This special issue of the Journal for Healthcare Quality (JHQ) called for papers on quality as a business strategy across the healthcare continuum. The response to this call brought several submissions, with topics representing improvement efforts aimed at lowering costs, improving reimbursement and case mix index, and increasing efficiencies. Improvement strategies for this special issue included acute care hospital, clinic, and community health settings with emphasis on innovation to achieve value-driven care.
From the papers selected, organizations that demonstrated the adoption of quality as a business strategy were able to show how this approach has impacted operating margins, value, and growth, while demonstrating that there is a relationship between an investment in quality and quality processes, as well as associated improvement in both clinical and financial outcomes. The focus areas of the specific quality as a business strategy topics in these articles represent the healthcare continuum from both acute and postacute care settings such as academic medical centers, acute inpatient, skilled nursing facilities, and health centers. Key highlights from the articles selected for this special issue follow.
Toumbs et al describe an approach that examined the relationship between the use of stroke documentation templates and trainee education and the impact on clinical documentation accuracy. Achieving optimal and accurate clinical documentation and data capture are requirements for any large healthcare system, but achievement is especially challenging in academic settings where medical trainees provide a significant proportion of care delivery. The outcomes of the work described significantly improved case mix index and expected length of stay, two factors that impact reimbursement as well as performance on stroke metrics as compared to benchmarks.
Healthcare-acquired conditions have financial implications for healthcare settings. Polancich et al describe an improvement project that pilot tested a systematic methodology for comparing costs for patients with and without hospital-acquired pressure injuries in an acute care setting. They found that although efforts to quantify the cost for care for patients with and without adverse events is challenging, focusing on the cost of adverse events can assist in validating the return on investment for quality processes and care.
The work of Lassen et al focuses on alternative payment models and their relationship with patient-level outcomes such as complication rates and operational differences between hospitals that participate in the Centers for Medicare and Medicaid Services (CMS) value-based initiatives. Their efforts yielded information suggesting that two CMS-bundled payment programs, the Bundled Payment for Care Improvement model and the Comprehensive Care for Joint Replacement model, should be further studied as they impact patient populations differently in different care settings.
Hogan et al examined the relationship between hospital vertical integration into skilled nursing facilities (SNF) and 30-day readmission rates for pneumonia and heart failure. Their findings demonstrated that hospitals that vertically integrated into a SNF experienced a reduction in hospital readmission rates for only one of these disease categories, indicating mixed evidence on the impact vertical integration has on readmissions in different types of hospital settings.
Strockbine et al described their findings related to work done to evaluate the effectiveness of a clinical decision support system (CDSS) on reducing unnecessary phlebotomy testing. They identified significantly fewer unnecessary tests after a CDSS was implemented, which resulted in cost savings. Furthermore, they suggested that with additional interventions with key stakeholders, the likelihood of additional savings would be enhanced.
These articles are examples of the robust improvement activities that interprofessional teams across the continuum of healthcare engage to improve the quality of care. These programs result in improved patient outcomes while decreasing costs and maximizing both reimbursement and value to patients treated within various healthcare settings.
Others, such as Modica et al recognize that focusing on quality is a business imperative and are taking new approaches, through the creation of a value transformation framework to drive change necessary for realizing value-based care in federally qualified health centers. This article describes foundational work done to develop their framework and illustrates the early benefits and impact of their model on community health centers as they work toward achieving the Quadruple Aim goals of improved health outcomes, improved patient experience, improved staff experience, and reduced costs.
Few healthcare systems have the resources to do the important work to systematically develop innovative models of care resulting in improved quality and safety while maximizing reimbursement and decreasing associated cost of care. Despite the differences in healthcare settings and populations served, the future of healthcare value will be dependent on embracing quality as a business strategy. The papers in this special issue are important because they demonstrate that by leveraging quality as well as quality structures, processes, and high reliability systems, we can achieve better clinical and financial results and, in turn, address-shared goals for value across the healthcare continuum.