The ocean of data now at the heart of healthcare quality improvement had its start almost 20 years ago with the establishment of core measures, a set of national standards of care and treatment processes for common conditions that are among the costliest – in both lives and dollars – to our healthcare system.
Core measures also address the challenge of navigating all the streams of data entering the digital sea. With hospitals, physicians, and other clinicians required to report multiple quality measures to a long roster of registries and similar entities, measurement requirements are often not aligned among payers, which has resulted in confusion and complexity for both providers and payers.
Our white paper, Core Measures: Abstracting Data and Answers for Healthcare's Costliest Conditions, further explains how and why the healthcare industry has developed myriad measures for evaluating performance, including: quality metrics to meet federal reimbursement regulations; safety goals to achieve accreditation and credentials; and, among others, survey questions to quantify the patient experience. Indeed, value-based reimbursements now require hospitals to demonstrate the quality of their patient care.
Core measure principles imply that it is reasonable to expect that every patient with a given diagnosis will receive the baseline, or core, care established through evidence-based medicine. The right treatment at the right time for every patient.
Johns Hopkins Medicine sums up core measures as “national standardized processes and best practices to improve patient care ... to provide the right care at the right time for common conditions such as stroke or childhood asthma." Although the measures are standardized, they do sometimes change or drop off the list of core measure sets.
Hospitals must report their compliance with core measures to The Joint Commission, the Centers for Medicare and Medicaid Services (CMS), and other agencies. As a result, consumer-patients and families can use core measure performance to objectively compare hospitals locally or nationally. The higher percentage compliance means the hospital is following the best steps to care for a patient’s particular condition.
Public reporting of core measures makes the stakes that much higher for healthcare organizations. See these resources for a more-detailed explanation:
Sepsis is an emergency, plain and simple. The condition claims a life every two minutes and it adds $24 billion to our annual healthcare costs and kills an estimated 258,000 Americans each year. Sepsis is also a challenging measure for abstractors.
At nearly $24 billion in 2013, sepsis was responsible for 6.2 percent of all hospital costs across the country. A study revealed that the mean expense per stay associated with those hospitalizations was over $18,000, making hospitalizations from sepsis 70 percent more expensive than the average stay.
But what makes sepsis particularly challenging for chart and data abstractors? The following resources are invaluable for answering that question:
'It's a lot like playing Telephone ...'
Does your hospital have staff dedicated to the task and the time and organizational commitment to training and staying abreast of manual changes? It’s clear that healthcare professionals already wear a lot of hats in their facilities. That’s why the additional load of core measures data abstraction and reporting can be overwhelming.
One of the Primaris Quality Data Services managers, Amy Parsons, used the “telephone game” analogy recently to describe what happens when abstraction training and processes are passed down from employee to employee without up-to-date training and, in some cases, no thorough training for the person who first passed down the know-how.
You remember the "telephone game?" Our blog post, "Why DIY is risky for core measures data abstraction" goes into more detail about those risks.
One of the most crucial takeaways from the data abstraction picture is realizing that when providers are using their own staff for the task, it’s even more difficult to extract and implement actionable insights. What barriers do you encounter to keep data from shifting your focus from quality healthcare?
Learn more with our blog and video:
Quality Talk Podcast
Episode 22 of the award-winning Quality Talk podcast explains core measures and the pain-staking, detailed data abstraction that is necessary to show that hospitals are following cutting-edge, best practices in treating a number of high-cost conditions. Quality Talk host Jodie Jackson Jr. is joined by Primaris Quality Data Services Managers Amy Parsons and Verna Gallagher. Listen here.
“The story continues.” It’s a fact that abstractors know quite well, because the specifications and manuals are regularly updated, and training continues. The closest we get to an end game with core measures is achieving the best care for every patient every time.
And then we look at new data and/or updated manuals, and continue making sure that quality care is being delivered in a timely way. And then we do it again.
What is a core measure?
Core measure principles imply that it is reasonable to expect that every patient with a given diagnosis will receive the baseline – core – care established through evidence-based medical research.
How are core measures reported?
The results included in and gleaned from the data represent the percentage of patients admitted with a specific diagnosis, who receive the recommended care measure.
What makes core measures unique?
Core measures represent high-volume, high-cost diagnoses that are associated with an increased rate of morbidity or mortality.
Why are core measures important?
Quality measure reporting provides a means to let the community know that the hospital provides high quality care.
Primaris has been a pioneer of core measure abstraction since our work with the Joint Commission (TJC) in 1999. We have trained hundreds of quality measure abstractors and advised clients on clinical documentation improvement since the original core measures pilot project.
Primaris abstractors maintain a >95% accuracy on inter-rater reliability (IRR) review. Recent averages have been 98%. We configure reporting and feedback processes to meet specific needs and use our experience of working with providers and platforms to suggest clinical documentation improvement that can improve scores.
This core measures ROI Calculator helps to illustrate the impact outsourcing can have for your organization. Based on core measure abstractions and cost data from KPMG, it is designed to estimate how much of your abstraction investment you can save and staff time you can free up for other quality activities such as data analysis and clinical quality improvement projects.
Of course, this is just an estimate based on national data trends.
Many providers are drowning in their data and struggling to keep up with quality reporting demands. Grab on; we can help! Have you considered outsourcing your abstraction needs? Download our e-book, "The 5 P's of Abstraction Outsourcing", to learn more about how letting our team of experts handle your abstraction can lead to quality reporting success for you and your team.
“Primaris’ partnership with us is characterized by their collaborative approach, constant communication and attention to detail… Having Primaris on-board is almost like having our own abstraction department.”
–Northern Hospital of Surry County
“Working with Primaris has brought several positive outcomes to our facility. Their partnership affords us time to focus on implementing new plans and procedures to ultimately provide outstanding patient care. The impact Primaris has made is evident when comparing our national scores against those of other organizations.”
-Rainy Lake Medical Center