Wise Quality America Introduces Optimize -- A Quality Performance System to Boost Hospital VBP Scores and Maximize Reimbursement

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New program addresses hospital reimbursement challenges under Value-Based Purchasing

Wise Quality America

A VBP score that is even a fraction lower than the norm can cost a hospital tens of thousands, even millions of dollars a year.

Wise Quality America today introduces a new quality-performance service, OptimizeTM, designed to help hospitals succeed under the complex new rules of Value-Based Purchasing (VBP), which this year begins dictating Medicare reimbursements to hospitals based on national quality measures.

A VBP score that is even a fraction lower than the norm can cost a hospital tens of thousands, even millions of dollars a year.

“We’re calling the service Optimize because that’s the essence of what we help hospitals do,” says Rebecca Wise, president and CEO of Wise Quality America. “It leverages everything we know about infusing continual improvement systems into the everyday work flow of hospitals and medical centers. These are very complex organizations under enormous pressure. So our emphasis is on making it simple. And of course effective.”

Simple is not a term most people associate with the massive new regulations of the Patient Protection and Affordable Care Act, which gave rise to Value-Based Purchasing as the new approach to funding government-sponsored healthcare.

The OptimizeTM service from Wise Quality America helps hospitals fully understand the requirements of VBP and the factors that contribute to their VBP score. Beginning in 2013, all US hospitals with Medicare and Medicaid contracts are being scored, and compared, on a matrix of publicly reported measures of clinical practices, patient satisfaction, and health outcomes.

Scores are published by the US Centers for Medicare and Medicaid Services. Hospitals falling below the median lose a percentage of their reimbursement; hospitals scoring above the norm capture not only what is due to them but a piece of the held-back money which CMS puts into a pool to reward better-performing hospitals. As the Patient Protection and Affordable Care Act is rolled out over the next several years, with a focus on performance, the potential impact on a hospital’s revenue streams will become increasingly significant

“The good news,” says Ms. Wise, “is that hospitals can improve their scores – and increase reimbursements – with proven quality management systems like ISO 9001. It doesn’t have to be ISO Certified, but there must be structure, not just effort. In addition, once Optimize is applied to the VBP processes, it can also be applied to other revenue-impacted measures such as readmissions and hospital acquired conditions. We know healthcare professionals are smart and very dedicated. That has never been the issue in hospital quality. It’s how well a diverse organization can perform collectively and reduce variation across multiple departments, personalities and workflows. A quality system is particularly important when individuals within the organization are so driven.”

Wise teams engage hospitals in a structured yet very collegial process. The company’s unique skills are derived from years in hospital management, accreditation, and ISO 9001 implementation.

The full scope of the OptimizeTM engagement depends on the size of the hospital and the extent of the issues causing its low VBP score.

Wise teams investigate all key processes relevant to quality in general and VBP indicators specifically. This entails visits to the clinical and ancillary departments that impact patient care. Findings are shared with hospital leadership and designated staff to ensure open discussion and problem solving. Before concluding, Wise Quality America delivers to the hospital an action plan for locking down process improvements and achieving higher VBP scores.

Wise Quality America is based in Cincinnati, Ohio, and delivers its services both nationally and internationally. Visit us at http://www.wisequality.com.

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Peter Greer
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