Texas Health Resources (THR) is wading into the world of company transparency. Full disclosure is the right thing to do, according to Dan Varga, MD, THR’s chief clinical officer (CCO) and senior executive vice president.
THR plans to publish safety and quality information in greater detail than what is available at Hospital Compare and other websites. The challenge is determining what can be disclosed and how to do it, he says.
THR is attempting to transform itself from an acute-care hospital system to a cradle-to-grave health system that promotes life-long wellness. THR believes accountability is a strategic advantage. Picking the quality indicators is the central issue.
Varga became THR’s first CCO and represents the final step in the elevation of clinical leadership within THR. Varga was CCO at KentuckyOne Health in Louisville prior to his current position. He is at the same executive level as Barclay Berdan, chief operating officer and senior executive vice president.
Varga said he is not aware of any other U.S. community-based integrated delivery system that is contemplating this level of transparency. The complexity of doing so is a daunting task.
“With Geisinger (in Pennsyvania) or some other self-contained system, you can measure (quality) pretty accurately. We work with a very diverse set of partners. We have 500-600 employed physicians and 5,000 credentialed. Can we measure acute and ambulatory care accurately? For (THR facilities and physicians), yes. For others, probably not,” he said.
Varga said current quality measures are fairly limited. For example, hospital readmission rates are a “proxy (for quality). It is a failure-mode indicator for care transition to a post-acute environment but it doesn’t tell you much. It doesn’t tell you what care you provided, whether you coordinate care or how well it was coordinated. We may need to include identification of patients at risk for readmission. That’s the science we’re working through right now.”
The standards, Varga said, need to be reliable, consensus-based, actionable and ” mitigatable.”
“Take readmissions. There are things we can do in the hospital and in the immediate post-care transition to mitigate readmissions. They are actionable. You can set up an ambulatory clinic, have home care programs, use technology-based monitoring and have nurse-call programs. But these are not consensus-based programs,” he said.
Another issue is proper benchmarks. Varga said some standards are absolutes, such as wrong-site surgeries (“It’s not comforting if your rate is declining,” he quipped). For safety practices such as surgical checklists and hand hygiene, the expectation is 100 percent. In other cases, it is a ranking against peers.
“The criteria need to be: we don’t own the indicator, the rules are transparent, it is something we do, and everyone agrees it is a good indicator. You need to be able to deliver what you’re trying to deliver,” he said.
Varga pointed out that some criteria become difficult and less controllable as the care strays from THR’s control. Ideally, he said, THR could have an impact on population health indicators in Dallas-Fort Worth but the organization is not the sole player in the healthcare market.
THR is working with Healthways to attempt to risk-stratify patients in its accountable care organization. It is using utilization trends, family history, chronic conditions and well-being assessments to steer clinical resources toward those who are expected to require more attention.
“This is different than patient-centered care,” Varga said. “Think about individuals as resource consumers. You look at (allocating resources) at the population level rather than the individual level.”
Varga said he hopes to capture “the method and science” of quality-measure reporting by the end of 2013 and build the effort into THR’s long-range capital and clinical strategic plans through 2016.
“This is going to be a fun journey,” he said. “It makes you get better.”
Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at firstname.lastname@example.org.