Problem: CMS Compliance Failures

If you are not in the top 20% of hospitals in the CMS core measures pay-for-performance program, then you are losing more than just a bonus payment. You are also at risk for reduced admissions as patients begin to select hospitals based on publicly reported outcomes data. Even worse, if you are in the bottom 20% of performers, you are likely to receive reductions in your payments in the near future.

Pay for performance has created an unrelenting pursuit of perfection, as it now requires a compliance score of nearly 100% to receive a bonus payment. Moving to such higher ground requires a radical rethinking of how work gets done – not only for the diseases covered under the pay-for-performance program, but for the organization as a whole. If you are not experienced in the art of innovation, this can be an insurmountable proposition.

Solution: Hardwire Critical Performance Processes

Achieving 100% compliance in CMS core measures is not as impossible as it seems. For the four primary core measures categories – AMI, CHF, pneumonia, and surgical care – there are only 32 process measures that must be adhered to. Do all 32 all of the time and top-decile performance is in your grasp.

The secret to achieving 100% compliance is to mistake-proof the process, making it altogether impossible for a defect to occur. strategicplanningMD is expert at designing and implementing mistake-proofing systems that are compatible with your operational structure and culture. We design systems specifically for your organization, rather than force the organization to change and adapt to an off-the-shelf solution that will only have short-term success. We:

  • Evaluate your current processes.
  • Conduct detailed feasibility analysis of your core measures program.
  • Model the CMS bonus payment system to determine potential financial impact.
  • Identify mistake-proofing opportunities to hardwire performance.
  • Recommend changes in specific job roles and responsibilities.
  • Create control systems to alert you to potential failures while they can still be corrected.
  • Conduct return-on-investment analysis of the entire initiative.

If you want to be a leading national performer in CMS core measures, then call us at 800-535-1559. We’ll show you the possibilities for adding pay-for-performance revenue to your bottom line.