September 19, 2012 Little River, SC NorthMyrtleBeachOnline.Com – The winner of the 2010 American Hospital Association (AHA) McKesson Quest for Quality Prize winner was McLeod Regional Medical Center in Florence, South Carolina. The award is not something to be taken lightly – the list of past and current recipients is prestigious and the criteria are seven pages long. It was not just a matter of filling out paperwork. Dick Tinsley, currently CEO of McLeod Loris/Seacoast, said recently, “The AHA did not make it easy. They sent a team on site and went through everything.”
Susan Pickle is the McLeod Corporate Associate Vice President for Quality and Safety and the very passionate voice for quality improvement. Pickle said, “Quality Improvement is the pursuit of doing things better than you are doing them today; pursuing perfection. I used to think that healthcare didn’t talk about pursuing perfection because it is a very human endeavor. There are so many variables in the pursuit of perfection [in healthcare], but it is just about the pursuit.”
On January 1, 2012, McLeod entered into a partnership with the Loris Healthcare System. Now Loris/Seacoast is continuing a trend of collaboration with McLeod on quality improvement that began in 2002. “The two centers and their boards have had a long focus on improvement and share the same desire for quality healthcare,” emphasized Pickle. With the new relationship, McLeod is incorporating their award winning Quality Improvement (QI) program into the Loris and Seacoast processes.
According to Tinsley, quality is the way McLeod seeks to distinguish themselves from their competitors. The 75 people who work in QI are corporate level employees, centralizing a program to provide a uniform approach to quality throughout all McLeod elements and enabling smaller McLeod medical units to tap into a large resource they could not afford on their own. The vast array of functional areas in McLeod QI is impressive - clinical improvement, operational improvement, operational effectiveness, service excellence, risk management, infection control, credentials, clinical outcomes and case management. Trying to cover all of these fields would be a daunting challenge for smaller hospital units.
Credentialing is a corporate level responsibility. “We know when we credential a doctor in Loris that [person] is the same quality as a doctor in as in Dillon, in Florence, in Darlington. Because for us, it is about when you come into a McLeod facility anywhere you are going to have the same high quality safe care by the physicians and the employees regardless of where you are,” said Pickle.
It all begins with the National Voluntary Hospital Reporting Initiative, a joint effort of the American Hospital Association, Federation of American Hospitals and the Association of American Medical Colleges. Data come from a lot of sources internal to McLeod – administrative, billing and information abstracted manually from charts. Pickle explained, “When a patient comes to the hospital they are assigned a certain number of billing codes that will tell us what was wrong with them, what was the diagnosis, what were the procedures and what was the final outcomes.”
Using that data, along with those other elements, QI compares McLeod’s performance to either local peers or to the performance of 600 not-for-profit hospitals. “Twice a year we compare our performance on mortality, readmissions, length of stay, complications and cost. Where we have the biggest gap between our performance and our peers, we will drill down in the data. Say there is a length of stay problem [with a particular infection]. We find out what kind of patients are we having compared to our peers. Are there particular doctors that had more than others? Is there a particular part of the county that is producing more of these types of patients? We really try to understand the data. Then we may find that we are not giving the medicine at a particular time and that would solve the problem.”
In the fourteen years since McLeod began its formal QI program, the quality improvement networks throughout the U.S. have vastly grown. “In the early days, we were looking at the literature for answers; calling other hospitals. Now that is pretty much out there.” McLeod can now tap into best practices at Premier Alliance, the Joint Commission, and the Hospital Quality Alliance among others.
The U.S. Government through the Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) drives some of the quest for quality improvement. Medicare and Medicaid Service reimbursements are tied to quality comparison. “We submit over 85 data elements to CMS and Medicare pays us on how good our data is compared to our peers. For example, let’s make this up. CMS says they will pay $5,000 for treatment of pneumonia. If your quality is better than our peers, CMS may pay $5,500. If it is worse, they pay $4,500. This is called value based purchasing. We are getting our first year of [value based purchasing], this year.”
While mortality data is extensively reported to CMS, hospitality mortality rates, which many consumers would like to see, are not publically available. “The reason you won’t see mortality rates [comparisons] right now is that mortality rates really need to be risk adjusted. Hospitals that care for higher acuity (seriously ill) patients would have a higher mortality rate. MUSC would probably have a higher mortality rate that would McLeod Regional. McLeod Regional would probably have a higher mortality rate than McLeod Loris because of the acuity of the patients. So to accurately reflect where a mortality rate is appropriate or expected or not, risk adjustments must be made. ” Some adjustments will have to be made because of geography. “We know that in the South, we are more uncomfortable with people dying at home, while in the North they prefer end of life care in their homes. There will be adjustments for access to medical care. In SC we have one doctor per 133 people, while in the Northeast its one doctor for every 100 people. ” By 2014, thoses things are expected to be worked out and mortality comparisons become part of Hospital Compare.
The consumer of healthcare services has at his disposal in SC the use of at least two sources, the Federal System Hospital Compare or My SC Hospital to review publically available statistics to make choices among hospitals. How reliable is the information since everything hinges upon self reporting? The data is generated and provided by the hospitals themselves. “CMS does validate our data. They have a number of different kinds of validation programs where we are required to send them our charts. They will go back and re-abstract our work – most of the data, about 80% - is manually abstracted from our charts. They will give us a set of specifications and definitions and we collected it and we report it.”
The coming year’s quality improvement priorities for McCloud are readmissions, emergency room wait times and patience satisfaction.