I loved an article I read in a recent issue of HFMA Magazine in the Healthcare Value section. The title is “The Secret to Building Effective Quality Programs” written by John Byrnes, MD. The finance playbook, described by John, includes these cornerstones:
Rule #1: Don’t allow clinicians to calculate cost savings. Finance and clinical counterparts should partner together using transparent calculations and data.
Rule #2: Ensure quality reporting is comprehensive. If a hospital can report financial data for every department, they should be able to report quality data. Make the data available across clinics and define system wide measures.
Rule #3: Ensure quality-control resources are adequate. By demonstrating the business value of quality improvements, the quality department should be able to secure the resources needed to build quality control processes.
Rule #4: Equate Chief Quality Officers to Chief Financial Officers. If it takes the CFO level position to ensure the financial health of the hospital, why wouldn’t we want an equal position to ensure that effective quality control procedures are established?
The common thread here is data and leadership isn’t it? On the data side, enterprise data warehouse solutions are important to source data for common measures for the hospital. This intersection of quality and finance also will be affected by the upcoming conversion from ICD-9 to ICD-10 coding methods. By permitting more-specific coding of patient conditions, it may be possible for care management organizations to identify which members require disease management and to tailor programs more precisely to their conditions, thereby raising the efficacy of disease management and saving both lives and money.
This article initially attracted my interest because of my background in finance and operational analytics, but I also had an unfortunate encounter with a mid-size hospital system recently with a family member that shook me to the core. There was no Quality Officer and no incident reporting process in place and no one to turn to after a life threatening situation unfolded with a close family member. My heart sank not only for my loved one, but for those who would encounter this in the future. I did report this to the Joint Commission and I hope that the culture has changed for this organization.