Identifying and Realizing Pay-for-Performance Opportunities

A large academic health system in the Southeast engaged ECG to conduct a comprehensive assessment and develop and implement a multifaceted work plan to help the system realize $12.4 million in incentive payments over three years for three primary metric areas:

• Harm avoidance and patient safety 
• Imaging stewardship 
• Unplanned readmissions

The ECG team identified historical barriers within the health system that impeded the organization’s ability to implement significant, sustainable improvements in P4P-associated quality metrics, including:

• Provider, staff, and IT bandwidth
• Inconsistent accountability and escalation paths
• Deficient or absent control plans
• Challenges with quality research dissemination
• Usability and functionality of the EHR
• Lack of real-time, actionable data

Through a close partnership and structured approach, the health system and ECG overcame these barriers to implement meaningful change and move quality performance measures toward benchmark targets.

ECG provided clinical and technical subject matter expertise through structured interdisciplinary work groups to reduce clinical variation and help the health system achieve both benchmark performance and improvement points in the following focus areas:

MRSA

• Implemented risk-based MRSA screening workflows 
• Established an evidence-based intervention bundle for patients who test positive for MRSA 
• Developed quality-metric reporting and bundle-compliance dashboards

SSI

• Implemented preoperative risk screening and patient optimization protocols 
• Educated surgeons on “present at time of surgery” documentation 
• Developed validated quality-measure reports for SSIs

ED Imaging

• Created new ED care team imaging workflows 
• Educated the ED care team on new workflows 
• Developed validated quality-measure reports for ED imaging

OP Imaging

• Developed validated quality-measure reports for OP imaging 
• Created new OP care team imaging workflows 
• Educated the OP care team on new workflows prior to implementation

Readmissions

• Determined postdischarge follow-up visit demand for patients with high risk of readmission 
• Hired medical scheduling coordinators 
• Developed and implemented a new hospital follow-up appointment workflow

ECG also developed an analytic and reporting framework to help the organization monitor the effectiveness of newly created clinical decision support alerts, which was not possible using existing EHR tools or capabilities:

• Developed SQL queries and customized tableau dashboards to easily visualize real-time performance, facilitating adherence to best practices
• Transferred analytic reporting package and dashboard files to embed in the health system reporting infrastructure

This analytic service equipped hospital leadership with self-service tools to monitor adherence to clinical workflows, evaluate patient outcomes, and adjust clinical decision support tools using data-driven insights.

Based on current performance, ECG projects that between FY 2023 and FY 2025, the organization may earn up to $12.4 million in P4P quality incentive payments.

The organization is projected to earn $8.7 million in Harm Avoidance and Patient Safety financial incentives, $5.4 million in Imaging Stewardship financial incentives, and $0.6 million in Readmissions financial incentives.