By: Dr. Timothy Brundage
Do you recall the days of being graded on a bell curve? Your grade didn’t necessarily depend on how well you knew the information and performed on a test, but rather on how you compared to your peers.
It occurred to me—after sensing nervousness from hospital administrators who watched their hospitals slip down industry ranking lists, such as U.S. News & World Report Best Hospitals—that these rankings are based on a similar curve.
According to the official announcement, “Prominent changes to the 2018-19 rankings methodology included more emphasis on patient outcomes and patient experience measures.”
You’ll never convince me that the well-respected hospital organizations that slipped down the list are no longer employing capable physicians who provide leading, high-quality care. That’s not it at all! Rather, the hospitals that top the list are focusing on CDI education, and thus documenting more effectively to support quality. The hospitals that rank lower aren’t performing worse than before—they’re just being outperformed on key metrics, such as mortality O/E.
Metrics and subsequent rankings are driven by how well your organization is documenting the entire patient tenure. If there is misalignment across the documentation spectrum, it will appear that you are underperforming, when that’s not the case at all.
Recent data—and personal observance—suggests that many programs within hospitals are designed for local vs. global optimization. For example, documentation teams are focused on optimizing the MS-DRG. Quality teams are focused on HACs (Hospital Acquired Conditions) and PSIs (Patient Safety Indicators). Utilization management teams are focused on documentation to support medical necessity. Each of these teams are effectively addressing the problems within their own space; however, they’re operating in silos. There needs to be a holistic strategy for the organization’s total performance, and each group needs to coordinate its efforts to contribute to that end.
If you’re not getting better, you’re falling behind—and you’re paying for it. There’s more urgency now than ever, as hospitals are facing a 1% penalty to revenue through CMS’s HAC reduction program. We can help! Keep up with the list leaders by keeping up with physician education, and get credit for the high-quality care you provide!