Georgia’s Flex Quality Program : CAHs Moving Toward Right Care Every Time

1. Georgia’s Flex Quality Program:CAHs Moving Toward Right Care Every Time March 23, 2011 Savannah, GA Lorna Martin, Patient Safety Specialist - Georgia Hospital Association Lewis Kelley, CEO – Chatuge Regional Hospital Dexter Shook, Risk Manager – Chatuge Regional Hospital CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

2. Flex at Work! CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

3. What Keeps Me Up at Night CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

4. Closing the Gap in Georgia CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

5. Georgia CAHs Gaining on National CAHs CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

6. Top 10 DRGs for CAHsQ3 2009 to Q2 2010 CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

7. CAH Core Measures Statistics Q3 2009 to Q2 2010 CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

8. CAH Ambulatory Surgery Counts CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

9. Benefits of HOP QDRP(Hospital Outpatient Quality Data Reporting Program) • Less elements to abstract than Inpatient measures • Easier to abstract • Three (3) of the measures are claims-based with NO abstraction required • Volume & impact CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

10. Benefits of HOP QDRP(Hospital Outpatient Quality Data Reporting Program) • Less time involved abstracting • One inpatient PN case takes approximately 45 minutes to complete • In the same amount of time you could get four HOP QDRP cases done CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

11. HOP QDRP Measures CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

12. Populations • Four populations: • AMI (OP-1, OP-2, OP-3, OP-4 and OP-5) • All AMIs transferred for coronary intervention and ICD-9-CM Codes found in Appendix A of the specifications • Chest Pain (OP-4 and OP-5) • All Chest Pains with ICD-9-CM Codes found in Appendix A of the specifications • Surgery (OP-6 and OP-7) • All surgical patients billed as outpatients (not as ASC) and CPT codes found in Appendix A of the specifications • Imaging Measure (OP-8, OP-9, OP-10 and OP-11) • Calculated from hospital Medicare fee-for-service claims data paid under the outpatient prospective payment system (OPPS). • Hospitals need not submit any additional data for the four imaging hospitals. CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

13. Where We Were US Averages • National = 84% Georgia Status • Average = 81% • CAH = 60%* “ALL or NONE” Right care every time for targeted core measures: AMI, CHF, PN CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

14. Getting There • Usual QI Activities • Data analysis • Tool kits • Shared learning opportunities • Mentoring program • External Peer Review CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

15. ACMs With the Lower Scores • PN2: Pneumococcal vaccine • Pneumonia patients, age 65 and older, who were screened for pneumococcal vaccine status and were administered the vaccine prior to discharge, if indicated • HF3: ACEI or ARB at discharge • Heart failure patients with left ventricular systolic dysfunction (LVSD) and without both angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) contraindications who are prescribed an ACEI or ARB at hospital discharge CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

16. Helpful Hints for PN2 • For PN2: pneumovac screening, go to the PHA resource page for the Immunization toolkit: • http://www.gha.org/pha/provider/toolkits/immunization/index1.asp • For PN2: pneumovac screening, go to the PHA resource page for the Core Measures Pneumonia toolkit: • http://www.gha.org/pha/provider/coremeasure/PN/index.asp CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

17. Helpful Hints for HF3 • For HF3: ACEI or ARB for LVSD go to the PHA resource page for the Core Measure Heart Failure toolkit: • http://www.gha.org/pha/provider/coremeasure/index.asp#HF3 CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

18. Innovative Techniques: You Can Get There From Here CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

19. I can’t let my neighbors beat me! Honor roll Name badges dots Quality awards Positive Public Recognition Punitive reports We don’t have to do this. CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

20. Lower Oconee Community Hospital Fall Protocol Revision (2009) Louis Smith Memorial HospitalImproving Patient Care through Technology: Implementing Teleradiology and PACS in a Critical Access Hospital(2006) Implementing an eMAR System in a Critical Access Hospital: Improving Medication Safety Through Technology(2009) Improving Patient Safety in Critical Access Hospitals and Long Term Care Facilities: Legacy Beds May Be Hazardous to Your Patients’ and Residents’ Health (2010) Monroe County HospitalCreating a Culture of Excellence to Promote Patient Safety (2006) Implementation of an Emergency Airway Management Program (2007) Implementation of a Successful Fall Prevention Program (2008) Recognizing CAHs Past CAH Patient Safety Award Winners (’02 – ‘10) Mountain Lakes Medical Center Development of a Data Driven Evidence-Based IV Insulin Protocol Requiring "No Mathematical Calculations“ (2005) Controlling Hypoglycemia in the Hospital: Revamping the Use of Subcutaneous Insulin (2008) Brooks County Hospital Improving Safety and Education Higgins General Hospital Implementation of Night Pharmacy (2003) Peach Regional Medical Center Medication Reconciliation in the Radiology Department (2007) Bacon County Health System Preventing Medication Errors by Promoting a "Culture of Safety“ (2002) CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

21. CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

22. Right Care Every Time Honor Roll CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

23. Can I publish my honor roll status? CEO engagement Reliability principles Trustee/ Physician education Quality liaison education HCFA (CMS): Public Mortality reports - the data are wrong! Reframing Quality data CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

24. Patients Not Receiving ACM “Right Care” Every Time CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

25. Vignettes from Dr. Resar Coaching Calls: Reliability Theory • Hospital related they had reached 100% compliance. Medical Director commented this was an “eye opening experience” for them. • During another Dr. Resar call, discussing the LVS assessment process, one hospital shared that they’d been at 100% for three months! CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

26. Moving Georgia to the Top TenGHA Strategic Board Initiative • Quality: Standing GHA Board Agenda Item • Communicated Board’s Action • Stepped Up Trustee and Physician Education • Increased Public Recognition • Increased CEO Engagement CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

27. Now, let’s hear from the real world… CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

28. Real World Tools CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

29. Real World Tools CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health

30. Real World Tools CAH Quality and Safety Improvement Network GHAREF FLEX In Collaboration With The Georgia State Office of Rural Health, a Division of the Department of Community Health