THA Rural and Community Hospital
2012 Symposium
Advances in
Rural Healthcare Quality
Paul Moore, DPh
Senior Health Policy Advisor
Department of Health and Human Services
Health Resources and Services Administration
Office of Rural Health Policy
Flex Medicare Beneficiary Quality
Improvement Project
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Pilot Project under Quality Improvement
Common Metrics
Demonstrating Improvements
Sharing Best Practices
Official Start: Sept 2011
http://www.hrsa.gov/ruralhealth/about/video/index.html
Or
www.Youtube.com
[MBQIP]
MBQIP Participation by
ORHP Region
MBQIP Participation
100%
90%
80%
70%
85%
82%
60%
76%
66%
77%
63%
50%
40%
30%
20%
10%
0%
Region A
Region B
Region C
Region D
Region E
(Northeast)
(Southeast)
(Midwest)
(Southwest)
(Northwest)
U.S. Total
Region A:
Region B:
Region C:
Region D:
Region E:
US Total:
54 of 66 CAHs (82%)
156 of 236 CAHs (66%)
477 of 559 CAHs (85%)
118 of 187 CAHs (63%)
214 of 281 CAHs (76%)
1019 of 1329 CAHs (77%)
WHY NOW???
At least 3 reasons….
JAMA
Quality of Care and Patient Outcomes
In Critical Access Rural Hospitals
“Compared with non-CAHs, CAHs had
fewer clinical capabilities, worse measured
processes of care, and higher mortality rates
for patients with AMI, CHF, or pneumonia.”
JAMA
“Patients admitted to CAHs had higher 30day risk adjusted mortality rates for all 3
conditions than patients admitted to nonCAHs.”
JAMA
“More than a decade after major federal and
state efforts to save US rural hospitals, these
findings should be seen as a call to focus on
helping these hospitals improve the quality of
care they provide so that all individuals in
the United States have access to high-quality
inpatient care regardless of where they live.”
JAMA
“Engaging in the process of collecting and
reporting data is an important step toward
developing an internal quality improvement
strategy.”
Rural and Community
Hospitals need to be telling
their “own story”…
… and the way we do
that is with quality data!
WHY NOW???
Because I was wrong
12 years ago…
…. from recent headlines…
Cuts For Rural Hospitals
“…. as part of debt ceiling negotiations, has
proposed $14 billion over 10 years to
“reform rural hospital programs.”
the President’s budget…
…called for $6 billion in cuts over 10
years to rural hospitals, claiming that the
proposal eliminates “higher than
necessary reimbursement”.
WHY NOW???
“Proving Value”
…to patients, payers and
policy makers!
Moving Forward….
What got our hospitals where they
are…
…won’t get them where we want to
go.
The emphasis is changing….
…from “how much” to “how well”
…from “ outputs” to “outcomes”
…from “Volume”
to “Value”
Simple definition…
Value = Quality / Cost
So how do we increase Value ?
Increase Quality
or
Decrease Cost
Value-Based Purchasing
(to “bend the cost curve”)
“Deja-vu” all over again?
Value = Quality / Cost
So…now that we will be held financially
accountable for Value…
Value = Quality / Cost
How do hospitals do better without all of the
focus being on cost?
Key…
Increasing Quality will decrease Cost.
Why FOCUSING our rural and
community hospitals on
“QUALITY”
is so important!
What will “Quality” look like…
Keeping patients from getting injured or
sicker while in our care…
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•
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•
•
•
•
•
•
Adverse Drug Events
Catheter-Associated Urinary Tract Infections
Pressure Ulcers
Injuries from Falls and Immobility
Central Line Associated Blood Stream Infections
Obstetrical Adverse Events
Surgical Site Infections
Venous Thromboembolism
Ventilator-Associated Pneumonia
What will “Quality” look like…
Hospitals, communities, patients and families
devoting new attention to making sure that
transitions out of the hospital are well
coordinated….
…helping patients heal without complication...
What will “Quality” look like…
Decreasing inappropriate and duplicative tests
and procedures because we are utilizing
electronic health records that provide us
with the information we need as providers…
What will “Quality” look like…
Increasing patient access to appropriate
healthcare providers in more cost efficient
settings through greater utilization of telemedicine …
IMPROVING QUALITY
Will
DECREASE COST
Aligns with the goals of the
Partnership for Patients…
1.
Keep patients from getting injured or sicker.
By the end of 2013, preventable hospital-acquired conditions would decrease
by 40% compared to 2010.
2.
Help patients heal without complication.
By the end of 2013, preventable complications during a transition from one
care setting to another would be decreased so that all hospital readmissions
would be reduced by 20% compared to 2010.
Potential to save up to $35 billion dollars over three years.
I have good news for you….
Rural and community hospitals can lead the
way nationally in achieving these goals!
Texas rural and community Hospitals can lead
the way!
…some already are!
But to get the job done will require
STRONG LEADERSHIP …
C-Suite and Board…
Physican Champions…
Other Providers…
Community…
Patients…
… everyone!
Rural and community hospitals have led
out with some very specific strategies to
bring about this change.
• 1. Make all leaders, employees and partners safety
professionals with accountability for practices and
processes that deliver safety.
• 2. Engage in action/learning collaboratives with
other hospitals; use proven resources.
Hospital Change package (cont’d)
• 3. Be data driven; build appropriate measurement
into operations; display openly.
• 4. Build hospital safety by forming community
relationships.
Your Hospital Engagement Network has
specific strategies to bring this about….
• 1. Establish a commitment to safety culture among
hospital leaders
• 2. Establish a user-friendly, rural hospital-relevant
data-gathering system that gives feedback and
benchmarks to hospitals
HEN Change package (cont’d)
• 3. Find and disseminate safety expertise, evidencebased materials and capacity development resources
• 4. Foster collaborative all-teach-all-learn, facility-tofacility relationships
• 5. Collaborate with collaboratives of HEN affinity
groups
Rural and community hospitals…
…engaging local leadership
…partnering with other hospitals
…leading nationally
…moving to better quality / outcomes
…avoiding harm and helping patients heal
Proving Value
Rural and community hospitals…
…have taken up the challenge
(but others still need to join…)
Rural and community hospitals…
… are leveraging their resources…
… and are moving to the next level in
delivering safe and efficient care…
Rural and community hospitals…
… can lead in this work…
…which
will ultimately define
healthcare in the future.
THANK YOU
Contact Information
Paul Moore, DPh
Office of Rural Health Policy
5600 Fishers Lane, Rm 5A-05
Rockville, MD 20857
Tel: 301-443-1271 Fax: 301-443-2803
[email protected]
http://ruralhealth.hrsa.gov
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