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Performance Monitoring and Dashboards for Monitoring and Dashboards for Hospitalists . ......

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  • Performance Monitoring and Dashboards for Hospitalists Leslie Flores MHA, SFHM April 29 and 30, 2014

  • Housekeeping

    Questions? Type them into the Questions box in the

    GoToWebinar panel on the right side of your screen at any time.

    We will wait and address questions at the end of the session.

    Copies of the slide set will be available via the CHMB website at www.chmbinc.com

    For questions, contact Lacey Buquet at [email protected]


    http://www.chmbinc.com/mailto:[email protected]

  • Leslie Flores MHA, SFHM

    Former hospital executive in Southern California

    Partner, Nelson Flores Hospital Medicine Consultants

    Advisor to the Society of Hospital Medicine for practice management issues


  • Agenda

    Why is it important to have a formal performance monitoring process?

    What types of metrics should you be measuring?

    Key data and analysis considerations

    Steps in developing a dashboard

    Sample reports and dashboards


  • Why Have a Dashboard, Report Card, Performance Report, etc.?

    Understand how youre performing Reduce variation Demonstrate value Identify trends External comparisons Reward good performance


  • Why Have a Dashboard, Report Card, Performance Report, etc.?

    To drive change Identify areas for improvement Hawthorne effect


  • Decide what to measure

    Set targets

    Generate and analyze reports

    Distill key indicators into a dashboard

    Develop an action plan

    Suggested Approach 7


    Take a Balanced Approach


  • Key Hospitalist Performance Domains

    Descriptive Metrics

    Work Effort and Productivity

    Clinical Quality

    Resource Management

    Service and Satisfaction



  • Quality


    Financial Service


    In Reality, Theres Lots of Overlap 10

  • Descriptive Metrics

    Not performance per se, but these metrics inform discussions about performance Volume

    Number and types of services Acuity

    CMI Top diagnoses or DRGs

    Payor mix


  • 12

  • Work Effort and Productivity

    Shifts worked per physician Number and type

    Clinical productivity Encounters and wRVUs Number of patients seen per shift

    Other work effort Committee meetings Academic work Performance improvement projects


  • 14

  • Management Reports RVU Metrics

  • Quality

    What to measure here is evolving quickly Hospital Value-Based Purchasing metrics

    Clinical Process of Care domain Heart failure discharge instructions Pneumonia initial antibiotic selection

    Patient Experience of Care domain Communication with doctors

    Outcome domain 30-day O/E mortality (AMI/HF/pneumonia)


  • Quality

    Readmission rates 72-hour

    Did focus on LOS management result in patients being discharged too early?

    30-day How good are care transitions and post-discharge follow-up?

    Other TJC core measures e.g. stroke core measures


  • 18

  • Quality

    Care transitions measures PCP notification of admissions and discharges Percent of patients with follow-up appointment

    scheduled prior to discharge Proportion of discharge summaries dictated or

    entered on the date of discharge Percent of time the discharge summary

    medication list matches that given to the patient


  • Quality

    Percent of patients with more than one attending hospitalist

    A measure of physician-patient continuity Compliance with order sets and pathways PQRS measures Percent of required VTE risk assessments

    performed on admission Percent of diabetes patients managed within

    target glucose range


  • 21

  • Resource Management

    Severity-adjusted ALOS Comparison to non-hospitalist peer group, external

    peer group (e.g., Premier, Crimson, etc.) or Medicare GMLOS

    Severity-adjusted average cost per discharge Major ancillary categories like imaging, clinical

    laboratory and pharmaceutical costs

    Avoidable/denied days as a percent of total days Utilization of consultants


  • Resource Management

    Patient flow variables ED admission notification to initial hospitalist order time

    ED admission notification to hospitalist in-person visit

    Time elapsed between ED call/page & hospitalist call-back

    Percent of discharge orders entered before 10:00 a.m.


  • 24

  • 25

  • Service and Satisfaction

    Citizenship Attendance at hospitalist group meetings Participation on hospital/medical staff committees

    and performance improvement initiatives Working extra shifts or otherwise helping out

    when needed Patient complaints Satisfaction surveys

    PCPs, ED physicians, specialists, nursing staff


  • Financial

    Hospitalist program cost center Performance to budget Financial support/stipend/loss per FTE

    Revenue cycle performance Charge capture rate and/or charge lag Total charges and collections by provider CPT code utilization Average net collections per wRVU Days in A/R Claim edits, rejection and denial rates PQRS performance


  • 28

    Source: Society of Hospital Medicines 2012 State of Hospital Medicine Report

  • Coding Intensity 30

  • Operational Reports - E&M Utilization

    Andrews, James Brandon, Kim Davidson, Tom Garcia, Fred Liget, Vicki Marnet, Stewart Rodriquez, Mary Thompson, Ed Wynn, David Yasini, Shabar

  • CPT Distribution 32

  • Management Reports Key Performance Indicators

  • Operational Reports Rejections and Denials Analysis



  • Understand Your Environment

    Each organization has a unique culture, goals, priorities, operational habits Terminology Analytical methods


  • Understand Data Sources and Limitations Common sources of data

    Hospital ADT, clinical, EHR, and financial systems Practice management and revenue cycle software Third-party data warehouses

    Premier, Crimson, Truven, UHC, CHMB Medicare data Third party survey data

    MGMA, AMGA, Sullivan Cotter, ECG, SHM


  • Understand Data Sources and Limitations

    Limitations Completeness and accuracy of inputs Reliability of reporting methodologies

    Attribution issues Availability and timeliness Sample size Sheer volume of data


  • Decide What Types of Analyses

    Individual vs. group? Snapshot vs. trend? Comparison to . . .

    Internal peer group? External peer group? Survey data? Established target?

    Statistical analysis options Average vs. median Arithmetic mean vs. geometric mean


  • The Problem of Attribution Which hospitalist? Hospitalist or consultant? Many metrics are best reported at the group level

    Mortality and readmission rates Some metrics best reported by admitting provider

    Initial antibiotic selection for pneumonia Some metrics best reported by discharging physician

    HF discharge instructions Some practices allocate credit based on the proportion

    of days each hospitalist cared for the patient Patient satisfaction or LOS


  • Blinded or Un-blinded?

    Usually best to present performance data about individual hospitalists un-blinded


    Each doctor sees every other doctors wRVU reports with names attached

    Note: where attribution is an issue, its usually better to blind the data or report it at the group level


  • What To Do With All This Information?

    High-level assessment Is this a plausible representation?

    What does this information mean for your practice? Opportunities for improvement Is the information actionable?

    Distill key metrics into a dashboard or report card




  • Creating Your Dashboard 44

  • Steps in Creating Your Dashboard

    Choose Dashboard Metrics

    Of all the information available to you, which few metrics should be presented in the monthly dashboard?

    Set Performance Targets

    Who/what is the comparison group? What is the range of acceptable performance?

    Design Dashboard Format

    How often will the dashboard be distributed? How best to show performance against targets?

    Assign Responsibility

    Who is responsible for producing source data? Who is responsible for preparing and distributing the monthly dashboard? Who is responsible for following up?


  • Creating a Dashboard

    Pick a handful of key indicators (10 15) Important to hospitalists AND stakeholders Readily measurable Consistently available Seen as valid Actionable


  • Creating a Dashboard

    Make it simple, short and attractive Show results graphically where possible

    Ensure the dashboard is regularly produced Routinely distributed to all hospitalists and key

    stakeholders Push vs. pull


  • Just Do It!

    Precise metrics and format are important but the most important thing is to have a dashboard And that it is updated and distributed regularly

    Dont let uncertainty about metric

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