Brad Beauvais

Does Money Really Matter? The Effects of Fiscal Margin on Quality of Care in Military Treatment Facilities

This study was prompted by an escalating interest in the quality of healthcare provided within the United States. The authors hypothesized that one determinant of quality is the adequacy of financial resources available to the healthcare organization. The authors addressed their question by using data from two Defense Department sources: the 2003 Health Care Survey of Defense Department Beneficiaries (HCSDB) and 1999-2003 data from the Department of Defense Medical Expense Performance Reporting System (MEPRS). The authors used a measure of military treatment facility fiscal margin to predict seven Consumer Assessment of Health Plan Satisfaction (CAHPS) quality dimensions. Regression analysis and multilevel modeling are the primary statistical methods. Results indicate a significant and positive association between organizational financial strength and quality outcomes. This finding indicates that organizations with more financial flexibility may be more adept at meeting or exceeding patient care expectations.

Healthcare quality in the department of defense.

ISSN: 0018-5868 (Print) 1939-9278 (Online) Journal homepage: http://www.tandfonline.com/loi/vhos20 Healthcare Quality in the Department of Defense Brad Beauvais , Paul Brezinski & Eric Schmacker To cite this article: Brad Beauvais , Paul Brezinski & Eric Schmacker (2008) Healthcare Quality in the Department of Defense, Hospital Topics, 86:4, 33-37, DOI: 10.3200/HTPS.86.4.33-37 To link to this article: http://dx.doi.org/10.3200/HTPS.86.4.33-37

Patient-Centered Medical Home Implementation Effects on Emergency Room Utilization: A Case Study

Abstract The Patient-Centered Medical Home (PCMH) concept has been commended for its potential to increase access to primary care while improving quality and health outcomes. Numerous studies have documented the benefits of the PCMH healthcare delivery modality inclusive of decreased emergency room (ER) visits among PCMH enrollees. Yet a debate wages on whether PCMHs are conceptually sound and clinically effective with few empirical studies dedicated to the study of this relatively new care delivery model (Friedberg et al. 2014; Agency for Health Research and Quality 2012; Cassidy 2010). As part of the campaign to implement the PCMH care delivery modality throughout the Military Health System, the Army Medical Command constructed a medical home at Ft. Campbell, Kentucky, in December 2010. The authors evaluated the effectiveness of this medical home in reducing ER visits and found enrollees were 67% less likely than standard primary care clinic enrollees to visit the ER when controlling for age, gender, race, beneficiary category, marital status, and outpatient visits. Additionally, men were nearly half as likely as women to visit the ER, and high outpatient users were twice as likely to visit the ER. This is an encouraging study for proponents of the PCMH model. Limitations and suggestions for future research are also presented.

Quality Indicators Associated With the Level of NCQA Accreditation

The National Committee for Quality Assurance (NCQA) is the most widely used accrediting body of health plans, but no study has explored how differences in health quality affect the accreditation level. Consumers may benefit as they guide health insurance purchasing decisions toward a cost-quality evaluation. The authors conducted a multinomial logistic regression analysis using data from the 2015 NCQA Quality Compass of 351 health plans. This study’s outcome variable represented NCQA accreditation at 3 levels: accredited, commendable, and excellent. The authors examined the relationship of patient satisfaction, monitoring and prevention activities, appropriate care, and readmission rates on accreditation level. Satisfaction and monitoring and prevention activities were significantly associated with higher levels of accreditation in all analyses, but readmission was not. The expanded coverage of the Affordable Care Act provides an opportunity for health plans to market to consumers the benefits of accreditation to foster higher quality care.

Fix These First: How the World’s Leading Companies Point the Way Toward High Reliability in the Military Health System

EXECUTIVE SUMMARY The 2014 Military Health System Review calls for healthcare system leaders to implement effective strategies used by other high-performing organizations. The authors state, “ the [military health system] MHS can create an optimal healthcare environment that focuses on continuous quality improvement where every patient receives safe, high-quality care at all times” (Military Health System, 2014, p. 1). Although aspirational, the document does not specify how a highly reliable health system is developed or what systemic factors are necessary to sustain highly reliable performance. Our work seeks to address this gap and provide guidance to MHS leaders regarding how high-performing organizations develop exceptional levels of performance. The authors’ expectation is that military medicine will draw on these lessons to enhance leadership, develop exceptional organizational cultures, onboard and engage employees, build customer loyalty, and improve quality of care. Leaders from other segments of the healthcare field likely will find this study valuable given the size of the military healthcare system (9.6 million beneficiaries), the United States’ steady progression toward population-based health, and the increasing need for highly reliable systems and performance.

Doing Well by Doing Good: Evaluating the Influence of Patient Safety Performance on Hospital Financial Outcomes

Background: As financial pressures on hospitals increase because of changing reimbursement structures and heightened focus on quality and value, the association between patient safety performance and financial outcomes remains unclear. Purpose: The purpose of this study is to investigate if hospitals with higher patient safety performance are associated with higher levels of profitability than those with lower safety performance. Methodology/Approach: Using multinomial logistic regression, we analyzed data from the spring 2014 Leapfrog Hospital Safety Score and the 2014 American Hospital Association to determine the association between Leapfrog Hospital Safety Score performance and three dimensions of organizational profitability: operating margin, net patient revenue, and operating income. Results: Our findings suggest that improved hospital safety scores are associated with a relative risk of being in the top versus bottom quartile of financial performance: 5.41 times greater (p < .001) for operating margin, 10.98 times greater (p < .001) for net patient revenue, and 4.03 times greater (p < .001) for operating income. Practice Implications: Our findings suggest that improved patient safety performance, as evaluated within the Leapfrog Hospital Safety Score, is associated with improved financial performance at the hospital level. Targeted focus on patient safety may allow hospitals to improve financial performance, maximize scarce resources, and generate additional capital to continue to positively evolve care.