Courting referrals with benchmarking data

Tooting your own outcome horn brings business

Benchmarking data serve a larger function than targeting quality improvement programs:Such data can increase referrals by providing sources with outcomes information they can’t ignore.

Take, for example, the Visiting Nurse Associa-tion (VNA) of Hudson Valley, a certified home health agency in Kensico, NY, that provides about 90,000 visits annually.

Although the agency has been capturing benchmarking data for seven years through Outcomes Concept Systems of Seattle, it only recently began using the information to promote its services, says Pam Ferrari, RN, director of quality. "We sensed that the cardiac unit at a nearby facility could have been referring more patients to us, so we gave them a presentation that explained our benchmarking efforts: what we did, why did it, and the outcomes we obtained," she says.

Ferrari says the physicians were amazed. "They asked, ‘You can do that for us?’"

The presentation helped physicians realize their criteria for orders of home care needed to be re-examined, she explains. "Previously, they were sending us only patients who were over a certain age. But outcome data helped them to see that if they sent younger patients on the first admission to us, perhaps there wouldn’t be a second, third, or fourth admission when they were older."

In today’s competitive market, using outcomes data to educate referral sources and payers is essential, she stresses. "Where home health nurses can have the most pronounced affect [on patient outcomes] is in teaching the patient and caregiver about the disease and how to manage it. Yet most managed care companies don’t want to authorize visits solely to teach patients unless you can show them that it will result in improved outcomes."

As capitation closes in, the patient education component of home health will become an even more critical link in the continuum chain as health care systems look for ways to reduce their readmission rate. But anecdotal evidence won’t work. "They want quantifiable data," Ferrari says. "For example, we were able to show our overall patient outcomes are higher, and we’re able to do it with fewer numbers of visits."

VNA was able to present strong data because the previous benchmarking efforts not only offered regional and national comparisons but also precipitated standardized care plans containing best practices. For example, by looking back over the first two years of data, Ferrari was able to identify the agencies’ most frequent diagnoses: diabetes, congestive heart failure, coronary artery bypass, total hip and knee replacements, and cardiovascular accidents. Then, by examining charts and talking with field nurses, she pinpointed those best practices that led to improved outcomes.

Now the practices are included on a standardized pre-printed form that uses a scale to measure upon admission and discharge the following areas: health status, patient and caregiver knowledge function, and skill function. For example, for the health status of a congestive heart failure patient, the nurses assess whether the patient is declining (25%), stable (50%), improving (75%), or problem resolved (100%). The care plan also contains a checklist for nurses to observe and assess the status of the patients’ respiratory, cardiovascular, genitourinary, musculoskeletal, neurological, and endocrine systems as well as their nutrition status, pain, and skin integrity.

Measures lead to improvements

To measure the patient and caregiver knowledge function, nurses note whether they verbalize no apparent knowledge (a score of 25%), minimal knowledge (50%), substantial knowledge (75%), or competent knowledge (100%). The skill function component uses a similar scale: Patients or caregivers receive a score of 25% if they demonstrate no skill, 50% for minimal skill, 75% for substantial skill, and 100% for competent skill.

The care plan also allows nurses to note any skill deficits such as intake and outtake, daily weights, pulse monitoring, safe use of oxygen, and safe and appropriate use of medications.

"For years, the nurses were collecting benchmarking data, and finally, with this tool, we were able to give them something back," Ferrari says. "They like using it because the best practices are derived from their own work, and it reduces paperwork."

For more information, contact: Pam Ferrari, Director of Quality, Visiting Nurse Association of Hudson Valley, 43 Kensico Drive, Kensico, NY 10549. Telephone: (914) 666-7616.