Harmony Healthcare Blog

2017 AHCA Provider Lounge Series: Quality in a Data-Driven World

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Tue, Dec 19, 2017

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Edited by Kris Mastrangelo

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Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Interview with Mark Parkinson, President and CEO of AHCA

Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Mark Parkinson, President of the American Health Care Association (AHCA), in the 2017 AHCA Provider Lounge. Governor Parkinson assures providers that despite the new regulations and census issues facing providers this year, there is light at the end of the tunnel.   (Audio transcription below).

 

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Transcribed Audio:

Kris Mastrangelo:   Great!  Welcome to the Provider Lounge American at American Health Care's 68th Annual Convention.  Today we have Mark Parkinson, President.  Thank you so much for coming.

Gov. Mark Parkinson:  Happy to be here.  Thank you for having me.

Kris:  Well there's a lot of discussion, a lot of questions and guidance needed by the industry and you did a wonderful keynote yesterday.  So, for those that couldn't join us maybe you could summarize it for the viewers.

Gov. Parkinson:  Sure well in a nutshell what we talked about yesterday was it's really tough right now to operate.  I think every year is tough.  It's just the normal work that we do in our buildings is really hard.  We also have to face the normal pressures on reimbursement and regulation.  The reason I think this year is super tough is because of census. You know in a lot of markets around the country census is down and assisted-living it's down because there's been too much building, in skilled nursing it's down because the length of stay has dropped particularly in post-acute the managed care companies are pushing people out of our buildings.   The accountable care organizations are doing that somewhat too.  So, on top of all the challenges that we normally have now we have a census issue.  My speech yesterday was that even though we have these problems I think that the future can still be bright because we're united as a sector in DC and I think we're stronger than we've ever been, because the quality in buildings is going up and the data proves that and because the aging of the population is finally going to start helping us I think that there is light at the end of the tunnel…and particularly for operators that are really good, super good, on quality indicators they're going to be included in all the future networks so they'll be in all the managed care contracts,  they'll be in all the accountable care organizations and so even though their length of stay will decline they'll have more volume and that will make up for a lot of the losses.  So, honestly, I was just trying to give the member some hope yesterday that despite as challenging as it's been that there are some good things that are going to happen.

Kris:  That's great and there are there are a lot of great things happening at the facility level like you said with quality measures, CQI, QAPI, compliance and there are a lot of more resources that are being put into the organization.  Is the government aware that if this amount of attention and resources are put into an organization that they have to be compensated for it?

Gov. Parkinson:  You're right.  Every time they issue a regulation it takes time away from all of the other stuff that we're doing.  Our belief is that we're all in this for quality.  Operators are in it for quality, the families and residents are certainly in it for quality and even though our members would disagree sometimes even CMS, that's what they want, they want quality outcomes.  We think the logical thing to do is for them to emphasize the quality measures in five-star – judge us by how we do on those, don't judge us by all this extraneous other irrelevant stuff and that's the problem with requirements of participation; even though you can look at individual parts of it and say it makes sense, what it's going to force our operators to do is to take their time away from the stuff that really matters which are those quality indicators.  I don't think the government really gets it.  I think they think they can just throw on an unlimited amount of stuff and somehow, we can absorb it, but we can’t.

Kris: And I agree, it's daunting.  I don't sleep.  I read everything.  Did I hear you say that maybe if they put together, if the five-star, there's sixteen quality measures but yet we have a total of 43 quality measures out there and then we have a set of QRP.  Are you implying or recommending that the five-star is the value-based purchasing?

Gov. Parkinson:   I think that there are too many things. I think they should decide on one set of quality metrics.   We should go after one set of measurements.  It sort of makes sense to us at AHCA that it would be the sixteen QMs that are in the five-star and then judge us on that.  We think that the five-star system should be based on the QM and should not be based on survey.  Right now, your survey controls about eighty percent of your five-star rating so what do we do we focus on all of the stuff to get a good survey.  If instead your base score was set by the QMs we would spend all our time working on the QMs which is what it should all be about in the first place.  We're actually putting together a proposal like that to take over to CMS early next year.

Kris:  Oh, that's fantastic because it is the average consumer - the patients, the organizations - they're not as savvy on value-based purchasing, QRPs…they just know it's a lot of stuff to do.  So, there are three different measures for rehospitalizations: QRP, value-based purchasing and five-star.  So that's difficult and the last comment is everyone's talking about data which of course we agree we like data, we like to analyze it and use it with QAPI, however, the data can be overwhelming just like the regulations.  So therefore, simplifying the data would be an advantage and having that to have the metric to function on.

Gov. Parkinson:  I completely agree you can measure too many things and you know we're now on our second iteration of the quality initiative is a good example.  The first iteration had four metrics that we asked people to hit.  They could understand those and there was a lot of focus around those and our second iteration we ourselves were probably guilty of this and adding too many things.   CMS has certainly done that.  We needed to figure out what is it that really matters.  Patients should be treated well, they    should be fed and helped, they should be kept in a safe environment, they should receive the care that they need.  We can all agree on that.  We need to focus on just a few ways that we measure that and that we incentivize people to achieve it.

Kris: And simplify.  The final comment is that if the facilities, the providers, are going to be measured on these metrics they need to have the data faster.  You can't execute your hospital readmissions if it's a year outdated you need and by the way, like the goal is quarterly but it's still too late.  If you're going to have pay-for-performance based on that measure so…but there are a lot of exciting things, there's a lot of complicated things, but we're very grateful to have you as the leader.  And I have to say that I am endorsing him for president of the United States.  I say this every time I see him because you have such a great reputation, do such a good job so I'm going put that on tape. 

Gov. Parkinson:  Well, thank you very much I appreciate it.  Thank you for doing the good work that you do on this as well.

Kris:  Thank you so much.


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Tags: Five-Star, Quality Measures

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