Comparative Data AnalyticsOffice of Performance Improvement

Anne Park

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MD Anderson Cancer Care Patient Care

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Clinical Activities FY08 FY12 % of Change

Hospital Admissions 22,194 26,726 20%

Hospital Patient Days 167,451 191,735 15%

Average Number of Hospitals Beds 510 616 21%

Outpatient Clinic Visits, Treatments, Procedures 965,248 1,281,498 33%

Pathology/Laboratory Medicine Procedures 9,221,298 11,619,591 26%

Diagnostic Imaging Procedures 479,146 497,660 4%

Surgery Hour 57,308 66,241 16%

Total Active Clinical Research Protocols 1,108 1,078 -3%

MD Anderson is accredited by the Joint Commission, an organization that ensures patients receive the best and safest health care possible.

The nursing program holds Magnet Nursing Services Recognition status from the American Nurses Credentialing Center.

For ten of the past 12 years, including 2013, MD Anderson has ranked No. 1 in cancer care in the “Best Hospitals” survey published by U.S. News & World Report.

MD Anderson provided $212 million in uncompensated care to Texans with cancer in FY12. This figure includes unreimbursed costs of care for patients who either have no insurance or are underinsured, or whose care was not fully covered by government-sponsored health programs.

The new Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Care Therapy will be an international center of clinical excellence focusing on using the latest advances in genetic testing to develop safer, more effective treatments for patients on a case-by-case basis.

Office of Performance Improvement

Clinical Operations Informatics:Clinical Operations informatics, which is part of Office of Performance Improvement, provides accurate and actionable process and outcome data, including dashboards, reports, external reporting and benchmarking capability. Our team uses the patient-centric Enterprise Information Warehouse (EIW) as well as other internal and external data sources to provide data analyses and research to provide reports, analysis and other information for patient care, research and operational decision making.

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Performance Metrics

Rapid Quality Reporting System (RQRS) The Joint Commission’s Core Measures (AMI, HF,

SCIP, PN) National Surgical Quality Improvement Projects

(NSQIP) Measures Ongoing Professional Profile Evaluation (OPPE) Press Ganey Patient Satisfaction Survey Comprehensive Cancer Center Consortium

Initiatives (C4QI) The Joint Commission (TJC) Core Measures &

National Patient Safety Goals (NPSG) Physician Quality Reporting & Value Based

Payment Modifier (PQRS) Value Base Purchasing (VBP)

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Economic of Healthcare

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$36 Billons$1,223 Billons

Top 1% spent >20% of spending ($275 billions)

Top 5% spent >50% of spending ($623 billions)

Bottom 50% spent 2.9% of spending ($36 billions)

What to do about it?

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“Top-line” revenue

enhancement of complex

cases for fee for services

patients (medical tourism:

international & out of state)

bottom line cost control by

eliminate waste & improve

operation efficiency (evidence

base practice, standardizatio

n, and benchmark)

FUTURE

PAST

About UHC

Member-owned alliance of more than 95% of the nation’s nonprofit AMCs and their affiliates

Started by AMCs in the 1984

UHC provides comparative databases, associated services, a Group Purchasing Organization, and networking opportunities

Specific competencies in comparative data, performance improvement, networking, supply chain, and revenue enhancement

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General Members Teaching hospitals and community affiliates of principal members

Principal Members Academic Medical Centers (AMCs)

Many of the participating hospitals submits outpatient discharges

2014 Integrated Academic Medical Center: Principal Members

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What is CDB/RM?

Clinical Data Base (CDB)Web tool that participating hospitals can benchmark openly with other hospitals by accessing transparent, web-enabled database Comparison of risk-adjusted outcomes for LOS, Mortality, and Cost

Goal: Performance Improvement

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Resource Manager (RM)Line item charge detail Seven key categories: Accommodation, Blood, Imaging, Lab, Med Surgical Supply, Pharmacy, & Cardiovascular

Goal: identify trends/patterns, connect usage with outcomes, advance cost management initiatives

CDB is the foundation Patient Level (demographics, diagnoses, procedures, outcomes) Aggregated transactions (defined by revenue code groupings) Contains all transactions

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Similarities/Differences between CDB and CRM

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RM enhances CDB’s foundationCharge Codes (Master Files)Detailed transactions (guided by revenue codes by identified but descriptions)Filters include only high impact transactions in most areas including pharmacyPharmacy is the exception –more extensive list

Risk Adjustment

Accounting for patient-related attributes, such as age, gender, or pre-existing conditions, so that comparison of health care measures among hospitals seeing different mixes of patients is as fair and meaningful as possible.

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Benchmarking & Quality ImprovementTo provide patient level predictions that can be compared with other similar patients (expected values)

To provide aggregate level predictions that can be compared with other hospital aggregations (observed / expected ratio)

What can we do?

Review individual patients

Case counts and look-ups by: condition, procedure, physician, PSI, HAC, etc.

Compare results within and across hospitals - How are we doing? - Who’s doing it better? Can we learn from them? - ‘But our patients are sicker’

Identify improvement opportunities - Process and Performance- Documentation and Coding

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LOS, Mortality, and Direct Cost Indices

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Clinical Practice

Coding and

Documen-

tation

Decrease Observed Value

Increase Expected Value

2013 to 2014 US News and World Report: Top 20 Hospitals for Cancer Care

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Vitals in Performance Tool (VIP)

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Quality and Safety Management Report (QSMR)

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CC/MCC Capture Rate

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Make It Actionable

Determine key areas with high impact, value, and relevance and focus

Change metrics with the changing times & improved performance

Ensure focus areas are within the scope of influence

Provide constructive feedback

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References

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References

Anne Park, Sr. Business Systems Analyst at akpark@mdanderson.org or 713.745.4817