An Integrated Model to Accelerate Patient Satisfaction Improvement.

Patient satisfaction is gaining traction in the strategic direction and daily operations of hospital executives. The financial penalty/incentive tied to patient satisfaction scores creates a burning platform to accelerate progress. Previous studies have shown the effectiveness of various improvement strategies including leadership rounding and employee training, among others. There has not been a study utilizing an integrated model that incorporates known best practices into a holistic approach. The integrated model included service excellence training, nursing unit-specific action plans, and weekly leadership rounding. Implementation of the model led to significant and sustainable improvements in patient satisfaction in the community hospital setting. This approach can be leveraged and scaled in other organizations to accelerate the pace of change.

Big Things Come in Bundled Packages: Implications of Bundled Payment Systems in Health Care Reimbursement Reform.

With passage of the Affordable Care Act, the ever-evolving landscape of health care braces for another shift in the reimbursement paradigm. As health care costs continue to rise, providers are pressed to deliver efficient, high-quality care at flat to minimally increasing rates. Inherent systemwide inefficiencies between payers and providers at various clinical settings pose a daunting task for enhancing collaboration and care coordination. A change from Medicare's fee-for-service reimbursement model to bundled payments offers one avenue for resolution. Pilots using such payment models have realized varying degrees of success, leading to the development and upcoming implementation of a bundled payment initiative led by the Center for Medicare and Medicaid Innovation. Delivery integration is critical to ensure high-quality care at affordable costs across the system. Providers and payers able to adapt to the newly proposed models of payment will benefit from achieving cost reductions and improved patient outcomes and realize a competitive advantage.

Implementation of a formulary management process.

PURPOSE: The application of lean methodology in an initiative to redesign the formulary maintenance process at an academic medical center is described. SUMMARY: Maintaining a hospital formulary requires clear communication and coordination among multiple members of the pharmacy department. Using principles of lean methodology, pharmacy department personnel within a multihospital health system launched a multifaceted initiative to optimize formulary management systemwide. The ongoing initiative began with creation of a formulary maintenance redesign committee consisting of pharmacy department personnel with expertise in informatics, automation, purchasing, drug information, and clinical pharmacy services. The committee met regularly and used lean methodology to design a standardized process for management of formulary additions and deletions and changes to medications' formulary status. Through value stream analysis, opportunities for process and performance improvement were identified; staff suggestions on process streamlining were gathered during a series of departmental kaizen events. A standardized template for development and dissemination of monographs associated with formulary additions and status changes was created. In addition, a shared Web-based checklist was developed to facilitate information sharing and timely initiation and completion of tasks involved in formulary status changes, and a permanent formulary maintenance committee was established to monitor and refine the formulary management process. CONCLUSION: A clearly defined, standardized process within the pharmacy department was developed for tracking necessary steps in enacting formulary changes to encourage safe and efficient workflow.

Evaluating the Effect of Physician Fellowship Programs on Surgical Outcomes for Coronary Artery Bypass Grafting Procedures.

This study examined the relationship between fellowship training of thoracic surgeons and their patient outcomes following a coronary artery bypass graft (CABG) procedure. The study used data obtained from hospital discharges from Florida hospitals from 2006 to 2010 and linked them with the quality of the hospital wherein the physician completed his or her fellowship. Quality rankings were based on the hospital's national ranking among cardiovascular hospitals at the time when the fellowship was completed. A risk-adjusted analysis showed that completing a fellowship in a nationally ranked cardiovascular hospital and a longer time since fellowship and residency completion were associated with lower complication rates for CABG surgeries. This is the first study to incorporate hospital discharge data, external hospital quality rankings, and physician training characteristics to evaluate patient outcomes. Such knowledge could help shape the future direction of health care training and provide an objective, outcomes-based evaluation method for physician training programs.

Educational backgrounds and quality of training of surgeons performing coronary artery bypass graft procedures in the state of Florida in 2010.

Quality of care is in part a result of the medical education practitioners receive. To date, little research has been conducted to assess the relationship between type, quantity, and quality of postgraduate residency and fellowship training and patient outcomes. This article explores the relationship of physician training and certification and surgical outcomes of patients undergoing coronary artery bypass grafting procedures in Florida during 2010. The data set includes 246 surgeons who, as a group, trained at nearly 48% of all thoracic surgery residency programs in the country. There were significant differences in board certifications for general surgery and thoracic surgery among physicians in different quality segmentations. Additionally, statistically significant differences were observed for mortality as a percentage of surgical volume as well as length of stay. These differences in characteristics and outcomes among segmentations of physicians warrant future exploration to identify underlying contributors to quality.

Care transitions programs: a review of hospital-based programs targeted to reduce readmissions.

PURPOSE/OBJECTIVES: An emphasis on a value-based payment model is expected to provide motivation for developing effective care transitions programs. For such programs to succeed, organizations must adopt an evidence-based, financially feasible model that enables improved coordination with providers, alignment of incentives, and measurement of key performance metrics, both clinical and operational. Evidence of cost-effective care transitions programs is important for deploying successful models broadly. PRIMARY PRACTICE SETTING(S): Hospital-based programs. FINDINGS/CONCLUSIONS: Current literature on care transitions programs highlights different strategies, patient populations, settings, and outcomes; however, it lacks sufficient supporting financial evidence that these programs are operationally sustainable and cost-effective within current and projected reimbursement schemes. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Care transitions interventions need to be further studied in different settings with different patient populations to identify the optimal approach(es). An additional opportunity for future investigation lies in translation of interventional programs targeted at readmission diseases in line for penalty by Medicare.

Big things come in bundled packages: implications of bundled payment systems in health care reimbursement reform.

With passage of the Affordable Care Act, the ever-evolving landscape of health care braces for another shift in the reimbursement paradigm. As health care costs continue to rise, providers are pressed to deliver efficient, high-quality care at flat to minimally increasing rates. Inherent systemwide inefficiencies between payers and providers at various clinical settings pose a daunting task for enhancing collaboration and care coordination. A change from Medicare's fee-for-service reimbursement model to bundled payments offers one avenue for resolution. Pilots using such payment models have realized varying degrees of success, leading to the development and upcoming implementation of a bundled payment initiative led by the Center for Medicare and Medicaid Innovation. Delivery integration is critical to ensure high-quality care at affordable costs across the system. Providers and payers able to adapt to the newly proposed models of payment will benefit from achieving cost reductions and improved patient outcomes and realize a competitive advantage.