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Hospital performance should be measured in terms of patient outcomes

10 November 2015 Dr Bobby Ramasia, Bonitas
Dr Bobby Ramasia, executive principal officer of Bonitas Medical Fund.

Dr Bobby Ramasia, executive principal officer of Bonitas Medical Fund.

Dr Bobby Ramasia, executive principal officer of Bonitas Medical Fund says that although recent efforts to measure hospitals’ performance are one dimensional, they are a step in the right direction.

“Performance measures should be closely related to patient outcomes rather than subjective patient experiences,” he says.

The initiative announced by Discovery last week follows a similar exercise in which the Centres for Medicare and Medicaid Services in the USA issued a rating scale based on patients’ experience in April 2015. Similarly, the World Health Organisation has a performance assessment tool for improving quality of care in hospitals which measures 124 indicators of hospital performance.

In 2008 an implementation pilot was rolled out in 37 hospitals in a number of countries including South Africa. The pilot test identified a number of challenges in the design and implementation of international research on hospital performance assessment.

However, despite the challenges, hospital performance measurement has proved to be an effective way to drive improvements in the quality of care delivered in hospitals.

Bonitas currently measures hospital performance according to cost efficiency, quality and patient experience at individual and group level.

“Case-mix adjustment techniques allow Bonitas to compare hospitals on a like-for-like basis. This allows us to contract with the top performing hospitals and include them in our hospital network

“The profiling of hospitals extends to the associated providers linked to a hospital admission. Understanding costs related to the total cost per event, rather than the direct hospital costs alone is crucial in monitoring and managing the quality of hospital-based care,” he explains.

Bonitas has also developed and implemented several quality assurance measures based on best practice and internationally accepted standards to measure quality in hospitals.

“These measures are risk-adjusted where appropriate using different methodologies and benchmarked against international standards,” says Ramasia.

A range of quality metrics are also in place which measure:

• In hospital mortality rates
• All-cause readmission rates
• Unplanned readmission rates
• Ventilator-associated pneumonia
• Surgical site infections
• Retained surgical objects

Ramasia says that although the results of these monitoring systems are not made public, they are shared and discussed during quarterly meetings with each hospital group.

“Hospitals are required to advise and report back on their initiatives to improve and address inefficiencies and quality issues” he says.

Bonitas has plans in place to expand and fine tune the hospital performance system. The scheme is expanding its existing “voice of the member” survey which is completed when members are discharged from hospital. Although the data is subjective, they do provide an indicator of hospital quality from a member’s perspective.

“This information can be interpreted together with quality data to identify any specific issues which will be subsequently addressed with the hospitals with a view to enhancing quality of care,” he says.

However attention should focus on finding and agreeing on measures of healthcare quality that are closely related to patient outcomes and then making them public. Only then will performance measurement live up to expectations for improving health care quality.

“The ideal scenario would be for the Department of Health, medical schemes and hospitals to collectively agree agreeing on a set of metrics and make the results available to the general public. This would really drive improvements in the quality of healthcare being provided to patients,” Ramasia concludes.

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