Never before has the value proposition behind IT investments in health care been so important. A performance-based reimbursement landscape requires IT infrastructures that contain costs and boost quality.
Three metrics in Title III of the 2010 Affordable Care Act -- value-based purchasing, the Hospital Readmissions Reduction Program and hospital acquired medical conditions -- establish a new paradigm for reimbursement at the federal level, where health care organizations must compete for a piece of the pie. This helps to ensure government is reimbursing for the best care available, but the smallest quality gap or error could impact a hospital’s performance ranking and, subsequently, payment. Competition will likely get more intense if only those with perfect scores reap the benefits.
During fiscal 2013, for example, hospitals must score a 93 percent on compliance with value-based purchasing measures to receive an average ranking. Frequently, a score of 100 percent is needed to rise to the top. In the first year of the Hospital Readmissions Reduction Program, 65.5 percent of 3,400 facilities were penalized, incurring $280 million in fees. Title III initiatives are slated to expand and escalate, and private health insurers are beginning to follow suit.
Simply put, much is at stake for health care providers and there is little room for error. To meet the aggressive quality and cost metrics, IT infrastructures that are supported by clinical decision support applications and drive standardization of industry best practices must become a priority. Leveraging limited budget resources will depend on the way health care facilities use clinical decision support technology. That includes tailoring treatment plans for a specific patient and doctor through a combination of CDS tools -- including data-driven alerts, filtered referential information, order sets for specific diagnoses, care plans, surveillance technology and smart documentation forms.
Deploying electronic medical records is a critical first step in the evolution of health IT, but the reach of clinical decision support in these applications is limited. EMR applications can provide real-time alerts at the point of care, but most are not equipped to consider broader contextual data related to a specific patient. The result is alert fatigue -- when physicians become desensitized to a barrage of notifications that seem irrelevant to their patients or workflow. Advanced applications can customize alerts.
Studies from market research firms such as KLAS suggest providers view online evidence-based order sets as one of the most effective CDS tools for standardizing clinical practices. By providing physicians step-by-step guidance based on the latest evidence, these tools guard against oversights and unnecessary steps. FHN Memorial Hospital, a 172-bed facility in Illinois, reported order set technology generated significant returns -- $1.1 million over five years -- and improved quality metrics for key areas, such as acute myocardial infarction, heart failure, pneumonia, mortality and outpatient surgical compliance.
Rules-based surveillance technology also will play a critical role in maximizing big data in health care -- drawing from a wealth of patient information that can deliver clinical intelligence. Combined with other CDS applications, the technology enables aggregation of patient data and real-time monitoring of care in compliance with performance metrics.
In one example, West Florida Hospital, a 531-bed acute care facility in Pensacola, doubled pharmacy-driven interventions to avoid adverse medication reactions through surveillance technology. By establishing monitoring rules around areas in need of improvement, the hospital improved care delivery and saved $18,000 per month through dosing adjustments and antibiotic-related interventions alone.
All federal and private pay-for-performance initiatives point to the need for greater emphasis on hospital performance. By building clinical knowledge management systems that leverage point-of-care decision support, rules-based surveillance technology and comprehensive reference tools, health care providers can identify and correct potential patient care issues. A well-thought-out strategy will ensure patients receive the best care possible -- every time.
Dr. Linda R. Peitzman is chief medical officer and executive vice president of clinical development and informatics at Wolters Kluwer Health, a provider of educational and resource products for health care professionals.