Consortium benchmarks nonclinical outcomes

Intake, admission, collection among core areas

Trying to find good, scientific benchmarking data for nonclinical aspects of home care is like trying to find a needle in a haystack, says David Baker, corporate director for home care services at OSF Healthcare System in Peoria, IL. He formed a group of agencies about a year ago to share data, experiences, and best practices in several nonclinical areas.

"OASIS [Outcome and Assessment Informa-tion Set] will give you one set of data for the status of patients," says Baker. "But we want to look at financial data, performance data, cost data, outcomes data, and patient satisfaction data. These are other important elements of care."

Working in a hospital-based agency, Baker says he is under more and more pressure to benchmark such data sets against others. "They’ve been doing this for years, and they would look at me like I was crazy when I said there was nothing out there for home care."

He was going to set up a benchmarking consortium on his own, but he found a partner in the Healthcare Management Council (HMC), a company in Needham, MA, that has done hospital benchmarking for several years.

Martha Tecca, founding partner of HMC, helped Baker put together a group of seven agencies to participate in the benchmarking project. Aside from two organizations in Chicago, the seven were all in different geographic areas.

The first step was to determine what would be valuable to collect and share. Baker wrote a list of things he wanted to know. "In home health, we need to know the direct cost per visit for each discipline. We need to know what the labor, travel, and supply elements of those direct costs are. I did the same thing for other areas — such as hospice, DME [durable medical equipment], and IV." That was a starting point for discussions.

Over time, the list has grown to include total cost comparisons; total direct cost comparisons; direct cost comparisons by discipline, including nursing, home health aide, social work, and physical, occupational, and speech therapy; performance by diagnosis, including diabetes, hypertension, coronary atherosclerosis, congestive heart failure, pneumonia, cerebrovascular accident, chronic obstructive pulmonary disease, chronic skin ulcer, osteoarthrosis, and femur neck fracture; indirect service comparisons; and practice comparisons.

Tecca says it was tough to come up with appropriate questions. "In general, the interest in information is greater for most than their ability to provide it given their current systems. They filled out the questionnaires, and about half the items they had said they wanted information on, they couldn’t answer. We had to go in and extract it from whatever forms they had."

Even more challenging was putting together the data on indirect costs, she says. "If you take the entire process from meeting the patient for the first time to meeting the patient’s needs, you have to break that down into core processes."

The group, which now numbers 12 organizations, came up with four core areas: intake, admission, caring for the patient, and collection of payment. "But within those four areas, there are a variety of functions in every organization," says Tecca. "You have to define the functions so each of the agencies can identify the costs associated with these processes. They can’t, in every case, give me functions that match one another. But there are clear sets of standard activities involved in each of these four areas. We are finalizing language now."

Growing and sharing

The goal is not just to share data but to facilitate discussion among members, too. There have been three meetings so far — one introductory meeting and two others. Already, Tecca says there have been "light bulb" incidents, where one participant has said something, and another has taken that comment and come up with a way to apply it in his or her own organization.

"There are broad and narrow goals," Baker says. "I want to have a nationally accepted and credentialed service that provides good comparable data that is accepted by both the industry and payer sources as a barometer of our performance. I want behind-the-scenes networking so we can look at best practices and share information."

Tecca explains the more specific goals. "In the end, we hope they will be able to look at specific data points and have meaningful conversations about them." For instance, if Agency A sees that Agency B has 27% home health aides, compared with its 10%, the discussion can focus on how Agency B makes that number work. "It’s more meaningful than saying Agency B has a lower cost base. It shows a specific reason why it is lower. We want to help them get at the actual practices behind the numbers."

The group hopes to continue growing. Tecca says the ideal situation would be to have several groups of 15 or so organizations that share data and information unreservedly. Right now, with two Chicago-based agencies, data must be doctored — Agency A doesn’t get data for Agency B and vice versa. "They are willing to share experiences and best practices, but not specific data." The cost is $5,000 to $15,000, depending on the size of the organization, Tecca says.

That could be an impediment, Baker admits. "With the changes in the reimbursement system, people are getting more and more frugal," he says. "People may need the service, but they don’t want to spend the dollars."

Tecca agrees but says forward-looking organizations will be willing to pay. "They understand that in a time when you have to make cuts, it’s important to know where to make the changes that will improve efficiency and cut costs but not affect the quality of care."

In most cases, even early data the charter organizations have provided and the best-practice discussions they’ve had should give agencies enough information for one FTE worth of savings, she adds. "Half the cost of a visit is indirect costs. That provides a wealth of areas to save money. If you save one FTE, that’s three times the most expensive cost of becoming part of the partnership."

She is even more chagrined that organizations are willing to shell out millions of dollars to change systems to handle OASIS. "That will be helpful to them, but we are trying to help them use the systems they have now, to get real value out of them and help make decisions that will make them operate more efficiently."

Every organization has specific information needs, Tecca says. "They need to know clinical quality, they need to know functional outcomes, they need to know patient satisfaction. But they also need to have information from financial and administrative areas and to integrate all the information together.

"Cost management is an issue for most organizations. The people who will participate in this have the quality issues down. But they are still learning about financial management. This enables them to enhance their cost and operations while maintaining quality."