Exploring the Effect of At-Risk Case Management Compensation on Hospital Pay-for-Performance Outcomes

Granata, Randy L.; Hamilton, Karen

doi:10.1097/ncm.0000000000000067

Cited by 3 publications

(4 citation statements)

References 18 publications

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“…Regarding the journals, the articles were published in 26 different journals, all described in Appendix A. Of the 33 analyzed studies, 21 (63.3%) were carried out in the hospital environment, four (12.1%) did not clearly describe the place of study [20][21][22][23] and in two (6.1%) articles, the study was conducted in more than one place [24,25]. The other places where the studies were carried out are presented Figure 4.…”

Section: Resultsmentioning

confidence: 99%

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Lean Healthcare Tools for Processes Evaluation: An Integrative Review

Barros

Bassi

Caldas

et al. 2021

IJERPH

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Several health services have used lean healthcare to seek continuous improvement of their processes. Therefore, it is important to investigate the evidence available in the literature about the most used lean tools in the health area to review processes and the main results achieved by the researchers. As an integrative literature review methodology was used, it was conducted in five databases, using the descriptor “quality improvement” and the keyword “Lean Healthcare”. A total of 33 complete articles were selected for analysis. The most recurrent tools were: define, measure, analyze, improve and control (DMAIC); value stream map (VSM); suppliers, inputs, process, outputs, customers analysis (SIPOC), Ishikawa Diagram and 5S. Through the analysis of waste, different interventions were implemented and the main results achieved were reduction in times (processing, waiting, cycle and total), costs, workload and increase in the number of calls. The findings enabled the identification of the main lean tools used in the health area to achieve better results. In particular, we highlight recent studies that have explored the lean six sigma healthcare approach. The results, in addition to contributing to the literature, will also assist managers in choosing the best tool to achieve continuous improvement in hospitals and other health services.

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Section: Resultsmentioning

confidence: 99%

“…The outcomes that stood out the most in the evidence were related to time, be it processing, waiting, cycle, permanence or total. Most studies showed improvement in these times, after the implementation of interventions based on the causes of waste previously mapped [21,23,25,29,31,32,38,42,[46][47][48][49][50]54,56,57,60].…”

Section: Discussionmentioning

confidence: 99%

Lean Healthcare Tools for Processes Evaluation: An Integrative Review

Barros

Bassi

Caldas

et al. 2021

IJERPH

View full text Add to dashboard Cite

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“…Therefore, capturing patients' expectations and identifying any unrealistic expectations they hold require detailed communication between inpatients and the healthcare service provider. As complex regulatory rules and pressures from managed care organizations require more of inpatient case managers' time, it is becoming more difficult for them to spend face-to-face time with patients (Granata and Hamilton, 2015). Therefore, it is recommended that providers and administrators seek process changes that allow for increased communication time between providers and patients.…”

Section: Discussionmentioning

confidence: 99%

Case management service quality and patient-centered care

Perera

Dabney

2020

JHOM

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PurposeProviding care that is patient-centered is an important objective in the modern healthcare industry. Despite this objective, hospital inpatient case managers and the services they provide are evaluated routinely without including patients' perspectives. Therefore, the purpose of this study is to fill this research gap by using patient expectations and perceptions to assess the overall quality of and patient satisfaction with hospital case management services.Design/methodology/approachThis paper investigates five dimensions of case management services – reliability, responsiveness, assurance, empathy and tangibles – and how they affect overall quality and patient satisfaction. Study surveys are based on the SERVQUAL instrument. Survey data from a cross-sectional sample of 67 inpatients are analyzed using principal component analysis, confirmatory factor analysis, GAP analysis and a predictive model.FindingsThe preliminary part of the study identifies “tangibles” and “nontangibles” – reliability, responsiveness, assurance and empathy – as the main components. Among these two components, only nontangibles have a positive and significant effect on both quality and patient satisfaction according to patient perspectives. GAP analysis indicates that gaps between patient expectations and perceptions of reliability and assurance are significant. Finally, the proposed predictive model reveals that gaps in assurance have a significant impact on both overall quality and satisfaction, while gaps in empathy have a significant impact on satisfaction, but not overall quality.Originality/valueStudies on service quality at the case manager level are limited. This study is the first in this domain to evaluate quality and satisfaction from the patient perspective.

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“…In some cases (eg, data harvested from other systems), copying the native report will suffice. Billing and economic data may already contain hospital “key performance indicators” that show current demographics and changes over time 13. In more sophisticated environments, these reports already include benchmarking information, comparing performance to other organizations and targeted goals.…”

Section: Discussionmentioning

confidence: 99%

Setting up a quality program: defining the value proposition for anesthesiology

Dutton

Davidson

Shukla³

2021

International Anesthesiology Clinics

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A robust quality improvement (QI) program is an advantage for any anesthesia practice, whether private or academic. Although the primary goal should be ongoing improvement of patient care, QI infrastructure also enables the group to demonstrate value to external stakeholders ranging from the federal government to commercial payers to local hospital administration.The QI program enables efficient management of the operating room, response to patient and surgeon complaints, and submission of public performance measures to the Centers for Medicare and Medicaid Services (CMS). A robust QI program supports the professional obligation of anesthesiologists to continually improve the safety of patient care. The QI program creates the measuring stick for improving outcomes over time, both for the group as a whole and for individual members. Collection and analysis of adverse events allow every provider to learn from the experience of others and create a substrate for improving systems of care within a "safety culture" of open and honest discussion protected from legal discovery or public embarrassment of the hospital, the practice, or any individual. The anesthesia QI program will support the health system's goals related to Joint Commission, Leapfrog, and other reportable patient safety initiatives, providing value to the relationship.This chapter reviews the steps involved in the creation and support of an anesthesia department QI program, including suggestions for data collection, incident analysis, and reporting. The goal is a department in which every member participates in Continuous Quality Improvement (CQI) as an expected clinical activity. 1 Institutional supportA robust QI program begins with commitment from senior leadership. Quality and performance data are required by the hospital system to meet regulatory requirements, and good performance is tied to incentive pay for hospital leaders. The hospital will ask each department-including anesthesia-to support their global efforts. An effective anesthesia QI program offers a competitive advantage: Groups that measure their performance are best positioned to improve it and can use the resulting data to win and maintain hospital contracts. 2 Department Chairs are more willing to invest in QI than in years past, but more than money is required. Senior leaders must make it clear by their actions that participation in QI is professionally valuable, and the Department Chair can emphasize this by selecting the right person to be the QI Director and then mentoring them in the role. Senior clinicians must be willing to acknowledge and discuss their own adverse outcomes and must model the willingness to change practice when needed. Not every member of the group must attend hospital meetings or review adverse outcomes, but those who do must be supported by their peers who stay in the OR. As the saying goes: "If you're not at the table, you're on the menu." Participation in hospital QI meetings is as important to practice viability as providing good clinical service-something...

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Exploring the Effect of At-Risk Case Management Compensation on Hospital Pay-for-Performance Outcomes

Cited by 3 publications

References 18 publications

Lean Healthcare Tools for Processes Evaluation: An Integrative Review

Lean Healthcare Tools for Processes Evaluation: An Integrative Review

Case management service quality and patient-centered care

Setting up a quality program: defining the value proposition for anesthesiology

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