Why manual benchmarking hurts patients and hospitals.
Healthcare leaders and providers are heeding the call: Patients want more visibility into their care. As patients pay more for benefits and weigh their provider options, they desire detailed information to make decisions. This goes for all types of services, from outpatient to inpatient to post-acute care, be it in a skilled nursing facility or a home setting.
Recent CMS proposed rules seek to give them what they want: improved healthcare price transparency overall. While most industry conversations about transparency in healthcare focus on cost or payer benefit design, transparency of the quality of care is equally important.
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When hospitals release patients to post-acute care settings, they need to understand facility performance prior to discharge. By selecting the optimal facility with high-quality clinical outcomes and completing a successful transfer of care, the provider improves patients’ health and decreases costs for the entire system.
Yet a recent study suggested that when patients are discharged from a hospital, they often have no information about the post-acute care provider quality and no way to evaluate which facility is best for them. Many hospitals give nothing more to patients than lists of skilled nursing facilities based on zip code alone. Making decisions based on location, rather than quality, is hardly a recipe for successful clinical outcomes.
This situation is equally unfortunate for patients and hospitals, which have a financial stake in ensuring patient post-discharge care is top-quality to avoid being penalized for high readmission rates by CMS.
Some health systems have recognized the need to deliver holistic care that includes patient interactions with various specialists including post-acute providers. They develop proprietary scoring systems to evaluate skilled nursing facilities and home health companies before referring patients to them.
CMS also publishes rich data sets on more than 15,000 U.S. nursing homes and 11,000 home health agencies performance as they relate to quality, staffing, outcomes, penalties, patient satisfaction, ownership, and other provider attributes. This data can bring to light how each provider is doing over time as well as compared to others.
Benchmarking in a traditional, manual way is not only cumbersome and time-intensive, but it also leaves a lot of blind spots. For example, which peer group—national, state, county, the same-size facility or the same ownership—is the right one to select for comparison?
Within each peer group, one must select quantitative and qualitative metrics that will get meaningful and actionable insights. There are so many possible combinations that many useful insights are undoubtedly missed in manual benchmarking. Consider the complexity of evaluating how a nursing home or a home health agency is doing when the Nursing Home Compare database has 330 data attributes and the Home Health Compare has 92 attributes about processes, quality measures, and patient experience.
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Once the insights on certain measures are generated, one has to interpret them, which requires having relevant context, such as knowing where that provider stands on other, highly related measures. For instance:
Kaiser Foundation Hospital in Manteca, California, is one of only two nursing homes in all of San Joaquin County that doesn’t have any facility-reported incidents, substantiated complaints, fines, or payment denials. It also has the lowest total number of health deficiencies (zero) of the 26 nursing homes in the county. (Source: OnlyBoth, Inc.)
Let’s also add that healthcare facilities are living and breathing organisms, changing all the time, and so insights about their performance change throughout the year.
This is why manual benchmarking can no longer support the needs of the healthcare community. It’s not possible to achieve true performance transparency and motivate improvement without a complete assessment of various performance categories—an endeavor that can only be achieved with automation.
Automated software can explore a much larger space of possibilities than people, uncovering and expressing all sorts of comparative performance insights. Moreover, technology can deliver comprehensive, reliable, and repeatable comparisons as often as new data are available, thus enabling performance transparency previously unprecedented in healthcare. Automated benchmarking can also deliver a broad array of noteworthy insights written in shareable, precise English, instead of an overload of dry averages, diagrams, and dashboards.
Automated benchmarking gives hospital decision makers, including physicians and administrators, a deep understanding of a facility’s strengths and weaknesses as compared to other nursing homes and health agencies. Insights on a variety of attributes—particularly if they are expressed in simple English—enable providers to recommend facilities that can best meet the needs of specific patients and conditions.
Nursing home administrators can use automated benchmarking to proactively assess their own performance. Not only can a nursing home use these insights to allocate resources more effectively, it can share them with hospitals and potential patients as it seeks to become a preferred post-acute care provider for local health networks. Nursing home A would say it’s thriving in one specific area, compared to its competition; or nursing home C demonstrates these exceptional outcomes for a certain condition, compared to nursing homes D, E, and F, within 10 miles.
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Additionally, the growing baby boomer population has begun filling facility beds and will demand more and better care in the next decade. By 2029, the U.S. Census Bureau says, more than 20 percent of the total U.S. population will be above normal retirement age. As this group’s residential plans evolve in response to personal health challenges, these patients, too, will want to understand a facility’s performance and how choosing the right one is imperative to their short-term and long-term health. Potential residents are drawn to an apples-to-apples type of outlook, as opposed to a dry reporting of facts and figures lacking good context. With this new benchmarking data, they can even search for their “deal breaker” factors to determine which facilities to visit as well as what indicators warrant further investigation.
As healthcare continues to restructure care and payment models around value-based requirements, providers are rewarded for successful outcomes. Excellent research, planning, and communication are paramount, especially when hospitals are forced to discharge patients quickly. If providers and patients are to take thoughtful, informed actions, performance transparency of post-acute care facilities is a necessity.
Automated benchmarking uses the power of data aggregation and intelligent computerized analysis to answer the core questions necessary to make informed decisions: by comparing a target to peers to understand how that target is doing, where it could improve, and what is best in class.
The potential of this technology has broad scope: Consider applications of performance measures in hospitals, hospice, dialysis facilities, and other healthcare sectors. Various stakeholders can take advantage of comparison-based data to achieve their goals and meet the intense demands of the healthcare environment.
Raul Valdes-Perez, PhD, CEO, and Andre Lessa, CTO, are co-founders of OnlyBoth Inc., based in Pittsburgh, Pennsylvania.
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