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The Impact of Pneumonia Core Measure Scores on Value Based Purchasing Financial Outcomes

Explore strategies to boost pneumonia care compliance, tackle barriers, and drive revenue in value-based purchasing systems. Strategies include improving core measure compliance, implementing interventions, and overcoming challenges.

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The Impact of Pneumonia Core Measure Scores on Value Based Purchasing Financial Outcomes

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  1. The Impact of Pneumonia Core Measure Scores on Value Based Purchasing Financial Outcomes Presented by Brenda Lee, MSN,RN

  2. Why are we focused on Pneumonia? • In FY 2010, UTHSCT compliance with the all-or-none bundle pneumonia core measure set was 85% - 20th percentile ranking (July 9, 2009 – June 30, 2010). • Value Based Purchasing Score decreasing from 83 to 23 for all core measures. Pneumonia measures are being dropped in the areas we are 100%.

  3. Pneumonia: Setting a Goal

  4. AIM Statement Improve compliance to 100% for all Pneumonia evidenced based performance measures by June 2011.

  5. Pneumonia: Building the Team • Physicians/Inpatient Nurses • ED Medical Director/ED Physicians/ED Nurses • Internal Medicine Physicians • Pharmacists • Quality Staff

  6. Pneumonia: Measuring the Problem 34 RFI’s Total

  7. Pneumonia: Interventions • Revise Pulmonary Order Set (prior separate) • Revise Physician Discharge Instruction Set • Design Concurrent Review Checklist for nursing • Present core measure compliance data to staff and physicians (committee/dept level) • Printed off booklets for medical staff and made download available • Nursing/MD staff educational program/in-services

  8. Pneumonia: Interventions • Address physician concerns per CDC Guidelines regarding administration of immunizations • Revise immunization protocol to align with CDC; dropping physician order to not administer as an option • Administer immunizations prior to discharge for all patients as appropriate – JUST GIVE IT!

  9. Pneumonia: Barriers • Current form approval process hindered “pilot” of forms and created delay in changes • Physicians outside of team wanted a separate order set for Pneumonia patients • Nursing did not want to perform concurrent review documentation – additional work

  10. Pneumonia: Interventions • Create Pneumonia Order Set • Adjust admission initial nursing assessment form to incorporate core measure requirements • Create a “pilot” plan utilizing next 5 patients with hospitalist admissions only • Post laminated Pneumonia Core Measure Antibiotic selection sheet as reference

  11. Results

  12. REVENUE ENHANCEMENT

  13. Pneumonia: Conclusions and Next Steps • An order set and forms revisions “pilot” process is instrumental for rapid cycle change • Continue to provide feedback as cases “fall out” as soon as identified (trending) • Implement aggressive campaign with medical and nursing staff for Influenza Vaccination • Continue study to determine if order set contributes to decrease LOS and cost of care

  14. Questions?

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