TOOLS FOR IMPROVING QUALITY – Class 5

Tools for improving quality include:  Evidence Based Medicine or Critical Pathways or Care Maps or Medical Guidelines, Benchmarking, Electronic Medical Records, Total Quality Management (TQM) and Continuous Quality Improvement (CQI).

  • Consider disease management – whether it should address entire populations or target just those individuals at greatest health risk. An article looked at a nonprofit health plan in Minnesota with 680,000 members, Health Partners, that did both by using technology to predict levels of risk combined with case management to increase the health plans profitability by lower hospital admissions – used education of patient, intervention, etc. Using technology to predict levels of risk combined with other things including nurse interviewing patients and assigning patients to a risk level from likely to be hospitalized within the next three months to beyond two years. Return on income increased.
  • A glimpse of behind the scenes operationally of a OB/GYN practice in Massachusetts that has six doctors, four nurse midwives, three nurse practitioners who practice in two office locations and one hospital in Northampton, Mass. Malpractice premiums increased 50% last year. The use of information technology, using Greenway’s PrimeSuite system because it was user friendly and ability to integrate electronic medical record (EMR) with administrative, financial components, HIPAA compliance, train staff, resulted in overall improvements in practice organization, workflow, scheduling and billing. Time spent by staff processing charges and claims reduced by 50%, scheduling appointments decreased from 6 minutes to 2 minutes per appointment, register patients saved $10,000 in staff expense with new system, flexible, decreased accounts receivables from 62 days to 41 days, able to generate custom reports to track contracts and fee schedules of 25 different payers, proper coding (before 32% of codes were under-billed, 15% over-billed, 53% billed correctly and if were billed correctly with the old system, practice would have increased revenue by 9.5%). One of the most important reports run on the Greenway system is a report that compares billable providers to rendering care providers because when doctors contract with a payer they are assigned an identification number and because midwives and nurse practitioners are not always assigned individual numbers they often bill under their physician’s number; previously when run reports based on what billed, would identify charges provided by a nurse midwife but listed under a doctor’s name which impede ability to determine the productivity of the nurse midwives or nurse practitioners and now can run reports based on rendering care provider.

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