Overview

Payers including the Centers for Medicare and Medicaid Services (CMS) are establishing pay for performance programs to reward healthcare organizations around the nation for performing well on industry standard quality measures. Healthcare organizations need to know where they stand with regard to quality performance since it will have a significant impact on reimbursement now and in the future.

TBS Response

Total Benchmark Solution, LLC’s (TBS’) goal is “to have the most robust solution for analyzing Quality Measures to enable Healthcare organizations to improve performance and Healthcare purchasers to make the best decisions when selecting providers.” TBS’s solution - Quality Benchmark Solution meets that goal. Quality Benchmark Solution provides healthcare organizations a solution to:

• Analyze over 700 Industry Standard Quality Measures from organizations such as Centers for Medicare & Medicaid Services (CMS), Joint Commission on Accreditation of Healthcare Organizations (JCAHO), National Quality Foundation (NQF), and Agency for Healthcare Research and Quality (AHRQ). Please visit Quality and Patient Safety Measures for a complete list
• Analyze any quality or patient safety measure your organization defines
• Analyze best demonstrated practice trends across healthcare organizations
• Analyze the potential bonuses, penalties and missed opportunities from CMS by care area

TBS analyzes your organizations' submitted data in its proprietary quality benchmarking solution that provides peer comparison (See Peer Groups for more information on our Peer Groupings) development and intuitive reporting methodologies. With this solution your organization has ability to run Unlimited Quality Reports, Unlimited Peer Groupings Analysis of Quality Measures, Unlimited Side by Side Analysis, Unlimited Best Demonstrated Practice Assessments, Unlimited Pay for Performance Reports and Trending Reports for any time period (Monthly, Quarterly or Annually).

TBS uses Quality Measure Disease Types and Domains to channel the quality measures into subsets allowing for analysis of the data at different levels. Below is a summary of the disease types that are analyzed with the quality measures, a detailed list of the can be found here Disease Types:

The quality measure domains that are included in the list of quality measures that TBS uses for analysis are (See Domains for a detailed list):

• Process of care - A healthcare service provided to or on behalf of an individual or population
• Outcome of care - The health state of an individual or population resulting from healthcare
• Access to care - An individual or population's attainment of timely and appropriate healthcare
• Experience of care - An individual or population's report concerning observations of and participation in healthcare
• Structure of care - A feature of a healthcare organization or clinician relevant to its capacity to provide healthcare

The Industry Standard Quality Measures TBS chose to use are the most functional measures available in healthcare today. Excelling in these measures will improve your organization’s performance and position your organization to gain from pay for performance. TBS developed criteria to select the most appropriate and significant Quality Measures. A Detailed approach to The TBS Criteria outline listed below can be found at Criteria:

• Importance of the Measure
• Scientific Soundness: Clinical Logic
• Scientific Soundness: Measure Properties
• Feasibility

Pay for Performance

CMS is one of the many organizations that will be offering pay for performance based on quality measures. As an example, hospitals below the performance median should be concerned because it may negatively impact their reimbursements. Hospitals above median have the opportunity to work to be the “best of the best” in the nation and qualify for the greatest possible incentive payments that payers will be offering.

Total Benchmark Solution, LLC. is committed to working with its healthcare provider clients and their users to provide the highest quality reporting tools and analysis to help maximize reimbursement through quality improvement. TBS’ Quality Benchmark Solution enables you to see where you stand on all CMS Pay for Performance measures. Please visit Pay for Performance for more information on how TBS can help maximizing Pay for Performance reimbursements.

Best Demonstrated Practices

TBS knows what it takes to achieve world-class performance in quality of care. We have interviewed many CEO's and Directors of Quality from the nations top performing hospitals and have developed Best Demonstrated Practice Assessment surveys, which allow you to view how your practices stack up with the best of the best. Please visit Best Demonstrated Practice for more information on TBS Best Demonstrated Practice Reports.

Know Where You Stand in Quality of Care

As an organization you should know the answers to the following questions:

• Do we know where our healthcare organization ranks nationally on industry standard quality measures (JCAHO, QIO, CMS, etc.)?
• Do we have a reporting tool that supports complex multi-entity organizations with a single common intuitive structure?
• Do we have a reporting tool in place that is going to help maximize our organization’s Pay for Performance through quality improvement?
• Do we have a reporting tool that shows easy to read, presentation ready graphics representing the important details for each quality measure?
• Do we spend too much time collecting data and not enough time with the important steps of Analysis and Change Management?
• Where should we focus our cost management initiatives in Quality of Care?

TBS has developed a solution that gives your organization the power to find the answers to these questions.

Benefits of the Total Benchmark Solution

The TBS Quality Benchmark Solution will allow your organization to:

• Manage organizational quality and patient safety measures
• Manage resources to improve quality of care and patient safety
• Increase Pay-For-Performance through quality improvement
• Effectively analyze and report on quality and patient safety measures for all healthcare organizations within your health system

Quality Measurement Assessment Checklist

• Did you analyze all of the CMS Quality Measures and Pay for Performance Measures that your healthcare organizations are subject to evaluation?
• Do you know where you stand today with regard to your performance on the CMS Quality Measures and your Pay for Performance measures?
• Did you meet the thresholds for Pay for Performance?
• Are you measuring your performance on the planned CMS measures and Pay for Performance measures on a monthly, quarterly and annual basis?
• Do you have a performance improvement plan in place for the CMS Quality Measures and the Pay for Performance Measures?
• Do you have abstracting standards in place?
• Are you doing chart abstracting audits (similar to how you have done audits on coding)?
• Do you have a method to measure and report on the future performance measures that Pay for Performance programs may adopt?
• Do you have a performance improvement plan in place for the future performance measures that Pay for Performance may adopt?
• For Healthcare Executives -- Are you ready to manage a new area that will impact reimbursement and profitability?

Why TBS?

• We bridge the gap between Quality Managers/Analysts, Physicians, Clinicians and the Executives/Administrators in order to facilitate organizational change to improve quality performance
• We provide a “common means” to bring together all quality measures across the continuum of care to facilitate change to improve performance in multi-entity healthcare systems
• We promote unparalleled effortlessness peer group creation so that organizations can determine where they are and where they can go to achieve world class quality performance
• We have developed “Best Demonstrated Practices” to help organizations not only understand where they stand but also what they can do about their identified opportunity areas