrections of its national readmissions penalties.

Instead, he advocated for a “value-based measurement system,” informed by federal metrics, but also incorporating real-time data, severity and volume adjustments, and trends.

Memorial Health System works with Southern Illinois University to help increase its capabilities in informatics, statistics, predictive analytics and other measurement-centric fields, he said.

Additionally, the hospital has ramped up its efforts to capture patient experience at multiple care sites. Current measures are episodic and don't capture customer loyalty over time, said Douglas Rahn, Memorial's executive vice president and chief operating officer.

More-accurate patient-experience measures are needed that take into account health literacy, preferences, shared decisionmaking and other variables, he said.

For many other types of measures, risk adjustment is a key determinant of performance. But risk adjustment is largely determined by clinical documentation practices, which can vary widely, said Jameson Roszhart, Memorial's director of case management and clinical integration.

Roszhart urged hospitals to pay special attention to their clinical-documentation improvement programs and perform concurrent documentation review of patients with reportable events.

Memorial has introduced “super visits” for its high-risk patients, he added. Those use a range of variables, including severity of illness, social support, cognitive state, behavioral health status, health literacy and patient engagement to determine total risk.

After providing patients with care management and coordination services, Memorial measures the same risk factors once again to determine how effective interventions actually were, Roszhart said. “We need next-generation risk adjustment,” he said.

Follow Maureen McKinney on Twitter: @MHMMcKinney

More Live@ACHE Coverage