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West Virginia Health Care Authority
Quality and Utilization Advisory Group
Summary of Work and Recommendations for Plan Development
Prepared by:
Marsha L. Boggess
Organization Performance Initiatives, Inc.
P.O. Box 11254
Charleston, West Virginia 25339
TABLE OF CONTENTS
I. Introduction
II. The Quality and Utilization Advisory Group Plan
III. Recommended Approach To Plan Development
IV. Recommendations
V. Conclusion
VI. Attachments
INTRODUCTION
In 1997, the West Virginia Legislature passed Senate Bill 458, directing the
Health Care Authority (HCA) to establish a Utilization Review and Quality
Assurance Program. The purpose of this program was to avoid unnecessary
or inappropriate utilization of health care services and to ensure high quality
health care in the state. To achieve this objective, the Bill provided
for the:
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(a) Coordination of the Utilization Review and
Quality Assurance Program with peer review programs presently established in
state agencies, hospital services and health services corporations, hospitals
or other organizations; |
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(b) Monitoring of problem areas, imposition of
sanctions and provision of incentives as necessary to ensure high quality and
appropriate services; and |
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(c) Establishment of a Quality Assurance Advisory
Group to facilitate program development. |
In response to this directive, the HCA established a Quality and Utilization
Advisory Group comprised of physicians, managed care leaders, hospital
executives, advocacy groups, legislators, public health directors, state agency
leaders and consumers. The group was selected based upon their experience
and demonstrated leadership in the West Virginia health care delivery system
and their perceived ability to provide continued leadership to achieve the
objectives set forth by Senate Bill 458.
Responding to the Directive: The Process
On April 20, 1999, the Quality and Utilization Advisory Group (QUAG) first met
to review their mission and goals and to formulate a high level plan to pursue
the desired outcomes of Senate Bill 458 (Attachment I). The diversity of
backgrounds, experiences and vantage points of the QUAG incited highly
interactive and spirited discussion as the group processed through the broad
scope and difficulty of the task before them. The strategy for approaching the
work was to divide the QUAG in to three sub-teams with a focus that mirrored
the legislation: Necessity of Admissions, Quality of Care, and Length of
Stay. At the conclusion of the initial kick-off session on April 20,
members of the QUAG provided the staff of the West Virginia Health Care
Authority with an indication of interest regarding personal participation on
one or more sub-teams. The staff of HCA reviewed the information provided
and the three sub-teams were formed, providing QUAG members with an opportunity
to participate on one or more of the sub-teams. The three sub-teams were
given a charter (Attachment II) and met in a facilitated forum to develop
recommendations to the full QUAG regarding how the QUAG should approach
fulfilling the mission of Senate Bill 458. Participation by the QUAG
members on the sub-teams was high and very interactive. The format for the
recommendations was structured to address the following topics and questions.
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What Questions Do We Propose to Answer? |
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What Issues If Addressed Would Be of Greatest
Interest and Have the Greatest Impact in West Virginia? |
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What Should Be the Scope of the Effort to Address
These Issues? |
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What Should Be the High Level Approach to Addressing
These Issues? |
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What Are the Proposed Steps That Are Needed to Move
Forward? |
Meeting notices and minutes from sub-team meetings were posted on the HCA
website and all QUAG members were invited to comment.
The full QUAG met on July 29, 1999 to review and comment on the work of the
sub-teams. (Attachment III) From this meeting a number of common
themes evolved, giving the participants and staff of HCA a potential framework
for addressing the challenges set forth in Senate Bill 458. This QUAG
forum provided valuable input to the West Virginia Health Care Authority as
they prepared the following plan recommendations.
THE QUALITY AND UTILIZATION ADVISORY GROUP PLAN
MISSION:
The mission of the Quality and Utilization Advisory Group is set forth in Senate
Bill 458: to develop a plan to avoid unnecessary or inappropriate
utilization of health care services and to ensure high quality health
care.
This mission is consistent with the proposed State Health Plan and supports the
mission of many of the health care programs and grants in both the public and
private sectors. This consistency of purpose provides a foundation
for achieving results through a strategy of coordination, an approach supported
by the words of the Bill, "The Board shall coordinate this program with
utilization review and peer review programs presently established in state
agencies, hospital services and health service organizations, hospitals or
other organizations."
GOALS:
From the Mission the following goals were developed and adopted by the HCA and
the QUAG:
1. Establish a Quality Advisory Group.
2. Establish a Utilization Review and Quality Assurance Program.
3. Coordinate the Project with Established Utilization and Quality Programs.
4. Develop a Plan for the Review of Key Program Attributes.
5. Monitor Identification of Program Areas.
6. Ensure High Quality and Appropriate Services and Utilization through
Incentives/Sanctions.
A phased approach to goal achievement was adopted, with an initial focus on
developing an approach to program development.
KEY QUAG DISCUSSION POINTS AND COMMON THEMES:
In the QUAG sessions as well as the small sub-team meetings, participants
identified and discussed the broad scope of the Bill, often searching for
additional guidance relative to legislative intent. The participants also
recognized that addressing the issues of quality and utilization posed a
difficult challenge, but accepting such challenge represented purposeful work
critical to the residents of the state. The QUAG recognized the various
vantage points of those involved in understanding and influencing healthcare
service delivery in the state and the need for buy-in to system changes as
appropriate.
To proceed with an effort to address quality and utilization, a number of key
ideas were identified, discussed and reinforced in small and large group
discussion:
1. The outcomes must clearly be defined within the standards of health care.
2. Mechanisms must be in place to measure and report outcomes.
3. The program must establish clear roles for those involved and impacted by
recommendations, achieve buy-in from those involved and have identifiable
consequences.
4. The challenges of health care delivery in West Virginia, including access to
care must be incorporated as information is analyzed and recommendations for
change are made.
5. Improvement initiatives should be focused on areas that are important to
West Virginians.
6. Cost must be incorporated in the focus on quality.
7. Perhaps length of stay and necessity of admissions should not be separate
and distinct focus areas, but should instead be addressed within the penumbra
of quality.
8. A plan to address health care quality and utilization must be developed
using a phased approach.
RECOMMENDED APPROACH TO PLAN DEVELOPMENT
Based upon the input received from the Quality and Utilization Advisory Group,
The West Virginia Health Care Authority recommends the Program be developed and
implemented in five (5) phases:
Phase I: Identification of Quality Indicators and Benchmarking of Other State
Programs
Phase II: Design of Systems for Data Collection and Analysis
Phase III: Data Analysis and Reporting
Phase IV: Development of Targets and Benchmarks, Measurement Systems and
Improvement Initiatives
Phase V: Development of a system for incentives and sanctions in support of
quality improvement and reporting initiatives.
The overall approach to Program development centers around the following
strategies:
Adopt a narrow focus in the beginning, and expand that focus as the
program gains experience and success.
Initially build on existing quality efforts within the state, then
expand to new initiatives based upon need and impact within West Virginia.
Define quality of care as inclusive of important indicators of
utilization such as length of stay and necessity of admissions.
Consider cost when evaluating current practices around the state and
developing new strategies for improvement.
Consider population based methodologies when developing programs.
In support of these strategies, the following program development
recommendations are made:
Recommendation 1:
Adopt a disease/injury state focus with an initial target of four key areas
that are important and can have the greatest impact in West Virginia. The
recommended areas for focus are:
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Diabetes |
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Cardiovascular Disease |
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Low Back Injury |
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End of Life |
These areas represent health concerns that are well documented as being
significant for West Virginia. In addition, each of these areas is being
addressed through other initiatives within the State and thus this strategy
represents a key opportunity for coordination of effort for enhanced results.
Action: Identify other focused initiatives in the state, and form a sub-team of
representatives of those initiatives to coordinate program structure, data
collection and reporting, and improvement interventions.
Recommendation 2:
Identify the Quality Indicators for the selected disease/injury states using
such resources as the HCUP Quality Indicators, HEDIS, JCAHO, NCQA, ORYX,
etc. Incorporate indicators on length of stay and necessity of
admissions as appropriate.
Action: Hire an HCA research associate to identify quality
indicators.
Recommendation 3:
Benchmark quality programs within other states to gain understanding of their
program outcomes and the strengths and difficulties of the process.
Action: Research associate will identify programs in other states and
sub-team of QUAG will review data from benchmarking efforts.
Recommendation 4:
Using selected quality indicators, design data collection systems and data
sources working in collaboration with:
Other West Virginia studies in progress, i.e. WV Disease Management Plan, WVMI,
West Virginia University, Marshall University, Bureau of Public Health, and
health insurance plans;
The database development initiatives of the Data Advisory Group;
State Health Plan Initiative; and
The CHRIS initiative in progress at HCA.
Action: Identify other quality initiatives within West Virginia focused on
the selected disease/injury states, and form a sub-team of
representatives from those initiatives; collaborate around data collection and
reporting.
Recommendation 5:
Establish a private/public partnership to:
Recommend quality standards and best practices.
Analyze and monitor quality data, and measure and report quality outcomes.
Design and implement quality improvement breakthrough projects and initiatives
to positively influence quality outcomes.
Engage in on-going benchmarking with other states to understand the problems
occurring in their quality systems and compare inpatient and outpatient
experiences.
Analyze existing West Virginia data to understand variations among facilities,
communities and high risk populations.
Identify and provide recommendations regarding high impact quality improvement
initiatives.
Action: Approach members of the QUAG regarding acceptance of a continuing
role. Add other key resources to achieve partnership profile.
Recommendation 6:
Using a population - based approach develop quality targets and benchmarks for
best practices, adopting a systems approach for measuring and improving
performance. The development of such targets and benchmarks should
consider:
Over-utilization of Services
Under-utilization of Services
Access to Services
Disparities of outcomes across communities, geographic areas, delivery systems
and heath issues
Costs associated with multiple strategies for target achievement
Healthy behaviors and practices
The initial focus of reporting should be population based versus provider based.
Action: Form task forces, with representation from all parties having
accountabilities within the system to recommend system targets and
benchmarks.
Recommendation 7:
Establish breakthrough quality groups to pursue quality improvement
Action: Form task forces, with representation from all parties having
accountabilities within the system, to review the processes associated with
achievement of outcomes, and make recommendations for improvement of such
processes and outcomes.
Recommendation 8:
Develop policies for incentives and sanctions that support data reporting and
quality improvement.
Action: HCA will lead an effort to formulate and implement specific
policies and plans. Such policies and plans should include the
development and adoption of quality standards, a provision for evaluating
provider performance, and a system of imposing sanctions when appropriate.
CONCLUSION
A continued focus on health care quality and utilization of services is critical
to meet the clinical, financial, and health care accessibility needs of West
Virginia. This focus has been recognized as a critical need nationally
and has been included as a key initiative of the West Virginia State Health
Plan. Improvement of the current processes can best be achieved through
the collaboration of all participants within the delivery system. The
Health Care Authority continues to be well positioned to facilitate a
collaborative effort among all parties to understand and achieve desired
outcomes. The Health Care Authority is prepared to accept this role and
proceed with specific program development contingent upon appropriate resources
being available.
Attachment I
West Virginia Health Care Authority
Quality Utilization Advisory Group Meeting
April 20, 1999 Meeting Notes
Present: See attached list.
Welcome and Introduction
Parker Haddix, Chairman of the Health Care Authority and Chairman of the
Quality Utilization Advisory Group, called the meeting to order at 10:05 a.m.
Mr. Haddix extended his appreciation to those present, and then identified some
of the current Health Care Authority activities to include the State Health
Plan, Data Advisory Group, and Interagency Long Term Care Panel. Mr. Haddix
then introduced the meeting facilitator, Marsha Boggess with Organization
Performance Initiatives Corporation. Advisory Group members were then asked to
introduce themselves.
Review of Legislation
Parker Haddix reviewed the sections of West Virginia Senate Bill 458 that
created the Quality Utilization Advisory Group, and called for this effort to
not duplicate the efforts of other agencies and their activities. The purpose
of this legislation and proposed mission and goals are as follows:
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Legislative Purpose Senate Bill 458 §16-29B-23 |
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Utilization Review and quality assurance; quality
assurance advisory group. |
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a. In order to avoid unnecessary or inappropriate
utilization of health care services and to ensure high quality health care, the
board shall establish a utilization review and quality assurance program. The
board shall coordinate this program with utilization review and peer review
programs presently established in state agencies, hospital services and health
service corporations, hospitals or other organizations. |
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b. With the assistance of the above-mentioned entities, and after public
hearings, the board shall develop a plan for the review, on a sampling basis,
of the necessity of admissions, length of stay and quality of care rendered at
said hospitals. |
Mission
Avoid unnecessary or inappropriate utilization of health care services and to
ensure high quality health care.
Goals
1. Create a quality advisory group
2. Establish a Utilization Review and Quality Assurance Program
3. Coordinate the project with established utilization and quality programs
4. Develop a plan for the review of necessity of admissions, length of stay,
and quality of care
5. Monitor identification of program areas
6. Ensure high quality and appropriate services and utilization through
incentives/ sanctions
Discussion on Communication
Mr. Greg Morris, Health Care Authority Executive Director, asked the advisory
group members to complete the survey forms, asking for preferences for the
manner of ways to communicate with them (e-mail, fax, telephone, and mail).
Another means to communicate will involve the Quality Utilization and Advisory
Group website www.hcawv.org/quag. The process used by this advisory group will
parallel the activities for the Health Care Authority's Data Advisory Group,
since each has a similar size, contains membership of public/private/consumers,
and has had work groups to accomplish the work of the group. Each of the Data
Advisory Committee's four work groups: Access/Privacy; Components of an
Integrated Health Information System; Standards, and Public/Private
Partnerships. Each work group has developed recommendations. The activities of
the advisory group may be viewed at the following website: www.hcawv.org/dag.
Mr. Morris also indicated travel expenses associated with the Quality
Utilization Advisory Group may be reimbursed by the HCA.
Presentation by Dr. Mary Emmett
Dr. Mary Emmett, Director of the CAMCARE Institute Center for Health Services
and Outcomes Research, discussed "Quality Measurement: Where Have We Been and
Where We Are Going". Dr. Emmett's presentation provided information to develop
a context for discussing the topic of quality by providing an overview of those
developments that have and are influencing the approach, method and tools for
measurement of the past and future issues of quality of care. (The discussion
handout is attached.)
Presentation by Dr. George Pickett
Dr. George Pickett, Medical Director of the West Virginia Medical Institute
(WVMI), provided information on the WVMI's quality activities at the national
and state level. The WVMI was created in 1973 as an external peer review
organization. It was first named the Professional Standards Review
Organization, and reviewed the experiences of physicians and hospitals. This
process involved looking for outlyers outside of the normal, bell-shaped
curve.
By 1983 this external review and analysis shifted to the concept of quality
improvement. While the process still involved identifying and addressing
outlyers, it focused on the systems approach by using data and information to
analyze and examine hospitalization and professional practices. The process
involved using an epidemiological, population-based approach to look for
variations and determine possible reasons for their happening. In the context
of a systems review, problems are believed to be the result of issues within
the system, not the individual professional or hospital. The systemic review
has concern for the misappropriation of resources, as well as profiling
patterns of care and looking for variations in what is happening and looking
for clues as to why this might be happening.
Quality improvement includes a six-step process: topic identification, study
group, design, data collection, analysis and feedback. Dr. Pickett indicated
that it is very important to have data integrity. He stated that sophisticated
analytical tools may be used to develop patterns or to find aberrant patterns
and could be a fault of an internal program. Sometimes it takes a third party
intervention to determine "Are you doing as well as you want to do?" It becomes
a system issue, not individual performance issues. Professionals want to get
better and they want information on how to build systems.
Overview of Inventory
Cathy Chadwell, Co-Chair of the Quality Utilization and Assurance Advisory
Committee, discussed the quality assurance inventory. She reported that
committee members were asked to complete an inventory of their organization's
quality activities. The objective was to increase the awareness of current WV
and US quality/utilization activities. Of the 40 QUAG members who received the
survey, 26 responded, with 2 determined not to be applicable, and 12 did not
respond. The results were distributed at the meeting. No analysis has been
attempted at this time since it is considered a work-in-progress document.
Brainstorming and Sharing Information
Advisory Group members were asked to review the inventory and to determine if
other resources could be identified to also include in the inventory. Group
discussions identified several groups, including those that collect proprietary
information that may not be available for public use. Included in the
discussions were JCAHO, NCQA, HEDIS, and payor data sets, University of
Maryland Quality Indicator, OASIS-home care, external quality review, employer
data, (GE, Steel, Coal accounts). Other resources were identified and includes,
epidemiological, health ethics, analytical resources, college of pharmacy
(disease management), consumer representatives (are topic specific) NIOSH,
physician, community medicine, academic resources, medical society (by
specialty) HCFA-OSCAR, CDC, URAC, Picker Patient Satisfaction Surveys, WV
Quality Council, American Association of Health Plans, and the Kellogg
Foundation Community Voices Project.
Meeting Critique
A critique of the meeting indicated:
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(1) many quality resources are available; |
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(2) these resources could take much time to process;
and |
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(3) advisory groups'activities should follow the
mission and goals of the group. |
Comments from the group discussions included concerns about short time frames,
frustration experienced when information is requested by major funding sources
(Medicare/Medicaid), the relationship between this advisory group and the
quality issue in the State Health Plan, the availability of the Picker
Institute to profile hospital data, the planned roles for the advisory group
members, and the difficulties experienced in other states regarding quality
activities. A comment was made that this could be viewed as an opportunity to
accomplish what other states have not been able to do, because of the size of
the state.
To accomplish the goals for the advisory group, three subgroups will be
established. Each subgroup will develop recommendations for an approach to
developing a plan for reviewing the necessity of admissions, length of stay and
quality of care. Advisory Group members were asked to complete a questionnaire
to rank in order their preferences for participating on the subgroups. Each
subcommittee will have an organizational meeting by May 25, 1999.
Committee members found the meeting to be helpful, provided great speakers, was
well organized, provided an opportunity to see and meet others. Other members
expressed concern for the timetable and ambitions, the need for clearer
guidelines, the perceived lack of understanding of the legislative intent
creating the group, the hope that the group will not experience a blue ribbon
syndrome and the need for process agreements for the group.
Follow up activities:
Notes from sub-teams will be distributed to other sub-teams.
HCA staff will contact members to let people know of the subgroup they will
participate in and the meeting details.
Information will be posted on the website and by other means of communication.
Subcommittee meetings by May 25, 1999 (HCA staff and MB).
Closing Comments
Parker Haddix indicated that he was encouraged by the participation and
understanding of quality issues of the advisory group members, affirmed that
the mission of the Health Care Authority is to protect the people of West
Virginia, indicated the West Virginia legislature will be apprised of the
findings and activities of the advisory group, and requested members to provide
information of interest to the group. Mr. Haddix stated that there will be no
attempt to obtain proprietary information. He asked for the members to not be
discouraged by some of the information discussed that identified some barriers
and obstacles, but instead to focus on what can be accomplished by a group of
committed members to move forward to protect the people of the State of West
Virginia.
Meeting adjourned at 2:50 p.m.
Meeting handouts:
Membership List
Quality Assurance Inventory
Communication Preferences Survey
Dr. Emmett's discussion outline
GOAL:
Reformulate task to examine:
1. Appropriateness of intervention (sub census necessity of admissions)
2. Review of all elements of care (including cost, length of stays,
effectiveness, etc.) for episodes of care through the entire spectrum of care
Consider focus on areas such as:
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1) end of life care; |
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2) cardiac disease; and, |
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3) psych conditions. |
If variation found after research, this becomes area for education, etc.
Target date: December 1999
Responsible: Full-time researcher -West Virginia Health Care Authority in
collaboration with committee
Quality of Care Sub-Team Recommendations
Presentation by: James Forsythe, PhD, West Virginia Medical Institute
Through Whose "Eyes" Are We Looking At Quality?
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Consumer |
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Clinicians |
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Providers |
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Insurers/MCO's |
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Policy Makers |
What Is Quality of Care?
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Assurance - meet standards |
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Common quality standards |
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Improvement - beyond standards |
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Benchmark |
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Outcomes |
PT/Consumer satisfaction
Define Quality Indicators
What are other states doing?
What are the current standards of QOC for providers?
Standards for the state?
Can we integrate all of the standards?
Ideas on How to Begin Defining Quality of Care Indicators
Guidelines
JCAHO/NCQ/ORYX - HEDIS
Consumer priorities - obj - sub (satisfied)
Quality of life indicators ·
Data sources for "best practices"
Explore packaged programs to implement in state
Population - based data
QA - did you get the expected outcome? Was it an expected cost?
HCA's utilization data
Monitoring quality QA/QC
Leadership for QI?
Consumers Options?
How should system operate?
What kinds of questions/issues are addressed/redressed for consumer?
Consumer's confidentiality and privacy vs. demand for public accountability.
Regarding Approach to Development of a Plan for Review
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Phase I |
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Define quality indicators |
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Benchmarks |
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Other indicators developed through input from
perspective of acute care hospitals, and others as defined |
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Decide attention focus for greatest impact on West
Virginians |
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Phase II |
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Develop system and methodology to assess and report
quality (outcome and process) include: |
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Collect data |
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Analyze data |
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Carrots and sticks |
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Bridge to other programs |
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Phase III |
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Implement the program as designed |
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Breakthrough QOC improvement |
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Incremental/Iterative QOC improvement |
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Comments and Clarifications From Breakout Sessions
and Large Group Discussions |
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Regarding common quality standards; need to find at
least one. |
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Need to review existing guidelines regarding Quality
of Care. |
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Where do we find Quality of Care standards and can we
go beyond the existing standards? |
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Some Member Comments: |
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Early discharge from acute setting equals admissions
to SNF. |
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As public servants, we are not doing our jobs looking
at utilization just because it is a complicated issue doesn't mean we can
refuse to look at it. |
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"We realize that we must change the consumer
expectations." |
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Other Concepts and Ideas Captured: |
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1. Early discharges result in readmits |
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2. Universal coverage: ultimate solution |
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3. Utilization appropriateness |
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4. Customer satisfaction |
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Quality of Care Work Plan |
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Make recommendation(s) to the Legislature on how to
organize a comprehensive agency(s) to remove communication barriers and improve
quality of care and life in West Virginia. |
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1. Compare corporate organizational structure with
other states. |
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2. Draft organizational chart to meet desired goal |
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3. Include preventive care (cradle to grave
coordination) |
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4. Wherever or however we organize there must be an
education component with a substantial budget |
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5. Differentiate consumers of healthcare and
coordinate their services |
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6. Have a mechanism to review government agencies to
ensure they are meeting the ever-changing health environment |
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7. Consider a single point of entry for access to the
health care system (holistic approach) |
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8. Review work of committee (QOC) to make
recommendations based upon existing structure |
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9. What are the QOC issues effecting the delivery of
care: (i.e., lack of a single point of entry) |
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10. Expanded knowledge of all available programs |
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11. Educate the consumer on how to use the current
systems |
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12. "Forcing functions" to change behavior |
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a. reimbursement |
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b. have consumer be actual purchaser |
Length of Stay Sub-Team Report
Presentation: Dr. James Cogan, MD,
Cigna Healthcare
What Questions Do We Propose to Answer?
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1. Who makes the decision regarding the Length of
Stay? |
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2. What are the factors that influence the Length of
Stay? |
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3. What is the payment source? |
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4. What are the true medical indications (type of
problem and intensity)? |
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5. Does the threat of litigation influence the Length
of Stay? |
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6. What are the government regulations that shape or
impact the Length of Stay? |
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7. What are the West Virginia factors that might
influence the variations in Length of Stay, i.e. geography? |
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8. Are there other states with lower Lengths of Stay
or Best Practices that influence lower Lengths of Stay? |
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9. Are there best practices, which are formalized and
become the standard of care: |
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Risk models |
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Not-at-risk models (where outcomes justify lower
lengths of stay) |
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10. What is the appropriate Length of Stay? |
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11. Does competition impact Length of Stay? |
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12. What is the impact of the Balanced Budget Act on
Length of Stay? |
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13. How do consumers influence Length of Stay? |
What Issues Would Be of Greatest Interest and Have the Greatest Impact?
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1. End of Life inpatient days |
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2. Cardiovascular issues |
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3. Availability of discharge services |
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4. Patient Education services and how it is related
to a timely discharge |
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5. Impact of lifestyle and culture on admissions and
subsequent Length of Stay |
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6. Information on best practices for a few select
services |
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7. Hospital use of best practices (consider survey) |
Scope of the Length of Stay Effort
Approach should include review of:
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Availability of discharge services |
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Education of the patient regarding their condition or
health status |
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Determining best practices in use within WV as well
as outside WV |
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Impact of lifestyle and culture on admissions and
subsequent Length of Stay |
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Need for dissemination of information regarding best
practices |
Approach 1. Get physicians and hospitals involved
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What are they doing in this area? |
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2. Condense questions we are trying to answer |
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3. What information is out there regarding End of
Life and Cardiovascular including Oncology, Chronic Obstructive Pulmonary
Disease? |
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1. Face to face meetings with providers and
associations to communicate goals and objectives |
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2. Ask what agencies/providers are already doing in
measuring Length of Stay |
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3. Find out what programs the associations have in
place |
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4. Encourage participation by provider groups |
Condensing the Questions
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1. Define the problem and intensity |
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2. Factors that influence Length of Stay |
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Payment type |
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Litigation |
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Government |
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Geography/demographics |
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Competition |
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Hospital type |
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Medical indicators |
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3. Who should be making the decision |
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4. Best practices/appropriate Length of Stay |
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5. Consumerism |
Research
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1. Designate a research person |
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2. Focus on two targeted areas End of Life and
Cardiovascular |
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3. Literature search |
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A. General identification of major areas of concern
in West Virginia |
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B. Look for specific topics by DRG (especially where
West Virginia has greatest variances) |
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C. Evaluate/validate/weigh data |
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D. West Virginia/Regional/US benchmarking (outcomes
emphasis) |
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E. Recommendations (develop with
stakeholders/experts) |
Package, Communicate and On-Going Measurement
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A. Get consensus on 4/5 codes |
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B. Package/roll out |
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C. Publish/measure/report out |
Comments and Clarifications From Breakout Sessions and Large Group Discussions
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1. Will probably require a full-time research person
assigned to the task (perhaps HCA) in collaboration with community. |
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2. Consider focus on areas such as EOL care, CVD,
Psych. If variation found after research, then it becomes an area for
education. |
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3. Consider reformulating the task to: |
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Examine the appropriateness of intervention and
subsume NOA |
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Review of all elements of care (include cost, LOS,
effectiveness, etc.) |
Some Member Comments:
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1. "The responsibility of the hospital is to give
feedback to the system. Hospital Board Members have a certain responsibility." |
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2. "We must have some recommendations for the
legislature." |
Other Concepts and Ideas Captured
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1. Episodes of interventions versus focus on
hospitals |
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2. Days going down - costs are not |
|
3. Inpatient versus outpatient cost shifting |
|
4. If cost was intent, look at drug costs |
|
5. Focus on research is good - look at alternative
approaches |
|
6. Cost - cost of technology - not same produce
comparisons |
|
7. Who should be ordering technology |
|
8. Is technology being used appropriately |
|
9. Medical intervention versus healthcare |
|
10. Go back to the Legislature to determine the
intent and the scope of future efforts |
|
11. Give the Legislature some guidance |
Conclusion
Based upon the outcome of today's meeting, Parker Haddix indicated that he felt
the HCA will now be able to provide a good report to the Legislature. He
thanked Dr. Forsythe and Dr. Cogan for their presentations. He indicated the
next steps in the process would be for HCA to analyze the information presented
and forward a report to the Legislature.
Regarding the QUAG "it's too early to say what its future may be." Perhaps the
sub-teams may reconvene periodically on certain issues.
The QUAG will be kept informed via the website and a final report will be
mailed to the members.
Prior to the meeting critique it was brought to the group's attention that the
West Virginia Coalition for Quality Health Care is looking at a number of
health related issues in West Virginia, using the Dartmouth Atlas Approach.
Meeting Critique
Positive/Benefits
|
1. "Good Lunch" |
|
2. "We are moving forward and making progress." |
|
3. "Admitting that this is one big task and coming up
with the recommendations for the legislature is an accomplishment." |
|
4. "A very positive process." |
|
5. "There was genuine gratification received from
hearing the perspective of others." |
|
6. "It is rare to see this many together at this
level of government" |
|
7. "This was a very well organized process, the
meetings, agenda, and materials" |
|
8. "This process is starting to build resource
capacity within the state." |
|
9. "This process has initiated a linkage between the
key people." |
AREAS FOR IMPROVEMENTS/CONCERNS
|
1. Healthcare systems as a whole can be compared to
"A Never Ending Story" some people are left out of the safety net. |
|
2. When developing the final plan do not add more
burden and cost. |
ADJOURN
| 