Benchmark and Trend Data Improve Quality and Processes Within the EP Service Line

Amanda Elfstrum, MBA, and Eric Hoesing*, Director of CV Services Medtronic, Inc., Minneapolis, Minnesota *Bryan LGH Hospital, Lincoln, Nebraska
Amanda Elfstrum, MBA, and Eric Hoesing*, Director of CV Services Medtronic, Inc., Minneapolis, Minnesota *Bryan LGH Hospital, Lincoln, Nebraska
In this article, the authors from Bryan LGH Hospital’s EP program discuss their participation in the Medtronic HEARTmark benchmarking program. Long recognized as one of the premier electrophysiology (EP) services in the Midwest, the EP program at Bryan LGH Hospital performs over 700 EP procedures each year, from device implants to complex ablations. Bryan’s EP program credits its success and growth to a staff committed to identifying innovative methods to foster growth and improve quality. It was in this context that Bryan’s EP program joined HEARTmark®, Medtronic’s proprietary national EP benchmarking program, in 2008 and used it as a springboard for performance improvement. Benchmarking Trends in EP Medtronic’s HEARTmark benchmarking program collects de-identified patient data, financial metrics and implant trends from participating EP programs on a quarterly basis to gain real-time understanding of trends within the EP service line. Each hospital’s data are analyzed and benchmarked against that of other participating hospitals and available Medicare data. Benchmarks allow the hospitals to compare their data with that of other programs nationwide to identify both best practices and opportunities. For example, practitioners may benchmark against Medicare’s DRG mix assumptions to determine whether their coding practices are in variance with the national norms, and if so, to identify and address the cause of the variation. This management tool generates a hospital-specific report for each participating institution, providing insight into all facets of the facility’s EP service line, from payer and procedure mix to contribution margins, costs and revenue. Annually, an aggregate report with de-identified hospital data from all participating institutions is also generated. Susan Heilman, Director of Economic Strategies and Solutions at Medtronic, explained: “Current data regarding EP service operations were not readily available in the marketplace, so facilities had no basis for comparison. Medtronic developed HEARTmark to help administrators at participating facilities understand performance metrics for their EP programs in a timely way, allowing for improvement of both quality and efficiency, which ultimately leads to better patient care.” Experience with HEARTmark at Bryan LGH The CV Services at Bryan LGH seized the opportunity to pilot the HEARTmark program in 2008, with Medtronic’s Healthcare Economics Department. They have been an enthusiastic advocate of the program ever since. In February 2008, Bryan LGH hospital administrators, electrophysiologists, cardiologists, nurses, case managers, and data analysts assembled to hear the results of their first HEARTmark report. We thought it was important that everyone involved in EP hear the same message at the same time. Ultimately the data analysis from the first HEARTmark report revealed opportunities for improvement within the service line. Some issues were easy to address; others took more time, planning and coordination among various groups. One of the findings from that first round of data analysis was that the Medicare Severity-Diagnosis Related Group (MS-DRG) mix for heart failure was lower than expected at Bryan LGH, when compared with Medicare’s expected national MS-DRG mix. Upon further discussion and analysis, the Bryan EP group determined the most likely cause of this discrepancy was not a healthier than average patient population, but rather a need for more detailed physician documentation of secondary diagnoses. Acting on this assumption, documentation specialists were hired to review charts and work with physicians on improving documentation for secondary diagnoses. The hospital also hired a full-time registered nurse to review charts prior to discharge to ensure the completeness and accuracy of documentation. Physicians came to recognize the impact that their documentation of patients’ severity of illness had on the hospital’s DRG assignments, and therefore, the facility’s financial bottom line. With these changes in place, Bryan LGH is now on target to increase its revenue by $1.5 million in 2010. Improved documentation has also impacted reporting of quality metrics, such as those submitted to the Joint Commission. Because the charts are more complete, both the risk-adjusted mortality rates and physician scores have improved. Bryan’s HEARTmark report also catalyzed discussion about how greater access to EP services by existing patients could improve patient outcomes. In response, physicians collaborated with CV Services to redesign standard order sets. Now, all echocardiogram reports note that any patient with an EF Summary Regarding the primary keys to success, quarterly reporting to both administrators and physicians are recommended. The information needs to be in front of everyone on a regular basis to maintain interest and accountability. The physicians and hospital continue to make refinements to the processes and are now looking to expand the changes to all cardiovascular service lines. Both parties recognize the value of their partnership in their ability to improve quality, enhance patient care, improve finances and create sustainable growth. Dr. Andrew Merliss, Medical Director for EP Services, provides final comments on the substantial benefits of the HEARTmark program: “Having benchmarks derived from other leading electrophysiology programs has helped us confirm what we have been doing well and highlight areas where we could do better. The program has helped us understand the importance of accurate coding so we can properly assess delivery of services to our patients and utilization of resources in comparison to other programs with similar service lines.” For more information, please visit: http://www.bryanlgh.com/