Using Data to Drive Dramatic Improvement In Albany
The U.S. Department of Health and Humans Services has adopted the National Quality Strategy as called for in the Affordable Care Act, establishing national priorities to achieve the Triple Aim: better health for people and communities; better care for individuals; and affordable care by lowering cost through improvement.
IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services for the 10th Statement of Work, serves to support the goals of the National Quality Strategy at the local level through collaborative efforts with health care providers, community service providers, Medicare beneficiaries and other stakeholders to conduct activities that are responsive to and driven by local circumstances, needs and capacities.
In this one year Special Innovation Project, CMS has directed IPRO to work with the leaders of local healthcare communities that show great variation from similar communities or national norms in terms of health care costs, quality, or both, to achieve sustainable improvement. The project focuses on the delivery systems for long term care services, including institutional and home health care and utilization of Long Term Care Hospitals.
The region of focus designated by CMS is the Albany Hospital Referral Region (HRR) as defined by the Dartmouth Atlas (http://www.dartmouthatlas.org/) which categorizes health care service areas throughout the United States for aggregated measurement of health care outcomes, utilization and cost for Medicare beneficiaries. The Albany HRR covers a large region that includes urban, suburban, and rural areas as noted on the map to the right of this narrative.
Long Term Care Hospitals (LTCHs) must meet all the Medicare Conditions of Participation for acute care hospitals and in addition must have an average Medicare length of stay greater than 25 days. Patients who are cared for in LTCHs are usually medically complex patients that require a longer length of stay for care management. Although there are no LTCH facilities located within the Albany HRR patients are sometimes transferred to regions with LTCH facilities for continuation of their treatment plans.
Community Partnerships & Collaborative Approach
IPRO will work with the Albany HRR communities to investigate variations in costs, quality and utilization of services compared to similar communities or national norms, to identify strengths and weaknesses and interventions which have the potential to improve patient outcomes. IPRO will work with the communities to identify the strengths and best practice interventions that can be successfully spread to other HRRs as well as the weaknesses that can be corrected to further enhance the efficiency and effectiveness of long term care service delivery in the Albany HRR.
IPRO will collaborate with the health care providers, community service representatives, Medicare beneficiaries and other stakeholders to perform a community-based root cause analysis within the Albany HRR and develop a work plan to improve long term care patient outcomes.
A root cause analysis (RCA) is a process for identifying the causes that underlie variations in outcomes. The analysis focuses on a process that has a potential for redesign. The RCA allows for an organization to identify the “root” of the problem including how, why, and where a problem, adverse event, or trend exists. It is a discovery process that identifies issues that are not readily apparent, so involving everyone who is affected by the process being investigated is important to identifying all the underlying factors contributing to the problem.
CMS Long-term Care Hospital Prospective Payment System
Overview on Centers for Medicare & Medicaid Services (CMS) Web site of information on the Long Term Care Prospective Payment System (PPS) Final Rule for Long Term Care Hospitals.
Report to Congress: New Approaches in Medicare
The Medicare Payment Advisory Commission (MedPAC) Report June 2004
Report to Congress: Medicare and the Health Care Delivery System
The Medicare Payment Advisory Commission (MedPAC) Report June 2011
The Dartmouth Atlas of Healthcare
The Dartmouth Atlas utilizes Medicare data to provide comprehensive information and analysis about national, regional, and local markets, as well as individual hospitals and their affiliated physicians. These reports and the research upon which they are based have helped policymakers, the media, health care analysts and others improve their understanding of the efficiency and effectiveness of our health care system.
Healthcare Communities Website
The Healthcare Communities Web site provides a forum for shared learning across healthcare systems across the continuum of care.