Online Program

Quality requirements- which initiatives are related to finance and compliance, and how do we make it all work?

Tuesday, November 5, 2013

Steven Powell, MD, MPH, Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH
The number of Quality initiatives and Quality requirements that a healthcare facility is expected and often required to participate is growing exponentially. While Quality has often, although not always, had a place in most healthcare organizations, there is an immediate need to "move this up on the organizational chart." Historically, Quality initiatives were small, local programs that were intermittently measured or sustained. This is not meant to degrade past Quality initiatives, but meant to point out that Quality in the current healthcare environment is often tied directly to reimbursement and compliance. Many facilities are finding it hard to keep up with the increasing expectations in the Quality arena, often with no increase in funding or increase in staff. This often results in organizational Quality measurement, but no actual Quality improvement. When this happens, it completely undermines the tremendous amount of work that initially occurred in order to provide the data. An additional problem is that many facilities have either multiple data gathering systems in place, completely disjointed systems, and even manual chart extraction requirements that severely hamper the ability to provide real-time information. Funding is required to simply bring up the Quality infrastructure in many locations to the point that an effective system can be in place. It will benefit organizations to spend the necessary time and investment to gather, organize, and describe all current Quality initiatives, which will ultimately allow organizations to develop a strategic understanding and strategic plan. It may very well be the case that Quality initiatives that are not currently tied to finance, reimbursement, and compliance may need to be redirected or put on hold. A limited number of resources must be deployed to the most important and needed arenas. This exercise will also allow organizations to eventually restart programs that were initially placed on hold by redirecting or refining specific efforts into a direction that aligns with the overall strategic Quality plan. Healthcare Quality should be undertaken with a strategic plan in place, with an understanding of financial and compliance implications, in order to appropriately improve the patient care deliver system.

Learning Areas:

Administer health education strategies, interventions and programs
Administration, management, leadership
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Define and identify current and pending required quality initiatives that impact the financial and regulatory status of critical access hospitals. Discuss potential methods of meeting quality requirements.

Keyword(s): Quality, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Chief Medical Officer and Vice President of Medical Affairs and directly responsible for Quality Intiatives, Quality Operations, reporting of our Accountable Care Organization, strategic planning, and all Quality financing. My organization has recently joined an ACO, become affiliated with a large academic medical center, and is undergoing increaseing patient census. All of these require a clear understanding of operating within the current and pending quality requirements.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.