The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants

Practice Patterns and Outcomes Reporting

By Brent A. Metfessel MD, MS, CMP™ (Hon)

Quality Profiling

Quality medical profiling and healthcare delivery metrics and outcomes analysis look beyond mere healthcare finances and costs. As readers of the Executive-Post are aware, pure financial analysis is the stuff of physician economic profiling; an emerging science to be sure.

Typically, good quality medical care leads to improved costs since stable patients have fewer unplanned visits, less emergency room usage, and a reduced frequency of hospital admissions, all of which save money. 

HEIDIS® Data

The Health Plan Employer Data and Information Set (HEDIS®) contains measures obtainable from claims, survey, provider, membership, and medical record data.

HEDIS® was developed in conjunction with the National Center for Quality Assurance (NCQA) and is a widely accepted specification for quality measures. 

Consumers, managed care organizations, and accrediting bodies have a high level of interest in the evolving HEDIS® metrics, to date.

These measures are divided up into a number of categories:

• Preventive services:  Includes childhood and adolescent immunization status, breast and cervical cancer screening rates, chlamydia screening in women, assistance with smoking cessation, and well-child visits.
• Access to care:  Includes access to preventive, primary care, prenatal and postnatal care services.
• Utilization:  Contains measures of frequency of selected procedures, inpatient utilization such as average lengths of stay for maternity and mental health patients, C-section and VBAC rates, and other measures of inpatient and outpatient utilization.
• Acute and chronic illness care: Examples are rates of beta-blocker use post-MI, comprehensive diabetes care (such as annual retinal exams), control of high blood pressure, appropriate medications for asthma patients, and follow-up within 30 days after hospitalization for mental illness.
• Provider data and statistics:  Includes residency completion information, board certification, and provider turnover.
• Membership statistics:  These measures deal with member demographics and total membership in the health plan.
• Survey data:  Includes member satisfaction survey results.

Assessment

The NCQA is continually revising its measures in the HEDIS® product and provides new versions annually. But, although HEDIS® contains many measures of quality of care; it provides few measures of actual clinical outcomes.

Conclusion

Have you experienced, or been reviewed, using any of these measures in your own hospitals or healthcare institution; please comment?

Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Financial Planning: http://www.jbpub.com/catalog/0763745790

Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Administrative Terms: www.HealthDictionarySeries.com

Subscribe Now: Did you like this Executive-Post, or find it helpful, interesting and informative? Want to get the latest E-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Filed under: Quality Initiatives |