Targeting Your Performance Management Requirements: Tools for the Large and Small Provider MedTrade Fall 2008 Wednesday, October 29 Moderator Mary Ellen Conway President, Capital Healthcare Group Bethesda, Maryland

Distinguished Panelists Susean Nichols, President Millennium Management Services Floyd Boyer, RRT, RCP Affordable Health Care Consultants Tom Cesar, President Accreditation Commission for Health Care, Inc. (ACHC)

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Objectives 1.Review the CMS Final Quality Standards and overall accreditation Performance Management requirements that providers must meet 2.Provide simple tools for the provider to use to meet these requirements 3.Present new concepts (including the Balanced Scorecard System) for attendees to learn and incorporate into their processes. 4.Answer your questions regarding Performance Management

Developing a Performance Management Plan

Performance Management... includes activities to ensure that goals are consistently being met in an effective and efficient manner. Performance Management can focus on performance of the organization, a department, processes to build a product or service, employees, etc.

CMS Quality Standards, October 2008 Performance Improvement 1.The supplier shall implement a performance management plan that measures the outcomes of consumer services, billing practices, and adverse events. The data collection may target certain aspects of services that have a potential to cause harm or injury, occur frequently, creating a greater than expected number of adjustments, repairs, or replacement; or require significant instruction to assure safe use and benefit of items.

CMS Required Measures 2.Five Minimum Measures  Beneficiary satisfaction with and complaints about product(s) and service(s);  Timeliness of response to beneficiary questions, problems and concerns;  Impact of the supplier’s business practices on the adequacy of beneficiary access to equipment, items, services, and information;

CMS Required Measures Five Minimum Measures continued  Frequency of billing and coding errors (e.g. number of Medicare claims denied, errors the supplier finds in its own records after it has been notified of claims denial); and  Adverse events to beneficiaries due to inadequate or malfunctioning equipment, items or services (e.g., injuries, accidents, signs and symptoms of infection, hospitalizations). This may be identified through follow-up with the prescribing physician, other healthcare team members, or the beneficiary or caregiver.

CMS Required Measures 3.The supplier shall seek input from employees, customers, and referral sources when assessing the quality of its operations and services.

Developing Performance Measures What is the company mission/vision? What services do you provide? What issues are important to the customer? What benefits will be seen by the customer or internal customers? Understand the value of the results.

Developing Performance Measures continued How will these results effect and improve the organization? What can you measure and change? What data collection sources are available? How can we collect, adjust, and analyze the data?

Simplifying the Program C ustomer – Satisfaction – Complaints P rocess – Billing – Delivery, Education, etc. R isk Management – Adverse Events

Performance Management Cycle

Quality Continuum

Collecting Data Appropriate Accessible Relevant

Accreditation Common Deficiencies 1.Quality Improvement /Performance Management 2.Personnel Records 3.Policies and Procedures 4.Staff Education

Performance Management Tools

AUDITS Satisfaction Surveys – Patient – Referral Sources – Employees – Community Document, Track and Trend – Complaints (document dates and times) – Incidents – Adverse Events – Infections of employees and patients Billing and Coding Errors Number of Medicare claims denied, errors the supplier finds in its own records after it has been notified of a claims denial

AUDITS The approved accrediting bodies require audits, those required by CMS, and may also require additional ones, such as: An annual evaluation of the program service/care At least one aspect related to the service/care provided Client Record Review The accreditor’s standards also outline the required elements of an activity or study

The Balanced Score Card

A management system (not only a measurement system) that enables organizations to clarify their vision and strategy and translate them into action. It provides feedback around both the internal business processes and external outcomes in order to continuously improve strategic performance and results. When fully deployed, the balanced scorecard transforms strategic planning from an academic exercise into the nerve center of an enterprise. (Balanced Score Card Institute-www. balancedscorecard.org) The Balanced Scorecard is a tool/snapshot of whether you are achieving your Quality Objectives.

Focus of a Balance Score Card Financial Performance Customer Service Process Improvement Learning and Growth

Are your customers happy with your services?

Are your processes working well ?

Are you developing your work force? Learning and Growth Resources for employees to achieve high performance and personal growth General skills enhancement education and training Mentoring from supervisors and co-workers Employee well-being and satisfaction Enhancing corporate team work.

Example of Quality Objectives Achieve $$$ in Revenue Collect third-party reimbursement quicker Achieve % rating on Customer Satisfaction Shorten time delivery trucks are on the road Reduce losses from outdated products. Conduct two skills enhancement in-services for each employee per year

Balanced Score Card Objective 1st Qtr. July- Sept. 2nd Qtr. Oct.- Dec. 3rd Qtr. Jan.- Mar. 4th Qtr. Apr.- June YTDComments OwnerOwner StatusStatus Measurement Customer C1 - Achieve an overall 95% Customer Satisfaction rating for external customers only. -- Surveyor/staff rating -- Standards/accred add value 96.1% 97.1% 94.6%. 92.0%. 94.9% LKLK Y Reported Quarterly 95% or greater = Green % = Yellow 80% or less = Red C2 - Achieve customer loyalty through a 95% renewal of eligible renewals. 80%78%94.0%97.1%87% 67 of 69 companies renewed SHSH G Reported Quarterly 95% or greater = Green % = Yellow 90% or less = Red

Financial Performance