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CJR Program Success: Stick to Metrics That Matter

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Data can be a valuable strategic asset for hospitals. Benchmarked internally and to national best practices, it can be used to identify opportunities to lower costs as well as improve quality and patient outcomes. But hospitals only benefit when the right data is communicated in the right way to the right stakeholders at the right time.

This is a challenge, considering the sheer volume of data that hospitals monitor and measure on a daily basis. Hospitals track daily metrics for utilization, quality, finance, patient satisfaction, and department protocols, to name a few. And now, nearly 800 hospitals across the country have new data requirements to contend with: the Comprehensive Care for Joint Replacement (CJR) program will require participating hospitals to collect and report data for CMS’s mandatory bundled payment initiative.

Hospital administrators are trying to determine which metrics to track in an effort to comply with CJR, and while there is no singular path to success, one approach can serve useful to leadership:

Keep it simple.

Tracking an abundance of metrics does not translate into a more successful bundled payment program. In fact, only a small handful of measures can predict success or failure with bundled payments. Hospitals should thus focus on just a few metrics to start, selecting those that can be effectively managed, advance the program’s strategic and clinical objectives, and fall within the physicians’ sphere of influence.

The initial metrics that should be tracked are those that are directly tied to the CJR final rule, published in November 2015:

  • Hospital-level risk-standardized complication rate following elective primary total hip arthroplasty and/or total knee arthroplasty (NQF #1550)
  • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey measure (NQF #0166)

Once the CJR program has matured and leadership has evaluated what worked and what needs improvement in terms of standardized clinical practice patterns and cost variation, new metrics can be added to the program dashboard. We recommend starting with length-of-stay and readmission metrics that are likely tracked already within the department, adding program participation and post-acute metrics, and ultimately tracking total cost of care:

  • Average length of stay
  • 30-day readmission rate
  • Adherence to care redesign protocols
  • Participation in program design and implementation, including care redesign process, program education, and steering committees
  • Discharge disposition (percentage of patients discharged to home, outpatient therapy, home health, skilled nursing facilities, and inpatient rehabilitation facilities)
  • Percentage reduction in patients discharged to inpatient rehabilitation facilities and skilled nursing facilities
  • Percentage increase in patients discharged directly home
  • Total and average episode cost compared to CMS historical and regional targets

Data holds physicians and clinical teams accountable for their performance through the 90-day episode, and the way and frequency in which it is presented is as important as the actual metrics. CJR data should be timely, clear, and easy to read as it makes the data actionable for physicians. In terms of frequency, metrics should be shared monthly with physicians, clinical care teams, and administrators to set expectations, highlight important values, and present improvement opportunities.

Starting with a small number of carefully chosen metrics and presenting them in an effective manner can result in significant changes, in both outcomes and cost. Organizations are already investing in the analytics infrastructure necessary to track, communicate, and predict clinical, utilization, and financial data. Within CJR and bundled payment programs, it is crucial that hospitals identify the guiding principles around data collection, including the appropriate metrics, visualization, and stakeholder audiences. This will ensure the data translates into meaningful results and will enable actionable changes leading ultimately to better patient care and an improved experience.

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