ACLP Quality & Safety SIG members have been tackling C-L Psychiatry’s ‘holy grail’—to demonstrate our value. They plan to publish a White Paper this year inviting discussion on defining quality measures and goals of care. In a short ACLP News preview series, they highlight pathways for moving forward. Here Soumya Sivaraman, MD, MSHQS, describes…
What is Vizient?
Essentially, Vizient is a company that provides analytic and consulting services to health care organizations. One of these services is a tool that ranks hospital systems against each other on the basis of how well they perform on quality measures—the Vizient Scorecard. This is one of several tools that many hospital administrators can use to track their hospital’s overall performance and compare it against peers across the nation. It can also be helpful for identifying areas needing improvement.
What is the Vizient Quality and Accountability Scorecard?
There are two scorecards: one for the hospital-based setting, another for the ambulatory setting. They look at data from all payers—not just CMS—thus giving organizations a better idea of the quality of care delivered to the broader population it serves. Domains within the scorecard help organizations identify areas of improvement in quality, patient outcomes, and lower costs in both inpatient and ambulatory settings.
The scorecard for the inpatient setting is an annual report for member hospitals based on patient-level performance data from a variety of different sources. These include the Vizient clinical database, CMS Core Measures, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey, and the Centers for Disease Control and Prevention’s National Healthcare Safety Network.
It ranks participating hospitals’ performance based on weighted domains under six categories: safety, mortality, effectiveness, efficiency, equity, and patient-centeredness.
The ambulatory scorecard ranks performance on access to care, continuum of care, quality, efficiency, and equity of care, with data derived from Association of American Medical Colleges-Vizient Clinical Practice Solutions Center, Vizient Access and Throughput Data, and the Vizient Clinical Data Base.
Why does the scorecard matter to C-L psychiatrists?
In an era of value-based payments tying reimbursements to the quality of services, C-L psychiatrists need to advance the discussion about how our services can lead to improved performance on the quality measures that are being reported to Vizient and other stakeholders and thus lead to cost savings and/or increased revenue.
One area where this has already been demonstrated includes hospital length of stay. General hospital inpatients with psychiatric disorders have prolonged lengths of stay compared to those who do not. Meanwhile, certain kinds of C-L Psychiatry interventions (e.g., proactive consultation) have been shown to reduce length of stay.
Other safety metrics—for example, the standard infection ratio of central line-associated bloodstream infections—can also be affected by psychiatric and behavioral conditions. Patients who are confused, agitated, or less able (or willing) to fully commit to their full treatment plans are likely to have more difficulty maintaining the integrity of their central lines, just as they are more likely to experience other safety events such as falls. These are examples of areas where more focused research led by C-L psychiatrists can identify new arguments for why investing in C-L Psychiatry is helpful not just to an organization’s mission but to its finances as well.