This is a slide show of our Quality Manager Product and its value to Managing Quality data for reporting to CMS and analysis for improved outcomes.

1. Best Practices in Quality Management
October 2009
1

2. Agenda
• Introduction
• April McLain
• Dr. Sunil Rao
• Demonstration
• Q&A
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3. Technology Medical Partners
• We focus on Healthcare Providers
• Hospitals
• Large Physician Practices
• We provide Healthcare IT solutions
• To Executives who want to Improve:
• Profitability
• Compliance
• Quality
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4. TMP
The Meaningful Use Experts
• TMP has been focused on Healthcare Quality for years
• Meaningful Use = CMS Quality Core Measures (Plus other items)
• CMS
• Pay for Reporting
• Pay for Performance
• Value Based Purchasing
• ARRA
• Certified EHR
• Meaningful Use
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5. What Does VBP Mean to CMS?
 Transforming Medicare from a passive payer to an
active purchaser of higher quality, more efficient health
care
 Tools and initiatives for promoting better quality, while
avoiding unnecessary costs
 Tools: measurement, payment incentives, public
reporting, conditions of participation, coverage policy, QIO
program
 Initiatives: pay for reporting, pay for
performance, gainsharing, competitive bidding, bundled
payment, coverage decisions, direct provider support

6. Meaningful Use
• “CMS is expected to publish a formal definition of meaningful use, for
the purposes of receiving the Medicare and Medicaid incentive
payments, by December 31, 2009.”
• “Meaningful use of EHRs, we anticipate, will also enable providers to
reduce the amount of time spent on duplicative paperwork and gain
more time to spend with their patients throughout the day.
• “Meaningful use, in the long-term, is when EHRs are used by health
care providers to improve patient care, safety, and quality.
A Message from Dr. David Blumenthal, National Coordinator for
Health Information Technology
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7. Policy Committee Recommendations for the
Definition of Meaningful Use

8. Meaningful Use is Being Defined and Will
Follow an “Ascension Path” Over Time*
2009 2011 2013 2015
HIT-Enabled Health Reform
Meaningful Use Criteria
HITECH
Policies
2011 Meaningful
Use Criteria
(Capture/share
data)
2013 Meaningful
Use Criteria
(Advanced care
processes with 2015 Meaningful
decision support) Use Criteria
(Improved
Outcomes)
*Report of sub-committee of Health IT Policy Committee

9. Healthcare Industry
Key Quality Drivers
Cost of
Quality Compliance
Patient
Care
• Patients-Centered Quality Care
• Quality is a Board Level issue
Net Profit
• Compliance is Required
• CMS Pays for Performance
Better patient care costs hospitals less and improves patient outcomes
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10. Quality is Worth It!
• CEOs
• Quality Scores of You and Your Competition Net Profit
• CFOs
• Cost of Bad Quality
• Cost of Compliance & Reporting
• COO, CNO
• Nurse Staffing Shortages
• Administrative burdens
To maximize CMS Reimbursement, and your
bottom line, you need to proactively identify
Quality Improvement opportunities now.
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11. Flash Poll
Is there a CEO or Board Level mandate
to improve Quality?
Does this relate to Core Measure scores
or your reporting process?
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12. CMS Compliance
More important than ever before…
• Cost of Compliance
• Quality Reporting
Cost of
• State Reporting (HB 197) Compliance
• ARRA and Meaningful Use
• CMS Core Measure Reporting Process
• Over 100 Required reports of clinical quality
• Abstraction From Many Sources
• Manual Data = Error
• Time & Cost of Each Report
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13. From Reporting to Quality
How do you move from Quality
Reporting or “meets minimum”
To
Managing the Improvement to the
Quality of Care?
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14. Moving from Reporting to
Quality Management
• How does your Quality process stack up?
• Retrospective Review of Quality Data?
• Concurrent Review of Core Measures?
• Ability to drill down and analyze Core Data? Financial
• Process changes easily deployed?
• Strategic Quality Goals being met? Improving Impact
Process •Patient Satisfaction
Concurrent •Real Time Analysis •Core Measure Scores
Analysis: •Real Time Alerts
•Timeliness of Data •Trending Reports •Efficient Reporting
Efficient •Usefulness of Data •Rapid Changes to
Reporting Better Data •Extend to include process of care •Pay for Performance
•More people involved
Manual Real Time Access •More Core Measures •Access to useful real
Meet Minimum Workflow •Competitive
•More Reports time data
Late Notifications •Include more people •Incentives for change Advantage
Staff Limited
Level 1 Level 2 Level 3 Level 4 Level 5
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15. Its Not Just sending data
The tracking and reporting of Core Measure performance is a huge
amount of work which occupies multiple clinical staff members
“This is another unfunded mandate”
and
• Data is 3 months old
• Vendors don’t help with abstraction
• No Reuse of Quality Data
• Multiple Reports = Multiple Abstractions
Data does NOT improve Quality
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16. The Cost of Core Measure Data
CMS Core Measure Reporting data is
very valuable and cost a lot to obtain
• The Patient Impact of bad quality is already felt
• The Cost of Fixing the problem already spent
• The Cost to abstract the information is required
• The Cost of waiting for CMS reports is frustrating
What are you doing with this Core Measure Quality Data?
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17. Flash Poll
Do you have access to Real Time Quality Data?
Can you identify quality problems and fix them
easily and rapidly?
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18. April McLain
• MBA, RN, licensed RN in the state of Ohio
• Over 25 years of hospital operation and consulting experience
• Chief Nursing Officer (CNO)
• Director of Quality
• Hospital Surveyor, JCAHO
• Current Responsibilities
• Interim Director of Quality
• Current Holzer Process
• People, Vendor, Workflow, Data
• Shortcomings (e.g. Q1 reports just received)
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19. April McLain
• Expectations for 2009
• CEO Mandate
• Real Time Data (Concurrent)
• Improved Processes
• Reduction in FTE
• Executive Quality Dashboards
Applying the system to do Real Time reporting,
Using Real Time Data to Improve Care
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20. Dr. Sunil Rao
• MD, MBA
• Over 15 years of Healthcare Experience
• Clinical,
• Operational
• Quality
• Experience in applying Lean Process techniques
• Clinical issues and other dynamics involved in performance improvement for
healthcare processes involving physicians
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21. Dr. Sunil Rao
• A Physician’s View
• Evidence Based Medicine = Best Practice
• Learn and Improve
• Benchmark Performance
• Feedback
• On errors in real time
• A Desire to follow proper procedure
• Physician’s need for Core Measure data
• In the simplest format possible
• With easy accessibility
• Up to date and relevant
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22. Applying Technology to Obtain Benefits
•Real-Time Quality Measures for Improvement
• Get Data from Any System
• Populate Any Form or Dashboard
• Reduce Cost of Data Abstraction
•Improving Processes
• Eliminate Administrative Tasks
• Reduce Task and Process Times
• Notify, Escalate, Manage by Exception
•Increase Net Income
• Reduce Uncompensated Care
• Reduce the Cost of Compliance
• Improve Quality, Satisfaction, Profits
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23. CMS Quality Manager™
• Real Time Quality Data Quality
DBMS
• Abstraction
• Workflow Processes (PN, AMI, SCIP, HF, OP)
• Notification and Control
• Quality Improvement
• Management Platform
• Alerts, Reports, Charts, KPIs, Never Events
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24. CNO Executive Dashboard
• Board of
Directors Report
• Concurrent
Review
• Drill Down
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25. Quality Database
• Quality Reports
• Charts
• Benchmark Data

26. Quality Manager
• SharePoint Portal
• Role Based
• Secure Access

27. Abstraction & Reporting
Workflow
• Data Drop Starts
Workflow
• Data is checked
against Rule Sets
• Processes
Launched
• Tasks Assigned
• QI Staff Notified
• Alerts

28. Quality Reports
• CMS Quality
Reports
• PN
• HF
• AMI
• SCIP
• OP
• Extend
• JCAHO
• HB 197
• Any Report

29. CMS Quality Manager™
built on Microsoft Technology
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30. Champion Health Foundation
Monthly CMS Outlook Sample Only
Welcome Joe User Today is Friday, November 13, 2009
April 2008 May 2008 June 2007 2nd Quarter Print | Help | Log Out
Page 1 | Page 2 | Page 3
Patient Demographics
Monthly Revenues
Work Queue Reporting CMS Quality Report Request
8.7
Patient Name status Assigned File Attending Physician Oncology 20
24
17.9
John Gross Pending QIN 4223 4162 - Crabtree ER 22.5
Normal
18
Rockford
19.8
M e thodist
Surge ry 38.6
36
23
Radiology 25
20.4
0 10 20 30 40 50
Alerts
Alerts from last 2 days
Pneumonia Submissions
SCIP CMS Responses
Denial Rates
Work queue thresholds
more...
New Patient List submission CNO Message
DRG 461 March 1 – 4:03 A.M.
I’d like to take this opportunity to publicly thank the management team and
DRG 462 March 2 – 4:06 A.M.
employees for the incredible job that they’ve done. This is our first dashboard
DRG 437
Dietary March 2 – $119,500
4:06 A.M. and I am so excited at this team’s vision and grasp of dashboarding. The work
incorporates current Enterprise Dashboard best practices and I’m told beats our
competition’s dashboard.

31. CMS Quality Manager™
Return On Investment
• Cost of Compliance = $500K+
• FTEs for growing requirements
• Cost of training and change
• Risk = $ Millions
• 4% of Annual Payment (P4R + P4P)
• Cost of Uncompensated Care
• Cost of Bad Quality
• Quality Benefits = Priceless
• Real-Time Visibility of Quality Measures
• Competitive Advantage (Hospital Compare)
• Patient And Employee Satisfaction
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32. Sample ROI Model
Your Hospital's Financial
Overview of Savings Numbers Impact Scale Authority
Annual Net Patient Revenues $527,284,629 FY 2007 from AHD.com
Annual Medicare Payment $263,275,743 $5,265,515 2% Fines or possible Bonus
Annual Inpatient Claims 38,000 7,600 20% Number of I/P Reports per year
Annual Outpatient Claims 402,000 80,400 20% Number of O/P Reports per year
Approximate Number of Patient Claims per Year 440,000 88,000 20% Total Number of Reports per year to CMS
Amount at RISK with CMS Quality Data 4.00% $10,531,030 2% Fines for non-compliance
Reporting Process 2% Bonus for Performance
Cost of QI Nurse Salary $ 68,000 300 Days per year
Current 18 Reports per day per QI nurse
Reports per Day I/P 25 $95,704 1.4 Required FTEs
Reports per Day O/P (and others pending) 268 $1,012,444 14.9 Required FTEs
Proposed 50 Reports per day per QI nurse
Reports per Day I/P 25 $34,453 0.51 Required FTEs
Reports per Day O/P (and others pending) 268 $364,480 5.36 Required FTEs
Net Impact on Staffing and Productivity $709,215 Improved Reports / Day/ QI Nurse
Additional Improvements Improvements listed as a % of NPR (Notes below)
Quality Measures in Real-Time 0.07% $369,099 Faster correction of Quality Issues(2)
Improved Competitive Avantage from Quality 0.05% $263,642 Better "Hospital Compare" position (3)
Ability to secure P4P Bonus 0.03% $158,185 Bonus based on best in class reporting and quality (4)
Ability to rapidly change processes in support 0.03% $158,185 Process Changes rapidly deployed to staff (5)
Total Additional Benefit from Automation $949,112
Total Value of Cash Flow at Risk $12,189,357
as a percentage of Net Patient Revenues 2.31%
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33. CMS Quality Manager™
Early Adopters
• Holzer Medical Center Project
• Full Platform roll out in progress
• Case Study Published
• Early Adopters sought
• Discount over target market price
• CMS Quality Manager Appliance
• We provide the Hardware Server
• We provide all Software
• We provide all Services
• 3-4 Month Implementation
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34. Other TMP Services
• Methodologies for solving problems
• Executive Workout, Assessments
• Six Sigma, Lean, Continuous Improvement
• Requirements Definition, Program/Project Leadership
Methods People
• Additional Resources
• Added Capacity to deliver project after project Your
Success
• Dedicated and Experienced Team
• Wider view of market and solutions
Technology
• Standard Technology Platforms
• Complementary to existing and planned platforms
• Scalable, Secure, Robust, World class, Cost Effective
• Any Real Time Data, Any Hospital Process or Measure
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35. Summary & White Paper
Top 10 Things to do
1. Establish Executive Priority
2. Assess your current situation
3. Start Fast
4. Identify the Baseline
5. Align Incentives
6. Establish a repeatable approach (Program)
7. Data Flow
8. Work Flow
9. Cash Flow
10. Repeat
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36. Establish Executive Priority
• How important are Quality of Care, Core Measure Scores, and Patient
Safety to the overall executive leadership?
• Does the board know about the last “Never Event”?
• Do you look at the public quality core measures of your competition?
• In relation to the many other issues, how does this stack up?
• What is the “Burning Platform” for this to take precedence?
• What is it worth to improve? Budget? ROI?
CEO &
Board
Executives
& Directors
Clinical & Quality
Staff
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37. Assess your current situation
• How well are you reporting CMS Core
Measures?
• Are the scores as high as possible?
• How do you plan to improve them?
• Do you have real time quality measures for
action?
• What other quality measure or process is
more important right now?
• Executive Quality Dashboards in need?
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38. Start Fast
• CMS reporting is required and will continue to
change, getting more and more difficult.
• Make sure this is the best possible process you can have.
• Measures and source data is known, is the process at its
best?
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