Using Technology to Avoid CMS Penalties

While hospitals seem to have an affinity for paper, paper forms are notoriously ineffective for tracking critical performance improvement information.

Using Technology To Avoid Cms Penalties

Two weeks ago, the Centers for Medicare and Medicaid Services (CMS) released this year’s list of hospitals being penalized – to the tune of 1% of Medicare payments – for patient safety penalties.

Eight hundred hospitals will see their Medicare payments cut – up from 751 hospitals the year before.

To make matters worse, 110 hospitals are being punished for the fifth-straight time, including Miami’s Jackson Memorial Hospital, the nation’s third-largest hospital with 1,756 beds and $1.2 billion in revenue. Jackson, which is also Florida’s largest hospital by revenue, will lose roughly $2.9 million because of the patient safety penalty. Add to that the hospital’s readmission penalty of approximately $1.6 million, and the total CMS penalty rises to about $4.5 million. If Jackson has any consolation, it is in the bittersweet knowledge that Baptist Hospital of Miami, the state’s second-largest hospital and Jackson’s close neighbor, is also on the penalty list – for the fourth time in five years. Baptist’s penalty is approximately $2 million.

If Jackson’s and Baptist’s woes aren’t enough to get your attention, then consider this: The 800 hospitals penalized this year are the most since the federal government launched the Hospital-Acquired Conditions Reduction Program five years ago. Although the program was supposed to incent hospitals to implement improvement programs to avoid the penalty list, more and more hospitals are finding themselves on this list and facing financial sanctions.

Is Patient Safety Getting Worse?

Despite the increase in hospitals being penalized for patient safety issues, patient safety in the United States is actually improving, according to a June report from the Agency for Healthcare Research and Quality (AHRQ). According to that report, from 2010 through 2014, the rate of hospital-acquired conditions decreased 17%. New data for 2014 to 2016 show an additional 8% decrease in hospital-acquired conditions.

While 8% might not seem all that impressive, the numbers behind the decrease are staggering, with an estimated:

  • 350,000 fewer hospital-acquired conditions,
  • $2.9 billion in costs saved, and
  • 8,000 inpatient deaths averted.

The Need to Move Away from Paper

Certainly, more still needs to be done, and the place to start is with all those paper incident report forms still being used by hospitals nationwide. While hospitals seem to have an affinity for paper, paper forms are notoriously ineffective for tracking critical performance improvement information. Why? First, those paper forms could easily become lost. Second, data entry is often a monthly or quarterly batch process, and by the time data is entered and analyzed, opportunities for improvement may be long gone. Third, manual data entry can be riddled with human error, which could lead to flawed analysis.

We would argue that to accelerate improvements in patient safety, we must harness incident report data in ways that allow us to analyze trends in real time so that we can implement data-driven improvements immediately. To that end, we must take advantage of Big Data, which uses sophisticated computational analysis to reveal patterns, trends, and associations – especially relating to human behavior and interactions – within very large data sets.

Big Data is not new – although it is new to healthcare – and it has already revolutionized other industries. In fact, in August, Towards Data Science listed “5 Industries Becoming Defined by Big Data and Analytics,” and although the website listed “Medicine” as No. 1, it excluded “Healthcare.” Medicine was on the list because of advances in telemedicine – specifically how practitioners are using “specialized equipment to track vital signs, assist with procedures, and make diagnoses” – not because Big Data was being used to make healthcare safer.

The other four industries on the list? Retail, construction, banking, and transportation.

But not healthcare.

How Technology Can Accelerate Patient Safety Improvements

There is little, if any, debate that Big Data has not been fully embraced by healthcare – although strides are certainly being made. However, we must quicken the pace, as Big Data holds the the next big breakthrough in patient safety improvements. For instance, a fully executed Big Data strategy will enable healthcare organizations to not only collect information electronically from a variety of sources, but also allow computational software to systematically review and analyze this information to create a better understanding and implementation of medicines, healthcare tools, procedures, and practices to ensure improved and safer care.

Because the power of Big Data has the potential to accelerate improvements in patient safety, Datix has devoted and invested substantial resources in the development of robust computational software applications, specifically DatixWeb and Datix Cloud IQ. These next-generation patient safety software solutions can continually mine data in real time, generating flags and alerts that can prevent negative events from occurring.

Today, we have only scratched the surface of Big Data technology. Still, we are confident that if the 800 hospitals on CMS’s penalty list had a fully integrated, electronic incident reporting system that provided ongoing data mining, alerts, and improvement strategies, they wouldn’t remain on that list for long.

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We will respond to your query and deal with your personal data in accordance with our Privacy Policy. If you are an organisation already benefitting from, or likely to benefit from, Datix’s products and services, we may get in touch with you to consider this further.