The DNA of Healthcare

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Winning Consumerism and Quality Scores Starts with Clean Patient Data

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Associate Vice President, Vertical Solutions Consultants

Healthcare is having a Field of Dreams moment. Remember in the movie the mysterious voice reaching out to Kevin Costner in his cornfield one night, saying “if you build it, they will come.”

Much of healthcare’s shift to consumerism has an impact on patient perception of their care and experience, which impacts survey scores, which impacts quality ratings, which impacts reimbursements.

So you see the pattern here. Not to downplay patient experience, but there is much more at stake to happy healthcare consumers than public perception.

Last week, CMS released its latest iteration of hospital Star ratings for 2020, marking the final update under the agency’s current methodology for rating hospitals.

The overall hospital star ratings are based on 57 quality measures across seven categories:

  • Effectiveness of care
  • Efficient use of medical imaging;
  • Mortality;
  • Patient experience;
  • Readmissions;
  • Safety of care; and
  • Timeliness of care

For the latest ratings, CMS used the methodology the agency established in February 2019, though it plans to update the methodology for its next round of ratings in 2021.

There’s More to Star Ratings than Quality Scores

Much like HEDIS, Star Ratings have become widely used tools to measure and improve healthcare effectiveness. They provide employers and consumers with the objective information they need for reliable comparisons of healthcare quality and outcome measures.

Healthcare organizations use HEDIS scores and Star Ratings to:

  • Assess the quality of health and drug plans
  • Encourage employers to select their plans in a bid for benefits
  • Determine which providers should be offered alternative contracts
  • Identify gaps in care and develop population-specific interventions and programs to improve outcomes
  • Ensure payers, providers and pharmacies have a vested interest in quality care metrics
  • Improve reimbursements for value-based care payment models and monitor compliance for incentive programs

But there’s more to Star ratings than hospital reported quality scores. The hospital consumer assessment of Heatlhcare Providers and Systems (HCAHPS) is a national, standardized publicly reported survey of patient perspectives of hosptials care. The public reporting, according to CMS, serves to enhance accountability in healthcare by increasing transparency.

But here’s where your field of dreams moment comes in: hospitals with fewer than 100 completed HCAHPS surveys don’t get Star ratings.

Improve Patient Data Quality to Improve Ratings

So what isn’t always taken into account is that many healthcare organizations are currently operating with surprisingly inaccurate or incomplete patient data. According to the Agency for Healthcare Research and Quality, efficient patient identity integrity, is defined as the “accuracy and completeness of data attached to or associated with an individual patient.” Effective patient identity management leads to high patient identity integrity.

The problem with data quality goes beyond data entry errors. Patient data erodes at an estimated rate of 3% per month. It’s in a continual state of flux as individuals change jobs, phones, addresses and even their names (marriages and divorces). And you have to reach them, before they will come.

If you start with clean, current patient records to distribute your HCAPHS surveys and reach your patient population, you’ll likely bring in better Star ratings and higher reimbursements. With optimized patient data, healthcare organizations can begin the process of contacting patients for accurate survey reporting and subsequently targeting care management and outreach for at-risk populations to improve care and prevent readmissions.

Stay tuned for part 2 of this blog on preventing readmissions, but the first hurdle is to channel Kevin Costner and remember: if you cleanse it, they will come.

To learn more about cleansing patient records, read our white paper: “The Top Four Ways to Improve Quality Ratings”

The DNA of Healthcare

At LexisNexis Risk Solutions, our goal is to provide the healthcare industry with insights and innovations to improve outcomes, grow market share, reduce fraud and increase compliance.

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