Capacity and Workforce Management

Drive Compliance with Clinical Quality Measures

7 essentials for improving performance on clinical measures

More than ever, the quality of care your patients receive is tied to reimbursement. Hospital-acquired infections (HAIs) will cost you money, as will preventable readmissions within 30 days for certain conditions. Based on nationwide experience to date, federal value-based purchasing bonuses are insufficient to overcome penalties. According to The Advisory Board Company1, the bar is only getting higher:

  • Readmission penalties reached their maximum in 2015 at 3% of all Medicare discharge revenue. The Centers for Medicare & Medicaid Services (CMS) estimates 2,666 hospitals will have their base operating diagnosis-related group (DRG) payments reduced by their proxy FY2016 hospital-specific readmissions adjustment, resulting in approximately $420 million in payment reduction
  • HAI penalties of 1% of total Medicare inpatient payments were levied against the worst-performing quartile of hospitals in FY2015. CMS estimates 807 hospitals would be subject to the 1% reduction in 2016
  • Care process measures comprised 70% of quality measures in 2013. Beginning in FY2016 compliance for all measures is based on outcomes, patient satisfaction and patient safety

Improve Clinical Quality Measure Scores and Lower Risk

Patient throughput and average length of stay (ALOS) are often proxies for care delays and quality lapses. Any lapse in quality can lead to longer lengths of stay, which can drive up cost and compromise patient outcomes.

You can't eliminate complications and outliers, but quality is largely about preventing care delays and ensuring nothing is missed or overdue—especially for patients with complex care needs. Visual controls can help reduce the risk of quality and safety lapses:

  • Color-coded icons help clinicians quickly identify isolation patients, fall risks and other patient safety concerns
  • Flashing timers can be used to indicate when a patient needs to be turned and to drive real-time compliance with core measure steps by telling clinicians whether they are carrying out required protocols within required limits

When patients with specific conditions are flagged using visual controls, case managers and quality directors can quickly identify these and other at-risk patients across your enterprise. And while managing preventable readmissions is extremely complex, patients who are actual or potential readmission risks can be identified and managed using custom views to ensure they receive tightly coordinated care and discharge planning.

Balance Workloads to Help Meet Clinical Quality Measures

Patient acuity can vary widely on any given unit and can change dramatically from shift to shift. Without translating acuity into workload requirements, staff assignments on the unit can range from light to heavy. Inequitable staffing assignments can impact staff satisfaction, patient satisfaction, productivity, patient safety and care quality.

Balancing workloads is essential to ensuring appropriate staffing levels and mitigating quality risks. By feeding objective patient assessment data into an acuity system, equitable staffing recommendations can be calculated based on skill mix, credentials and regulatory requirements. These targets can then be updated in the staffing and scheduling system and used by managers to flex their staffing as needed.

Learn how the ANSOS One-Staff™ Assignment and Workload Manager module helps enable managers to anticipate workload conditions and make equitable staffing assignments.