session

Dashboard Metrics Evaluation

NHS-FPX6004 Healthcare Law and Policy

Instructor: Dr Sandra Mcdade

June 1, 2024

Mercy Medical Center’s Dashboard Metrics Evaluation

Introduction

Healthcare organizations should operate competitively in areas such as quality care, services, and benchmarking, with clearly defined goals and objectives to achieve satisfactory results for patients and society (Novitasari, 2022). To achieve these objectives, it is crucial for healthcare organizations to revisit their mission and vision statements with stakeholders and the board of directors, especially if these statements are not currently the focus. This ensures that the main emphasis remains on helping people achieve better wellness. Benchmarking is vital within healthcare facilities as it allows for comparing the performance of these facilities against both local and national benchmarks.

Importance of Benchmarking in Healthcare

In the era of health care reform, health care leaders must understand what quality care entails and how quality in health care connects to the standards set forth by relevant federal, state, and local laws and policies. Understanding relevant benchmarks that result from these laws and policies and how they relate to quality care and regulatory standards is also vitally important.

Diabetes Care Benchmarking

Upon comparing Mercy Medical Centre's benchmarks in diabetes care to state and national standards, it became evident that while Mercy is close to the benchmarks for eye exams and foot testing, it meets the target for HgbA1c compared to state benchmarks and is nearly meeting national standards. However, Mercy Medical Clinic underperforms in foot checks for the same patient group, with only 60% of patients receiving exams, falling 22.9% below the state average of 82.9% and 24% below the national average of 84% (Mercy Medical Center). In assessing the clinic’s HgbA1c benchmarks, Mercy Medical Centre is only 1.4% below the Minnesota state target and within 10.5% of the national target. Although Mercy meets 90% of the state's benchmark, it falls 3% short of achieving 90% at the national level (Mercy Medical Centre).

Consequence(s) of not meeting prescribed benchmarks

Understanding where MMC falls short in meeting diabetic care benchmarks is crucial in addressing the broader implications of such underperformance. When healthcare guidelines or standards are not achieved, there are significant implications for organizations and interprofessional teams. In the context of Mercy Medical Centre (MMC), there are many consequences of failing to meet diabetic care benchmarks.

First, failing to attain these benchmarks can have adverse impacts on clients and their satisfaction levels. For example, with only 59% of patients with diabetes aged 40 or older receiving an eye examination within the year, MMC has performed worse than the state and national averages (Mercy Medical Center). Consequently, patients are more likely to develop diabetic retinopathy and other eye complications, which can negatively impact their overall health. Similarly, a low foot check rate increases the likelihood of diabetic foot complications, such as ulcers and infections, leading to high morbidity among patients.

Secondly, the organization’s inability to meet benchmarking indicators highlights the poor quality and competitiveness of healthcare organizations like MMC. When quality signals are crucial for patient choice and referral patterns, poor performance on key indicators demonstrates the organization’s inefficiency in providing high-quality care (Kharazishvili et al., 2020).

The implications of not meeting these set standards are not only limited to negative effects on patient’s health but also have significant organizational impacts. Noncompliance with diabetic care standards can lead to severe financial repercussions, loss of accreditation, decreased reimbursement rates, and reputational damage, all of which will affect the organization's position within the health system.

Credible findings from the literature further affirm the calamitous effects of these consequences. For instance, research has shown that organizational performance below certain thresholds is associated with financial consequences in healthcare centers (Levy, 2021). Additionally, it has been established that when an institution loses accreditation due to poor performance, both its status and patients' confidence are negatively impacted. Moreover, findings indicate that lower reimbursement rates can undermine an organization’s long-term viability and its ability to deliver high-quality services. Including such evidence in the analysis strengthens the paper’s argument about the significance of adhering to required standards in diabetic treatment. This perspective highlights not only the potential consequences for patient health but also the organizational repercussions, emphasizing the need for performance improvement efforts (Kharazishvili et al., 2020).

Analysis of the Benchmarks Provided by Laws or Policies

According to the Healthcare Effectiveness Data and Information Set (HEDIS), the current national average rate of performing annual eye examinations among diabetics is 75%, and for foot exams, it is 84% (Wadhera et al., 2020). These benchmarks can be used to establish the competency level of a healthcare organization like Mercy Medical Center. The Centers for Medicaid & Medicaid (CMS) also specifies different quality measures for diabetes management under the Merit-based Incentive Payment System (MIPS). These include maintaining an HgbA1c level of 7% or lower, comprehensive annual eye exams, and foot care, and patient education (Diabetes Self-Management Education) (Wadhera et al., 2020). Achieving these parameters is strategic for healthcare organizations regarding payment reimbursement strategies and penalties established by CMS.

Performance Evaluation Against Benchmarks

Mercy Medical Centre has significant room for improvement to meet the diabetic care standards set by NCQA and CMS. The clinic, on average, only conducts eye exams for 59% of its members annually, falling short of the HEDIS standard of a minimum of 75%. Additionally, 60% of foot exams are conducted, which is below the 84% target, and the rate of foot ulceration risk assessment is only 2% (Mercy Medical Center).

One of the key indices to assess target achievement is the HgbA1c level, which is related to diabetes stability. This illustrates how CMS has set target ranges in which patients’ HgbA1c levels should fall, and how Mercy Medical Centre's achievement of these goals may be evaluated against stated benchmarks. Using criteria derived from CMS regulations, the extent to which the organization complies with them can be determined by how well it controls blood sugar levels and manages complications related to poorly controlled diabetes.

The final benchmark refers to periodic eye exams for diabetic patients in compliance with HEDIS standards. Such examinations are critical for identifying diabetic retinopathy and other vision issues in the early stages to prevent vision loss. Referral rates for follow-up annual eye exams of patients with diabetes at Mercy Medical Centre can be compared to HEDIS standards to determine whether the center adheres to the recommended practices in diabetic care. Eye, foot, and kidney exams are essential services commonly needed by diabetic patients due to the complications that frequently affect these areas. By comparing its performance in conducting foot exams, we are better positioned to determine how effective Mercy Medical Centre is in preventing complications affecting the diabetic foot and the overall well-being of its patients (Narayan et al., 2024).

Staffing and Training Needs

Proper staffing with well-trained personnel who can dedicate sufficient time to educate patients about the importance of tests is critical (Kimbell et al., 2020). Understaffing and inadequate training in patient education and test scheduling are major reasons for underperformance in eye and foot testing. Additionally, a lack of diversity among staff may reduce patient trust and compliance.

Building trust and respect with patients is vital for their adherence to prescribed treatments (Peimani et al., 2020). Mercy Medical Centre must prioritize improving patient care to avoid severe consequences, including patient distrust, inadequate staffing, and insufficiently trained personnel. Diabetes, characterized by high blood glucose due to insulin deficiencies, can lead to severe complications such as heart disease, stroke, blindness, and kidney disease if not controlled. Diabetes affects approximately 37.3 million people in the United States, with an additional 122.4 million individuals being pre-diabetic (Levy, 2021).

Recommendations for Improvement

Since Mercy Medical Centre is underperforming on diabetes care benchmarks, the hospital should promote ethical and sustainable strategies involving its main stakeholders, including the board of directors and the community. Specifically, it is recommended to invest in increasing the number of staff, their training, and purchasing more testing equipment. This approach aligns with ethical values such as excellence in patient care, equality in health, and sustainable development by enhancing human capital and patients’ overall well-being.

Recognizing the critical need to maintain competitive quality of patient care and achieve exceptional patient satisfaction, this paper recommends that a collective group of stakeholders, including the board of directors, commit capital funds to enhance staffing through comprehensive training and increased availability of proper testing equipment. Additionally, purchasing more testing equipment will enable more comprehensive and routine tests, thereby improving diagnostic accuracy and patient outcomes. 

Engaging patients and healthcare practitioners to foster their support for identifying and addressing underperformance areas will help reduce mistakes and improve outcomes. Allocating funds for staffing, training, and equipment will yield a good return on investment and keep us competitive. This investment will enhance human resources with adequate education, improve service competencies, and increase patient confidence, ultimately improving the community's health status.

In the long run, this will create a sustainable business model and promote growth. Implementing accurate benchmarking and achieving higher patient satisfaction will differentiate our organization from competitors, reinforcing our brand promise of quality and reliable healthcare solutions. Human resources and the extensive use of better-quality equipment are key areas that contribute to long-term planning and a strong market position. As discussed, investing in these areas will greatly benefit our patients and improve overall health outcomes across our organization.

However, the ethics of a healthcare organization should focus on the patients. A principal element of this is the provision of benchmarks, which help us understand how our facility compares to state and national averages. Without these benchmarks, Mercy Medical Centre may not be able to conduct its operations effectively due to strict operational guidelines set by laws and regulations. We must perform certain practices with patients and compare the results to avoid providing unsatisfactory or dangerous health services.

Ethical and Sustainable Actions

Engaging patients and healthcare practitioners to foster their support for identifying and addressing underperformance areas will help reduce mistakes and improve outcomes. Allocating funds for staffing, training, and equipment will yield a good return on investment and keep us competitive. This investment will enhance human resources with adequate education, improve service competencies, and increase patient confidence, ultimately improving the community's health status.

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In conclusion, investing in staff training and additional equipment will enable MMC to meet diabetic care benchmarks, thereby enhancing patient outcomes and ensuring compliance with regulatory standards. Improved performance on these benchmarks will lead to better patient satisfaction, financial stability, and organizational reputation.

References

Kimbell, B., Rankin, D., Ashcroft, N. L., Varghese, L., Allen, J. M., Boughton, C. K., ... & CLOuD Consortium. (2020). What training, support, and resourcing do health professionals need to support people using a closed-loop system? A qualitative interview study with health professionals involved in the closed loop from onset in type 1 diabetes (CLOuD) trial. Diabetes technology & therapeutics, 22(6), 468-475.retrieved from: https://www.liebertpub.com/doi/pdf/10.1089/dia.2019.0466

Kharazishvili, Y., Kwilinski, A., Grishnova, O., & Dzwigol, H. (2020). Social safety of society for developing countries to meet sustainable development standards: Indicators, level, strategic benchmarks (with calculations based on the case study of Ukraine).  Sustainability,  12(21), 8953. https://www.mdpi.com/2071-1050/12/21/8953

Levy, L. A. (2021). The exploding incidence and prevalence of diabetes. The Diabetic Foot. Retrieved from: https://podiatrym.com/pdf/2021/4/Levy421Web.pdf Mercy Medical Center (Shakopee, MN)

Narayan, A., Kocher, B., & Shah, N. R. (2024). Improving The Quality Of Quality Metrics.  Health Affairs Forefront. https://www.healthaffairs.org/content/forefront/improving-quality-quality-metrics

Novitasari, D. (2022). Hospital Quality Service and Patient Satisfaction: How The Role of

Service Excellent and Service Quality?. Journal of Information Systems and Management

(JISMA), 1(1), 29-36. Retrieved from: https://jisma.org/index.php/jisma/article/view/255

Peimani, M., Nasli-Esfahani, E., & Sadeghi, R. (2020). Patients’ perceptions of patient–provider communication and diabetes care: A systematic review of quantitative and qualitative studies. Chronic illness, 16(1), 3-22.retrieved from: https://journals.sagepub.com/doi/pdf/10.1177/1742395318782378

Pourkazemi, A., Ghanbari, A., Khojamli, M., Balo, H., Hemmati, H., Jafaryparvar, Z., & Motamed, B. (2020). Diabetic foot care: knowledge and practice. BMC endocrine disorders, 20, 1-8. Retrieved from: https://link.springer.com/article/10.1186/s12902-020-0512-y

Wadhera, R. K., Figueroa, J. F., Maddox, K. E. J., Rosenbaum, L. S., Kazi, D. S., & Yeh, R. W. (2020). Quality measure development and associated spending by the Centers for Medicare & Medicaid Services.  JAMA,  323(16), 1614-1616. https://jamanetwork.com/journals/jama/article-abstract/2764986