An Evaluation of Local Health Systems

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An Evaluation of Local Health Systems Michael L Taylor MD FACP CMO, Truven Health Analytics ©Truven Health Analytics Inc. All Rights Reserved. 1 Introduction…
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An Evaluation of Local Health Systems Michael L Taylor MD FACP CMO, Truven Health Analytics ©Truven Health Analytics Inc. All Rights Reserved. 1 Introduction and Overview  All measures, except for patients satisfaction, are for the period October 2010 through September 2013  The “current time period” results are for the October 2012 through September 2013  Patient satisfaction results are for the calendar years 2011, Timeframes 2012 and 2013  The Medicare Provider Analysis and Review (MEDPAR) File  Contains data from claims for services provided to all beneficiaries admitted to Medicare certified acute care hospitals  Hospital Consumer Assessment of Healthcare Data Providers and Systems (HCAHPS) sources  A national survey of patients' perspectives of hospital care (i.e. satisfaction) ©Truven Health Analytics Inc. All Rights Reserved. 2 Introduction and Overview  The strength of a hospital’s performance can be evaluated as a function of both its results during the most recent time period and the trend over time  For broad measures (e.g. overall complication rate) both the trend over 12 quarters and the most current year’s results are shown  All results are presented in terms of an observed to expected ratio (OE ratio)  The expected amounts are based upon a national acute care hospital average, adjusted for the case mix of the hospital or hospital system being evaluated ©Truven Health Analytics Inc. All Rights Reserved. 3 Introduction and Overview Results are reported at the hospital system level for 5 systems Health Health Health Health Health System A System B System C System D System E In addition, the results are broken out by 15 hospitals within these systems that were designated by the client. ©Truven Health Analytics Inc. All Rights Reserved. 4 Introduction and Overview, Measure Sources Measure Measure Source Cost Per Case (Overall and for Truven Expected Resource Demand Medicine, General Surgery and model (ERD), the ERD is a set of regression models Orthopedics) that predict expected cost, based upon demographic factors, diagnosis and procedure factors. * Patient Safety Events  Overall Rate Patient Safety Indicators (PSIs), developed by the  Pressure Ulcer Rate Agency for Healthcare Research and Quality (AHRQ)  Post-Op Pulmonary to capture potentially preventable adverse events that Embolism or Deep Vein compromise inpatient patient safety. Thrombosis  Death among Surgical Pts With Treatable Complications *Cost is based upon the “Cost to Charge Ratio” and reflects underlying facility cost ©Truven Health Analytics Inc. All Rights Reserved. 5 Introduction and Overview, Measure Sources Measure Measure Source Truven Expected Complications Rate Index (ECRI) Complication Rate (Overall model is used to determine observed and expected and for Medicine, General complication rates using patient demographic and Surgery and Orthopedics) clinical information. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a national, standardized, publicly reported survey of patients' Patient Satisfaction perspectives of hospital care. Data are adjusted for the effects of patient-mix and mode of survey administration. ©Truven Health Analytics Inc. All Rights Reserved. 6 Cost ©Truven Health Analytics Inc. All Rights Reserved. 7 Overall Cost per Admission Average Cost per Admission Actual to Expected Ratio Health System A + Health System B Health System C Health System D Health System E  All 5 systems had costs which exceed the -0.09 expected adjusted -0.07 nation average amount. Trend for Actual to Expected Results Over 12 Quarters -0.05  Hospital systems were close in performance (a lower slope is favorable) -0.03 and showed almost no -0.01 change in performance over the 12 quarter time 0.01 period. 0.03  System C showed the 0.05 best overall cost performance and 0.07 Systems E and B the 0.09 weakest. 1.30 1.25 1.20 1.15 1.10 1.05 1.00 0.95 0.90 Current Actual to Expected Ratio (a lower ratio is favorable) ©Truven Health Analytics Inc. All Rights Reserved. 8 Overall Cost per Admission – By Hospital Cost per Admission On an individual hospital Actual to Expected Ratio basis, performance within -0.09 system was widely -0.07 Trend for Actual to Expected Results Over 12 Quarters dispersed for both System A -0.05 and System C—with System -0.03 (a lower slope is favorable) B showing somewhat -0.01 greater dispersion having 0.01 both the best and worst 0.03 performing hospitals among 0.05 the 15 individual hospitals 0.07 being compared. 0.09 1.40 1.35 1.30 1.25 1.20 1.15 1.10 1.05 1.00 0.95 0.90 Current Actual to Expected Ratio (a lower ratio is favorable) Blue axis show the experience for the average of the five Health Systems ©Truven Health Analytics Inc. All Rights Reserved. 9 Cost, Observations - Conclusions  Hospital system performance did not vary widely and did not change substantially over time  System C and System A were the best performing hospital systems E and B the weakest  Service line and overall cost performance were closely related  Hospital systems that were good cost performers overall tended to be good performers in 2 of the 3 individual service lines examined  System C showed strong cost performance overall and in all 3 lines of service ©Truven Health Analytics Inc. All Rights Reserved. 10 Quality ©Truven Health Analytics Inc. All Rights Reserved. 11 Quality Overview Quality Domains Patient safety events Complications of care  The overall performance for the patient safety event rate and complications was reported by hospital system, individual hospital and service line  Performance for the 3 specific patient safety indicators (PSIs) listed below were reported by hospital system and hospital  Pressure Ulcers  Death among surgical patients with serious treatable complications  Postoperative pulmonary emboli or deep vein thromboses (i.e. clots) ©Truven Health Analytics Inc. All Rights Reserved. 12 Quality, Complications ©Truven Health Analytics Inc. All Rights Reserved. 13 Overall Complication Rate Overall Complication Rate  Systems B and D were Actual to Expected Ratio the strongest hospitals in Health System A + Health System B Health System C Health System D Health System E this quality domain and -0.09 the only 2 hospital -0.07 Trend for Actual to Expected Results Over 12 Quarters systems to have an -0.05 overall complication rate (a lower slope is favorable) -0.03 lower than expected. -0.01  System E was the 0.01 weakest performer by far 0.03 0.05 with a complication rate 0.07 almost 20% higher than 0.09 expected. 1.30 1.25 1.20 1.15 1.10 1.05 1.00 0.95 0.90 Current Actual to Expected Ratio (a lower ratio is favorable) ©Truven Health Analytics Inc. All Rights Reserved. 14 Complications, General Surgery – By System Complications General Surgery 2013 Results 1.40 1.24 1.20 1.16 1.09 1.03 1.00 0.84 0.80 0.60 0.40 0.20 0.00 Health System A Health System B Health System C Health System D Health System E While there was a strong correlation between service line performance and overall performance, this was particularly pronounced for General Surgery. As was the case across all service lines, B and D systems were the top performers. ©Truven Health Analytics Inc. All Rights Reserved. 15 Complications, Medicine – By System Complications Medicine 2013 Results 1.40 1.19 1.20 1.11 1.00 0.88 0.76 0.78 0.80 0.60 0.40 0.20 0.00 Health System A Health System B Health System C Health System D Health System E It is noteworthy that this service line was the only service line where System C, an at best middle of the pack performer overall and in other service lines, shows excellent results. ©Truven Health Analytics Inc. All Rights Reserved. 16 Complications, Orthopedics – By System Complications Orthopedics 2013 Results 1.40 1.20 1.20 1.07 1.01 1.00 0.79 0.80 0.68 0.60 0.40 0.20 0.00 Health System A Health System B Health System C Health System D Health System E System B was the leader in this quality domain for this service line. ©Truven Health Analytics Inc. All Rights Reserved. 17 Complications, Further Analyses  Subsequent to the initial presentation of results Truven Health examined the relationship between cost and quality, providing some statistical analysis of the results  There was a weak negative correlation between cost and quality performance (r=-.33), hospitals that performed somewhat better in the cost domain performed somewhat worse in the quality domain Cost and Quality Performance Comparison by Hospital System 1.40 1.20 1.00 0.80 Complications 0.60 Cost 0.40 0.20 0.00 Health system A Health system B Health system C Health system D Health system E ©Truven Health Analytics Inc. All Rights Reserved. 18 Quality, Patient Safety Events ©Truven Health Analytics Inc. All Rights Reserved. 19 Overall Patient Safety Event Rate Overall Pt. Safety Event Rate Actual to Expected Ratio Health System A + Health System B Health System C Health System D Health System E  There was a strong correlation between the -0.10 overall patient safety -0.08 Trend for Actual to Expected Results Over 12 Quarters event rate and the -0.06 complication rate -0.04 (a lower slope is favorable) -0.02 (previous section). 0.00 Systems B and D are the 0.02 frontrunners and 0.04 Systems A and E the 0.06 weakest. 0.08 0.10 1.40 1.30 1.20 1.10 1.00 0.90 0.80 0.70 0.60 Current Actual to Expected Ratio (a lower ratio is favorable) ©Truven Health Analytics Inc. All Rights Reserved. 20 Patient Safety Event Rate, General Surgery – By System Pt Safety Events General Surgery 2013 Results 1.40 1.33 1.32 1.20 1.04 1.05 1.00 0.80 0.64 0.60 0.40 0.20 0.00 Health System A Health System B Health System C Health System D Health System E There is a strong correlation between overall performance and performance in this service line as well as with the complication rate. The hospital systems that performed well for patient safety for this service line were the same ones that had low complication rates. In both cases the System D was the top performer with System B and E also showing good results. ©Truven Health Analytics Inc. All Rights Reserved. 21 Patient Safety Event Rate, Medicine – By System Pt Safety Events Medicine 2013 Results 1.20 1.08 1.13 1.06 1.00 0.80 0.73 0.60 0.42 0.40 0.20 0.00 Health System A Health System B Health System C Health System D Health System E The General Medicine and Orthopedics service lines (see next slide) appear to be System C’s opportunity to stand out. As was the case for complications, it was the best performing hospital system for the General Medicine service line whereas elsewhere its performance was not exceptional. ©Truven Health Analytics Inc. All Rights Reserved. 22 Patient Safety Event Rate, Orthopedics – By System Pt Safety Events Orthopedics 2013 Results 1.20 1.12 1.00 0.77 0.79 0.80 0.69 0.60 0.40 0.21 0.20 0.00 Health System A Health System B Health System C Health System D Health System E System C was a strong performer across all 3 service lines ©Truven Health Analytics Inc. All Rights Reserved. 23 Quality, Patient Safety Events - Specific Safety Indicators ©Truven Health Analytics Inc. All Rights Reserved. 24 Quality, Patient Safety Events - Post Op Clotting* * Postoperative Pulmonary Embolism or Deep Vein Thrombosis Post Operative Pulmonary or Deep Vein Thrombosis Actual to Expected Ratio  There was a good Health System A + Health System B Health System C Health System D Health System E correlation between the 3 specific patient safety indicators and the overall patient safety event rate.  Consistent with this, System D was the top performer across all 3 measures and the C system the weakest performer.  All hospitals exceed expected performance levels for this measure. ©Truven Health Analytics Inc. All Rights Reserved. 25 Quality, Patient Safety Events - Pressure Ulcers Pressure Ulcer Actual to Expected Ratio  Again System D showed Health System A + Health System B Health System C Health System D Health System E the best performance in this area as well, far outdistancing the other systems.  They also had the greatest rate of improvement. ©Truven Health Analytics Inc. All Rights Reserved. 26 Quality, Patient Safety Events - Mortality* *Death among Surgical Inpatients w/Serious Treatable Complications Death among Surgical Inpatients w/Serious Treatable Complications Actual to Expected Ratio Health System A + Health System B Health System C Health System D Health System E  In general, performance was poor in this area compared to the adjusted national average. ©Truven Health Analytics Inc. All Rights Reserved. 27 Quality, Observations - Conclusions System A was a System B also showed System C was very consistently weak strong results inconsistent performer quality- wise,  Because this system  In the General Medicine showing high rates of experience was broken service line it had a lower complications and out by hospital we can than expected patient safety events see that in addition to complication and patient  Of particular note was showing good quality safety event rates the poor performance of results, it also showed  Overall patient mortality one of this systems less inter-hospital rate was very strong hospitals, it showed variation in performance  Elsewhere it showed weak performance for patient safety events and than the much more middle or lower complications overall as poorly performing performance well as across all service System A. lines greatly impacting the system results Health System A Health System B Health System C ©Truven Health Analytics Inc. All Rights Reserved. 28 Quality, Observations - Conclusions System D consistently While showing better showed excellent results in more areas performance in nearly all than the System A, quality areas, it was the System E, generally quality leader showed weak quality performance Health System D Health System E ©Truven Health Analytics Inc. All Rights Reserved. 29 Patient Satisfaction ©Truven Health Analytics Inc. All Rights Reserved. 30 Patient Satisfaction  The responses were to the question, “How do you rate the hospital overall?”  Responses are on a 1 to 10 scale, higher is better  Overall rate is the average score  The system specific, cross hospital rates are a straight, non-weighted average across the hospitals in each system  The satisfaction ratings of the individual hospitals within a system were consistent with respect to the rate of improvement  If the system as a whole was improving or deteriorating all of the individual hospitals tended to do likewise ©Truven Health Analytics Inc. All Rights Reserved. 31 Patient Satisfaction Health System Average Satisfaction 90 Health System A 85 Health System B 80 Health System C 78.89 78.22 76.67 Health System D 75 Health System E 70 Total US 65 2011 2012 2013  The satisfaction with the hospital systems was similar, the highest and lowest scoring hospitals were within 6% of each other and all were above the national average in 2013.  This was particularly true of the top performers. System A, B, and D scores were within 1 point of each other as the top performing hospitals.  With the exception of System A, all systems showed improvement over the 3 year period. ©Truven Health Analytics Inc. All Rights Reserved. 32 Satisfaction Observations - Conclusions  Satisfaction appears to be commodity-like at the system level  To the extent that differences do exist, the performance of System D and B were consistent with their strong performance in the quality area  The satisfaction ratings of the individual hospitals within a system were consistent with respect to the rate of improvement  If the system as a whole was improving or deteriorating all of the individual hospitals in that system tended to do likewise ©Truven Health Analytics Inc. All Rights Reserved. 33 Overall Conclusions  Cost and quality are not positively correlated  Higher quality performance does not predict lower cost  Quality was where hospital systems differentiated themselves  Hospitals were not widely separated by cost or satisfaction  System D shows consistent strength in all quality areas and was highly rated from a satisfaction stand point  While not the least expensive system on a case mix adjusted basis, it is in the middle of the pack cost-wise in a very tight market ©Truven Health Analytics Inc. All Rights Reserved. 34 What’s Next  Drawing conclusions from the data  Identify opportunities for improvement  Identify opportunities for the delivery of cost effective quality care  Develop baseline metrics  Identify on-going measurement strategy  Coordinate of communication  Work to align with benefits Remember this is not one and done this is a process ©Truven Health Analytics Inc. All Rights Reserved. 35 More than Data. Answers. ©Truven Health Analytics Inc. All Rights Reserved. 36
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