3 Ways a Proper OPPE Analysis Can Improve Performance and Impact Your Hospital Value-Based Purchasing Reimbursements

3 Ways a Proper OPPE Analysis Can Improve Performance and Impact Your Hospital Value-Based Purchasing Reimbursements

Jul 18, 2018
  • Author:
    Lisa Rothmuller, CPCS
    AVP, Clinical Solutions and CVO Services
    Lisa works with clients and organizations to provide Strategic Account Management and best practice and solution consulting. Lisa has a bachelor's degree in Economics/Finance from Bentley University in Boston, Massachusetts and currently resides in San Diego.

Dinner with family and lunch with co-workers are the breaks from our busy schedules that we all cherish. Good food, friendly company, and great service is what we all aim for during these outings. While we can generally pick a restaurant with good food and we mostly have a say in the friendly company that we invite, it is the third factor of great service that we often leave up to chance.

We all wish for great service but there is no doubt that we have all experienced both fantastic and poor service while dining out. Both of these experiences play a role in our decision to return to a restaurant. If we experience great service, we’ll continue our patronage to that restaurant; if we experience poor service, we’ll caution our family and friends about visiting that restaurant.

While excellent service is not always on the top of the list for why to re-visit a restaurant, it is these return visits that lead to consistent revenue and growth for a restaurant. The same rings true for healthcare facilities. Most of us hope that we don’t need to visit a doctor or hospital often, but during those trying times, we would like to know we will receive the best quality of service.

With quality in mind, The Center for Medicare and Medicaid Services (CMS) launched their Hospital Value-based Purchasing (HVBP) Program in order to set performance standards and reward acute-care hospitals for the quality of care they give patients. CMS is basing the level of reimbursements on measured performance scores as they relate to the quality of care.

# 1. Identifying Best Practices

Evaluating every provider is a hefty task. Especially if you work within a health system that employs thousands of health care providers. Capturing all of this data not only helps determine which of your doctors are performing well, it also allows you to track trends that may be used to create new practices within the organization. For example, if a provider, or group of providers, is consistently showing a lower ALOS than the group or national benchmark, exploring the reasoning behind this data can lead to having this practice adopted system wide as a new standard of care.

# 2. Uncovering Areas of Improvements 

While we may not like to admit it, we all have areas where we can improve and the same is true within health care organizations. The ongoing discovery of these areas needing improvement and developing improvement processes, demonstrates that your organization is dedicated to quality patient care and safety. Some of their performance measurements may be due to the need for additional training or mentoring. If a provider’s performance is showing increases in adverse outcomes, they may need additional proctoring in a certain clinical protocol to refine their skills. Having a system in place that can quickly identify these areas and put an action plan in place is crucial for success. Doing this ensures that your providers are delivering the highest quality of care. The result can have a major impact on your Clinical Care score for HVBP reimbursement.

#3. Incorporating Patient and Caregiver Feedback

The patient’s opinion matters whether it is positive or negative. OPPE measurements capture provider’s clinical knowledge, patient care outcomes, professional skills, and areas of improvements. CMS is also looking to hold organizations accountable for patient and caregiver experience. To obtain this data, health systems need to make sure they are evaluating CAHPS scores and also using tools to evaluate online reviews for providers that can be obtained detailing how a patient felt about his or her experience and if they would recommend that provider or not. A good system can collect these performance indicators in a single dashboard for a comprehensive assessment.

Gathering and evaluating all of this data is daunting, but proper analysis and action plans can be the key to maximizing your Value-Based Purchasing reimbursements. Now you have the tools to know how to better integrate your OPPE measurements into the current CMS value-based scores. By creating best practices, continuing to make improvements in quality of care and listening to your patients you can make sure that your hospital is maximizing its monetary rewards.