Posted: December 1st, 2022

Gauging Clinical and Financial Performance|Applied Sciences

Gauging Clinical and Financial Performance|Applied Sciences

Quality measures can help gauge both clinical and financial performance because they can be built using data about clinical and business operations that have associated costs or revenue. There are structural measures that focus on the physical environment (e.g. hospital rooms, staffing, equipment) or systems measures (e.g. the admitting process or surgical scheduling) that are often used to help inform financial performance along with reports about productivity, capital expenditures, accounts payable and receivable and reimbursement rates.

External

Externally, the relationship between quality and finance is supported by payment models such the Centers for Medicare and Medicaid’s (CMS) Value-Based Purchasing (VBP) system. This payment model reimburses clinicians and health care facilities based on their performance in specific quality measures that demonstrate efficiency and safety, because less redundancy in patient care can help save money, and avoiding complications means less unexpected costs. You can view a description of the VBP system by clicking here.

Internal

Internally, an organization can monitor financial performance by analyzing productivity in various departments and comparing actual expenditures to the quarterly budgets. If the data shows that specific financial goals are not met, then the organization can find out what can be done to improve the clinical and business processes involved.

Data, Data, Everywhere
Virtually every unit, department, and operation in a health care organization generates volumes of data that reflect their day-to-day activities. These data form the basis of the information that is used to monitor the quality of patient care, improve the organization’s processes, evaluate job performance, and comply with internal and external quality requirements. Quality measurement therefore, encompasses an entire organization, since every component employs processes, maintains some type of output (outcome) and utilizes capital and resources (costs).

Information Flow
Information flows throughout an organization from many different directions, and quality data can flow upward or downward. For example, the transcription unit of an HIM department shares its productivity report with unit staff, then the HIM department director, who then submits the information to a senior administrator, such as the Chief Information Officer. Conversely, senior management may communicate administrative data to the department level to educate middle management and first-level staff about the organization’s overall performance. In each case, the data generated at each level is used to compile information that indicates whether specific goals and objectives are being met, or if there is a need for improvement. Essentially, organizational quality data creates a composite picture of how well an organization is performing.

Quality Measurement
Quality measurement not only applies to every part of an organization, it also emphasizes the way each part is connected or related. This is demonstrated in the relationship between proper health care and financial performance, and the way that data is shared among departments. If there was no admitting department to collect data from patients, then the HIM department could not generate a medical record number, and the patient billing department could not create an account. The Strategic Planning Committee uses patient volume and utilization data from the Utilization Department to justify expansion of a clinical service. Therefore, it is important for all departments to be aware of their data requirements and have the ability to analyze and use data to improve quality.

Additional Resources
· Define Quality – And Then Enforce the Equation

· Understanding Publicly Available Healthcare Data

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