Quality metrics that are used in healthcare Centers.

There are hundreds of financial and quality metrics that hospitals and other care facilities are expected to track and improve on. As the Centers for Medicare and Medicaid Services (CMS) continue to add and modify quality programs, it can be difficult for hospital leaders to focus on the most vital and easily-improved metrics.

Quality metrics that are used in healthcare Centers.

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Naturally, individual facilities will focus on specific metrics depending on their current and ideal performance. While some hospitals prioritize financial performance, others may seek to improve the patient experience. Before we go into more detail, however, let’s first define “quality metrics.”

Quality metrics that are used in healthcare Centers.

What are hospital quality metrics?

Hospital quality metrics are a set of standards developed by CMS to quantify healthcare processes, patient outcomes, and organizational structures.

In value-based payment models, quality metrics are used to adjust provider reimbursement rates, offering a bonus in the event of above average ratings or a penalty for failing to meet standards.

Quality metrics that are used in healthcare Centers.

Below we’ve listed the top 10 essential hospital metrics to track, with examples from Definitive Healthcare’s comprehensive platform of market intelligence.

1. Length of Stay

Length of Stay measures the length of time between a patient’s admittance to and discharge from a hospital. This metric is most often tracked over months and annual quarters, though it can also be tracked over the course of a few weeks. Length of stay measurement can be used throughout a hospital or for a specific therapy area, such as acute myocardial infarctions (AMIs).

Quality metrics that are used in healthcare Centers.

This data is important because it provides hard data over time on care efficiency. Longer patient stays are associated with greater risk of hospital-acquired infections (HAIs) and other hospital-acquired conditions (HACs), as well as higher patient mortality rates. An exception to this rule are cardiac patients. Those admitted for heart failure see lower mortality rates with shorter hospital stays, but higher readmission rates. Like with other conditions, there is risk of releasing patients too early and overlooking potentially life-threatening complications.

Quality metrics that are used in healthcare Centers.

Patient length of stay also impacts hospital financial performance. Naturally, the longer a patient stays at a hospital the more money is required to care for them. In addition to patient care costs, CMS emphasizes shorter patient stays where possible, offering financial incentives to reduce the time patients spend in hospitals for an episode of care.

Quality metrics that are used in healthcare Centers.

2. Readmission Rates

Readmission Rates track the percentage of patients that are admitted into the same or another hospital within 30 days of being discharged for the same condition or a complication from the original episode of care. This metric measures quality of care given to patients. High hospital readmission rates indicate that physicians and other care providers are not delivering the proper care to patients, overlooking complications or relevant patient data. Lower hospital readmission rates, by extension, indicate a strong quality of care.

Quality metrics that are used in healthcare Centers.

3. HCAHPS

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures 64 markers of patient satisfaction. Topics included in the survey range from care quality to cleanliness of the care facility. Results from the survey are released as star ratings on a scale of 1 to 5, with 5 being the best possible score. HCAHPS scores provide actionable data on how hospitals can improve patient care and services offered.

Quality metrics that are used in healthcare Centers.

4. Mortality Rates

Patient mortality rate measures the percentage of patients that die in a hospital’s care before being discharged. This metric is a strong indicator of providers’ ability to stabilize a patient’s condition following surgery or another procedure. According to the Centers for Disease Control (CDC), the national average patient mortality rate is 2 percent, for a total of 715,000 patient deaths annually.

Quality metrics that are used in healthcare Centers.

5. Bed Utilization Rate

Bed Utilization Rate (also called Bed Occupation Rate) refers to the number of hospital beds being used at any given time. Knowing bed demand in real time is important to providers who need to know the difference between available beds and patients awaiting care.Balancing bed availability can be difficult. If occupancy is too low, the hospital is likely losing money through unnecessary staffing and facility maintenance. If occupancy is too high, care quality could decline because there aren’t enough clinicians to care for the admitted patients. According to Definitive Healthcare data, the average bed occupancy rate is 49 percent. The rate is higher for urban hospitals than for rural hospitals. Urban hospitals have an average bed utilization rate of 57.36 percent, where rural hospitals have an average rate of 36.36 percent.

Quality metrics that are used in healthcare Centers.

6. Incidents

Hospital incidents include unintentional consequences or side effects of hospital procedures, including conditions like sepsis, postoperative respiratory failure, pulmonary embolisms, hemorrhages, and other reactions or infections. This metric measures the ability of healthcare professionals to provide comprehensive, high-quality care to patients without triggering an adverse reaction.

Quality metrics that are used in healthcare Centers.

Tracking hospital incidents is vital to understanding the quality of care a facility is providing. Incidents provide hard data on what steps a hospital should take to improve its services as well as reduce patient mortality and readmission rates. According to Definitive Healthcare data, 784 hospitals reported receiving a penalty for hospital-acquired conditions in fiscal year 2019.

Quality metrics that are used in healthcare Centers.

7. CMS Program Performance

CMS spearheads dozens of initiatives aiming to reduce overall healthcare costs and improve care quality across the country. Some of these programs, like the Medicare Shared Savings Program, target Accountable Care Organizations (ACOs). Others, like Fee-For-Service Part B, target hospital spending. Regardless of the target facility or organization, CMS value-based programs offer financial rewards for improvement on a variety of clinical and quality metrics.

Quality metrics that are used in healthcare Centers.

8. Average Cost per Discharge

Tracking the average care costs per patient discharged can aid hospitals understanding of which therapy areas see overspending. Similarly, this metric shows where hospitals make the greatest profit as well as whether the costs associated with patient care actually improved the patient’s outcome. Cost per discharge is a dynamic measure that can be adjusted for a hospital’s case mix and other patient population demographics.

Quality metrics that are used in healthcare Centers.

9. Operating Margin

A hospital’s operating margin refers to the facility revenue after subtracting operating costs such as wages, medical equipment and supplies, rent, and other expenditures. To remain operational, hospitals must be able to pay these fixed costs without going into debt.

10. Bad Debt

Bad Debt refers to revenue loss that occurs when a hospital requests payment from a patient for care provision and does not receive the full amount. New, narrower guidelines were enacted as of January 1, restricting what qualifies as bad debt. Under the original guidelines, any lack of repayment was reported as bad debt. Now, bad debt is only valid if there was an event in a patient’s life, such as unemployment, that led to the inability to pay for their care.

Quality metrics that are used in healthcare Centers.

Quality metrics are used in healthcare are used to examine the quality of care in order to ensure high-quality care and ensure cost-effective healthcare. Two metrics at WellMed Medical Management include The Pink Box Report and star rating. The Pink Box Report is a type of dashboard used to track the rank and status of all recommended preventative care interventions, screening, and quality metrics for all patients at WellMed (Windh, 2016).

Quality metrics that are used in healthcare Centers.

Primary care providers are provided with the report as a spreadsheet indicating each panel member, and the rank on all measures. Primary care providers are supposed to reach out to their patients, book appointments, and complete all the appropriate activities for a year. Primary care providers are awarded bonuses according to the panel members and how best they address gaps in care. This ensures that healthcare providers provide high-quality care by ensuring effective and optimal provision of office visits, preventative care intervention, and screening of WellMed patients (Windh, 2016).

Quality metrics that are used in healthcare Centers.

A five-star rating is also used to rate and measure the quality of provided services. The health plans and healthcare services are rated on a scale of 1-5 stars, where the rating of 5 is the highest. A rating of 5 stars indicates that the health plans and services are of high quality, while a rating of 1 indicates poor quality (Ryskina et al., 2018). The rates are finally shared with all healthcare providers in the organization. Sharing of the results allows healthcare providers to improve on services and metrics having low quality, ensuring a better provision of care and other services.

Quality metrics that are used in healthcare Centers.