Latest / Nurse Leadership Dumpster Fire / Hospital Metrics: Weapons!
Transcript
- speaker-0: Using hospital metrics can feel intimidating if you don't know what you're talking about. But if you can master understanding how to use metrics, it can be one of the most valuable tools to a nurse leader in their toolbox. It's something that you can use to really harness in your resources, protect your people, and tune into your team to have the best functioning team possible. Today we're gonna be using an analogy like we're going to war to help you. Break down and understand the way that you can use metrics to the best advantage of your ability to really create a high-functioning unit. And let's be honest, sometimes it feels like you are at war when you're a manager and you're really battling to make sure that you get what you need on your unit. So we're gonna be breaking this down into three separate types of metrics. Today, we're gonna be specifically diving into quality metrics and what you need to know to really harness in this type of metric. speaker-1: Before you want to use your weapon to staff your army, you need to understand how the bills get paid in healthcare. First off, the patient receives a service. Then a cost is generated at one of three areas. That's going to be the patient paying out of pocket, the third-party payer insurance. It can be government funded, it can be private insurance, it can be other federal programs such as Medicaid, Medicare, et cetera. And then the other one is your casualty type insurance or accidental death and dismemberment. speaker-0: Now, to further understand reimbursement, we need to go back in time a little bit and have a quick history lesson on how the Centers for Medicare and Medicaid actually do reimbursement. Why are we talking just about CMS or s the Centers for Medicare and Medicaid? Yeah, well. Because the CMS program is what sets the stage for all healthcare reimbursement. Essentially, CMS makes the blueprint and everyone else conforms around that. So that's what we have to understand so that we can really get a grip on how we actually get reimbursed in hospital. speaker-1: So let's talk about a cookie analogy and how it used to work compared to how it all works now. speaker-0: Prior to 2012, CMS or Centers for Medicare and Medicaid had a flat rate reimbursement system. Whenever you went to the hospital and you had a service that was rendered, the charge was given and CMS would reimburse a flat rate and it didn't matter if that quality was high or bad, you got the same payment no matter what. speaker-1: In the old way, it didn't matter what the cookie tastes like. If it was flat, gross, it didn't matter. You still got paid the same rate regardless of what your output was. speaker-0: was. So if I made a really delicious cookie and Teresa didn't put any sugar in her cookie, we were still gonna get paid the same amount. So I was putting in more effort to make a delicious cookie and she was cutting cost by cutting out the sugar, but we still got the same amount of money. So in this system, she could put out lower quality products and get paid more than me. And that was one of the problems we were seeing in efficiency and reimbursement and healthcare. speaker-1: Interesting. So the other aspect of the history is in 2010 the Affordable Care Act was passed. And then in 2025, we transitioned into a value-based health care. speaker-0: Model. So what value-based model care actually means for CMS is that they still have a base flat rate that they start with. But when they reimburse you, they're gonna withhold 2% of the money that they're gonna pay back for you. And then at the end of the year, if you have generated high quality metrics over and over and over again, they're gonna give you that 2% back. So they're rewarding you for having high quality. On the flip side, if you generate poor quality, And your quality numbers are going down, down, down, and you're showing a trend that you're not taking good care of your patients, they're gonna keep that two percent. So now speaker-1: So I have to put sugar in my cookie now? speaker-0: Yes you do, actually. If you wanna make the same amount of money as me, you actually have to put in some effort. speaker-1: Dang it, I was just I was making such good money. This is ruining it. speaker-0: Yes, and that was the problem. So this change in CMS really helped start to level the playing field and making sure that we were not only making money in healthcare, but that we were also producing good patient care. Because you have to have both sides of this coin in order to have a successful hospital. The hospital has to be able to make money to keep the lights on, but you also want to make sure that you're delivering a quality product. speaker-1: But it gets even better. It does? speaker-0: This speaker-1: Yeah. So there's even a ranking system, ranking one through five. And the higher your rank, the bigger the bonus you get. So being a five star quality hospital and care provider, you get more money. Wow. speaker-0: So if we continue to actually put sugar in our cookies and we keep making really delicious cookies, we're actually not only gonna get our full money back, but we're gonna get bonuses. So in twenty twenty six alone and the year's not even over yet, CMS has already given out thirteen billion dollars in bonuses. And that is a lot of money when it comes to healthcare dollars. speaker-1: I think I better put sugar in my cookies. So when it comes to high quality, you're talking about the perception and the rankings that allow patients to decide to come to your facility. So that brings patients in. In addition, it also attracts high quality performers and and better workers. So basically, high quality means you get reimbursed at a higher rate and you have the option to get that bonus money. Then that allows you to better supply and build your army. speaker-0: And you're gonna have more revenue coming in because you have more patients actually coming to your facility. So the cascade actually works like compound interest, and all of those things help lead up to more money and a better quality. So it feeds the system and keeps it going on a positive feedback. In reverse, low quality has a similar cascade, but it's going the reverse way. And this can turn into a downward spiral that quickly can turn into a dumpster fire. When you have low quality metrics, patients can see that when they look online and they may think that place doesn't make me feel safe and I don't want to go there. So now you're only gonna get the patients who are destitute and have no other options. They may not be able to pay their bills. You're going to be reimbursed by Medicare and Medicaid at a lower rate, and insurance rates are likely going to follow. Employees that are looking for work are going to see those metrics and they're going to realize that that means unsafe staffing ratios. low pay and bad working conditions and you're not gonna get the high quality employees. You're only gonna get the employees who nobody else will take. So you're gonna be working with the scum of the bucket. So when you end up on that low quality spiral, it can be very difficult to get out of it. speaker-1: So this kind of sounds to me like debt a little bit. speaker-0: Little. speaker-1: Like the higher quality you are in, more of a compound interest like I'm earning at a higher rate. Mm-hmm. But this is creating that debt loop that you can't get out speaker-0: Yes, very similar to the how the financial world works. Which makes sense because this is healthcare in America and America functions off of a business exchange type of environment. That is the way our culture works here. And if we try to neglect that, that is part of how we function and we're ignoring that piece as managers, we can be missing a key component to help us be successful. speaker-1: As a frontline leader, what is it that we need to do to recover from this? Do you know? speaker-0: Well, it can be very tricky, but there are some things that you can do as a frontline manager. And we actually did face this a few years ago. We were in a situation in our facility, we were working in an ICU, managing an ICU, and we had gotten flagged because our 30-day mortality rate, which is one of the quality metrics that we're gonna talk about in a minute, was getting flagged as very high. That means patients look were coming into the hospital. that looked like they should have been able to survive based on evidence based practice and then they were suddenly dying. So it looked like we were actually taking healthy patients and then killing them. It was a bad look for our unit. Right. speaker-1: And that actually when we got dug into the data, what we found is we were doing what we should do, of course, taking care of our patients, making sure they were safe, especially when they came in. They were really sick and we managed all their care. But then when we went to document, we documented after we fixed them. speaker-0: Yes. So we our staff were doing what they were supposed to be doing and taking care of the urgent situation. But when they documented the vital signs that they were putting into the medical record that were getting pulled that was leading into this 30 day mortality rate was actually making it look like the patients were healthier than they were. But it was a little bit of a lie because the patient's blood pressure might have looked okay, but it was because they had been given fluid and medication to raise the blood pressure. speaker-1: Yeah, all those interventions made those numbers look good. speaker-0: So after we realized that it was just a simple documentation error, we went back to the team to try to get them to change the way that they practiced. However, in normal fashion, when you bring a change to your team that potentially means you need to take a new step or you might need to do a redundant step, it didn't initially go over very well. So then we realized that we actually had to bring back this why so that they understood how this was going to impact them directly. Do you remember what we said to them, Teresa? speaker-1: I think we kind of explained exactly this. We talked to them about the fact that it was looking like we were killing healthy patients or not letting healthy patients survive. And where they were leaving our ICU and bouncing back, whichever you want to look at, because it's a morbidity mortality rate. So what we kind of did was explain to them that purpose and said, It's okay to chart bad vital signs. We need you to do that. Yes. So we did a little bit more. speaker-0: And I know that it seemed like we were asking them to do something redundant, but what we explained to them was that this was how our unit was getting graded. And we all get graded on something in healthcare. And because this was what was grading us, and that metric was looking negative, even though we weren't doing anything wrong, it was making it difficult for me to explain why I needed to get what I needed to the people in the C-suite that aren't seeing what's happening on the front lines. They only have access to the data and spreadsheets. They don't see the patient in front of us. So these metrics are actually the weapon that we use to come back to them and say, I need this because this is how this connects back to the actual patient in the bed. Our job as managers is to be a little bit of that translator from the executive to the frontline nurse. speaker-1: True. So after that explanation, they got on board. And then the metrics flipped and we looked like what we should have looked like from the beginning, because again, that wasn't the reality. And then we were finally able to get the support our troops needed and make them happy and get and get into that give and take role. speaker-0: Yes, as frontline leaders, we not only need to understand why this reimbursement and these metrics matter, but we also have to remember to bring that back to the front line and how that affects them directly. Nobody wants to work on a short staffed unit. Nobody wants to feel like they're not gonna be able to get overtime if the if they're working extra, like they're not gonna actually get paid. Nobody wants to have ratios that are unsafe. And these are the metrics that are going to help you get what you need. So you need to remember to bring that back to the frontline staff so that you actually can get your team to engage and help you. Because remember, when you're a leader, you're not just dictating what happens on your unit. You're using your whole team and you're more like the commander. You're the coach. You're the person who's trying to get the unit to move as a whole. And if you aren't getting that buy-in from them, you're not going to get anywhere. speaker-1: So the next area that we need to go into is the did they get hurt metrics? This looks more like those hospital acquired infections, our morbidity and our mortality rates. What does that mean? What is our 30-day survival rate for all of our sepsis, our strokes, our STEMIS? The other one is our surgical complications. Did they end up with a DVT or any a PE or any other c post surgical complications such as infections? Those metrics hurt. cause harm to our patients, increase l length of stay, and decrease our reimbursement rate. speaker-0: And so when the executive team sees negative metrics on your unit with the patients that you're taking care of, it makes them think that you're not doing your job correctly. And maybe you're not. But maybe it's a documentation error. Either way, you need to be aware of what's going on and how to actually harness that weapon and pivot so that you can get where you need to go. So in some, If your unit is performing well, it's going to be easy to ask for resources. An executive team is going to want to give more to a unit who looks good on paper because that generally means they're going to get better reimbursement and they're going to get more money for the facility and maybe even they're going to get paid more. But hopefully that extra money is coming back to the frontline staff. speaker-1: So if your unit is struggling with quality because of limited resources, you need to take that information and develop a plan. Look into what it what is this struggle and what are those limited resources? How can we make differences? So then you can take that information and go present it to your leadership team and say, if you want me to help get to this place and improve our metrics, I need these resources in order to successfully get us there. And this is how. Now, sometimes you have to prove it before you can get it. So you may even need to get it started in that direction and say we can't keep this trajectory without more support. I'm going to fall back because my staff are getting tired. So you may have to do a little bit of that communication and be that liaison and that communicator between your executive level leaders and your staff. speaker-0: They are not seeing what's happening on the front lines. So using this weapon is the way that you can help tell the story. Whether you're doing well and you're asking for more so you can expand, or whether you're doing poorly, you need to be able to connect that story back to the reason why, so that they understand the connection between the resources and the quality, because they don't always get that. So you need to Really understand this part for you to be able to best structure everything in your unit and get what you need to make your staff feel prepared and safe. speaker-1: Your weapon it ends up being useless though if you don't have any sort of shield to protect you. So in our next video, we're gonna be going over the shield and what you need to do, which is your efficiency metrics. Those efficiency metrics are gonna be what helps bring that protective up so that your weapons can stay sharp. speaker-0: Before you go, drop a comment and let us know what metric you're struggling with the most on your unit. If you want some advice or some tips, please reach out and we'd be happy to discuss it. speaker-1: and subscribe.