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Hospital Ratings' Impact on HIT

August 22, 2016

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Last month, in the latest step in its Hospital Quality Initiative, the Centers for Medicare and Medicaid Services (CMS) introduced a new five-star ratings system for U.S. hospitals.

The very-public Hospital Compare site, designed to be a go-to consumer resource for comparing medical facilities, puts new onus on healthcare providers to put their best foot forward. And with only two percent of hospitals obtaining the coveted five-star designation thus far, there’s plenty of room for improvement.

Specifically, providers will need to focus on the 64 measures impacting the star ratings outcomes. The measures fall under seven weighted categories including mortality, safety of care, readmissions, patient experience, effectiveness of care, timeliness of care, and efficient use of medical imaging.

Clinical measures influencing the ratings focus on heart related issues, stroke, pneumonia, hip and knee replacements, surgery complications and infections, with readmissions factoring in heavily. Much of what the industry has already seen by way of EHR adoption focuses on capturing and sharing data that falls under mortality and safety and effectiveness of care categories. The next phase of gleaning insights from that data is presently in full swing as facilities clamor to adopt analytics resources that can help them derive actionable insights from the data now being captured.

Hospital ratings measures also place particular emphasis on patient experience, which is among the highest-weighted categories in the ratings algorithm. Patient communication with nurses and doctors during the hospital stay, as well as patient care and recovery instruction post-discharge factor in largely. Investments in patient portals, remote patient monitoring, telehealth, and admissions/discharge/transfer (ADT) coordination are already entering the market with additional investments in broader patient communication platforms anticipated.

While it’s doubtful that things like SMS and social media correspondence with patients will show up as line items in the hospital ratings algorithm, it is highly likely that hospitals looking for a competitive edge will adopt the platforms as new patient engagement channels for better coordinated care. That move towards more narrative patient data will foster the need for additional investments in unstructured data management solutions.

The timeliness of care tier of measures makes emergency room (ER) workflow an additional area of focus for providers looking to improve or maintain their overall ratings. These measures make it necessary for providers to have a good handle on not just the overall time patients spend in the ER, but the incremental time periods spent there as well, including how long it took for patients to be admitted, to see a care giver, to receive pain medication and to be assigned an inpatient room. Tech platforms like Clockwise.MD are entering the market to help providers monitor and streamline patient wait times.

Heightened consumer awareness of public ratings data will undoubtedly drive provider-side attention to maintaining favorable ratings. Regardless of how hospitals elect to prioritize the bevy of HIT initiatives that could impact their performance on the new ratings scale, strong HIT governance will be paramount to pulling it all off. A well-conceived plan, coupled with well-designed infrastructure, will go a long way towards helping providers plan for the long-term picture as expanded ratings measures emerge.