David. J. Murray, MS, BS, CCEP, CHPC, CCO for Colorado West HealthCare System, spoke to the 6th Annual Becker's Hospital Review Meeting about not only his board fiduciary responsibilities, but also government legislation linking quality and risk.
In his current role, Mr. Murray has been asked to complete strategic planning and conduct quality, risk management and oversight. There are no silos between divisions in his organization, which support clinical staff and patients.
As part of his position, his board fiduciary responsibilities include:
1. Answering to various government agencies that can inspect a hospital.
2. Being aware of rules and regulations that change constantly.
"If anyone who specializes in compliance tells you they are an expert, they are fibbing. These change almost every day," Mr. Murray said.
Responsibilities and accountabilities of the board and senior management include:
1. Submission of accurate claims and information
2. Referral statutes
3. Payments to reduce or limit services
4. Relationships with Federal healthcare beneficiaries
5. HIPAA
"We have understand the complexity of our patients from the clinical side from the ambulatory through hospital," said Mr. Murray
To clearly define quality, Mr. Murray says it includes six aspects care must be:
1. Safe
2. Effective
3. Patient-Centered
4. Timely
5. Efficient
6. Equitable
"Healthcare organization boards have distinct fiduciary responsibility," said Mr. Murray. "Quality is also an enforcement priority for healthcare regulators."
Mr. Murray and his organization also look at underutilization and overutilization as well as risk, patient safety, incident reporting, push for enterprise and risk management across all systems, not just one hospital. The incident reporting data is then tracked to look at compliance issues.
As a whole, Mr. Murray says he gets involved in quality and risk management hands-on only when things get broken, but his job also entails looking at patterns of issues.
In terms of government enforcement of quality and compliance, the OIG model compliance provides quality oversight, medically necessary services, over/under utilization of those services. Guidance for Model Compliance Guides also provides quality initiatives and links in each guide.
"Our corporate compliance division has security, privacy, risk management and safety, quality accreditation and licensure and internal audits. We have great coordination across these functions," says Mr. Murray.
Furthermore, if a patient has no primary care, there will be a high priority for telephone follows ups with nurses from case management groups. If the health system is able to target groups for transitions of care communication, the results from consolidating admissions into one stay in a specific hospital example saw a decrease in readmission rate and a decrease in cost.
After looking at the populations of his region and data mining, Mr. Murray found gaps in care and ways to improve patient transitions. His findings, after making phone calls to patients, also found:
1. 972 Patients empanelled at Grand Valley Primary Care (GVPC) are diabetic
2. 81 have not been seen within the past year
3. 62 are School District 51, two of which have not been seen within past year
4. 111 GVPC patients visited Grand Valley Urgent Care (GVUC) in past year, totaling 353 visits
5. At one point, 367 diabetics had their last HbA1C = 9 or higher
This lead Dr. Murray to see that there was a financial barrier to care that was keeping patients from the primary care. These findings also lead to longitudinal chronic care management with outcomes tracking, aggressive inpatient management, as well as diabetic education, partnership linkages, provider education and feedback loops on patients. This lead to no more avoidable visits in the ED and improved after-hours access to care.
Mr. Murray also looked at variance in cost of treatment from various providers, such as total joint replacement with and without co-morbid conditions, and average operating room charges. The average operating room saw a lot of waste financially.
"I saw we had no control of vendors coming in the back door. I was highly interested in that and we put a stop to that. Surgeons were having vendors come in and implant anything they want and the vendor was given a PO there in the surgery suite, and I never saw such a thing," said Mr. Murray. "We don’t have that anymore but we have to normalize the spending. The object is usually to at least break even but certainly not lose money."
If a physician wants to go off the standardization of supplies, they better have a "darn good argument," said Mr. Murray.
Mr. Murray also saw a huge increase in professionals meeting core measure requirements and other benchmarks after they changed their reporting to a monthly reporting feature.
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