DHM Quality Post - May 2021
thequalitypost
Greetings from Cat, Saj, Ari and Jenica
Welcome to the 122nd edition of The Quality Post! In this issue, we feature updates from our Health System's Health Equity Council, provide tips on how to wrench in the DHM QI Metrics patient list in APeX, encourage you to submit your improvement work to the UCSF Health Improvement Symposium, and provide the latest performance on our True North Quality Metrics.
inthisissue
Cover Piece
HBR Tip: Ways to Boost Your Productivity
UCSF Health Equity Council Updates
DHM QI Metrics: Get the Most of Your APeX Patient List
Submit to the UCSF Health Improvement Symposium
FY21 DHM True North Quality Improvement Metric Performance
Updates in Health Policy Since the November Election
The No Surprises Act was passed as part of omnibus in December, 2020, the first federal consumer protection against surprise medical bills. Several states had passed similar laws, but large self-ensured employers are not regulated by state insurance commissioners, so many patients were left unprotected from surprise medical bills. Surprise bills are out-of-network charges that leave patients on the hook for a larger portion of the payment. They typically arise from emergencies when patients cannot choose their site of care, or from elective surgeries at in-network facilities with out-of-network providers. In 2017, 18% of ED visits included a surprise bill for people with employer-sponsored insurance. Consumer protections have broad and bipartisan public support, but similar legislation stalled in Congress in 2019 due to a combination of partisan gridlock and lobbying on the part of physicians--largely those with Private Equity backed practices, some of whose business models rely on surprise medical bills. The No Surprises Act takes effect in 2022, and has three main components depicted in this graphic from Kaiser Family Foundation:
The American Rescue Plan Act of 2021 (the recently passed $1.9 trillion stimulus package) includes the most significant change to the individual insurance market since the passage of the Affordable Care Act in 2010. The key provisions are: eliminating the "subsidy cliff," expanded subsidies for those already eligible (anyone under 150% FPL can get zero premium plan), and special consideration to those on unemployment insurance (allows cost sharing assistance beyond premiums at higher income if on unemployment). The ACA created the subsidy cliff by pegging federal premium subsidies to gross income as a percentage of federal poverty. The subsidies stop at 400% FPL ($51,040 for an individual), leaving those with gross incomes between $51K and $100K paying huge percentages of their income on premiums (up to 20% for a 60 year old making just over the subsidy cliff). For many, this meant that they were too wealthy to receive a subsidy, but not wealthy enough to afford insurance. The new law pegs premium subsidies to a percentage of gross income, capping at 8.5%. Combined with the Biden Administration's extended open enrollment period through August 15, 2021, this allows millions of Americans to reconsider purchasing insurance through an exchange like Covered California. The CBO estimates that 1.7 million people will gain coverage through these changes. Encourage your patients to check out Covered California, which also assists with MediCal enrollment if patients are eligible (<138% FPL). There may be a more affordable option for them this year! Bay Area focused navigator organizations funded by Covered California include California Coverage & Health Initiatives, Asian American for Community Involvement of Santa Clara County (South Bay), and Alameda Health Consortium (East Bay).
Four Ways To Boost Your Productivity
We’re all looking for ways to boost our productivity. The good news is that it’s an achievable goal. Here are a few proven strategies to help you get more done in less time:
- Plan your work around your internal clock. This means aligning the tasks that require the most brain power with your energy peaks throughout the day.
- Plan out tomorrow’s schedule tonight. When we write down what we intend to do, we’re far more likely to actually do it.
- Develop rituals for different kinds of work. This may mean doing a certain task in a particular workspace or at a particular time of the day.
- Avoid being 100% booked. If your calendar looks full, deliberately schedule time to do nothing. You can use this time as a buffer between meetings to tackle unexpected tasks that crop up during the day.
Try at least one of these strategies this week, and notice any differences in your productivity. You got this!
This tip is adapted from “4 Ways to Get More Done in Less Time,” by Amantha Imber
UCSF Health Equity Council Updates
The UCSF Health Equity Council was established in 2018 to ensure that health equity is a strategic and operational priority in our health system, and consists of 20 members across all UCSF sites. The group is co-led by Diane Sliwka, Malcolm John, and Sarah Lahidji. The specific goals of the Health Equity Council are focused on health disparities identification and improvement. To do this work, there has been focus on the following domains:
1) Establish and promote system-wide data definitions and data governance for equity-related variables.
2) Prioritize health care sensitive disparities hat are most critical.
3) Integrate equity-related variables into analytic tools
4) Facilitate the application of quality improvement science to disparities improvement work.
Examples of health system-wide equity improvement work over the past year and the results thus far are listed below.
Use the DHM QI Metrics APeX Patient List
Do you ever wish your Patient List view in APeX had the most helpful information to allow you to effectively care for your patients and enable you to quickly check on key quality metrics, including the DHM True North Metrics? We highly recommend that you wrench in the DHM QI Metrics APeX list. Here's how:
1) Clock "Properties" under the "Patient Lists" header
2) In the pop-up window, click "Copy"
3) Type "DHM QI Metrics"
4) Click "Accept" and click "Accept" again in the original pop-up window.
5) Voila! You now have an easy way to see if your patients have ACP documentation, what their primary language is, what their estimated day of discharge is and progress towards completion of discharge milestones, what their mobility scores and goals are, if they have a foley catheter in place, and other important things such as the patient's RN and phone #.
Submit to the UCSF Health Improvement Symposium
Why are we hosting our 5th Annual Improvement Poster Symposium? The opportunities to learn from each other, share best practices and innovations, and build a community for improvement work are critically important for our patients and the success of UCSF Health. This is true now more than ever as we recover from the pandemic. An annual poster symposium provides a vehicle to recognize great work and foster our culture for continuous improvement.
How will a virtual symposium work? To accommodate safe distancing precautions, we will be gathering virtually this year.
Before the event:
- Teams submit a poster by May 13th and a 4-5 minute pre-recorded video poster presentation explaining the relevant information about the project.
- Videos will be displayed in an online gallery and shared with all attendees one week before the live event.
- Attendees will be encouraged to view videos in advance and note which poster teams they would like to visit live on the day of the symposium for direct interaction.
During the event:
- On June 9th, poster teams will be organized into individual virtual rooms for 30 minute sessions. Attendees will visit the virtual rooms to engage directly with teams, to ask questions, and to learn more about the improvement work. Everyone will have had an opportunity to view the posters and videos in advance so that this time can be prioritized for questions and answers.
After the event:
- All posters and videos will be compiled into a Poster Booklet and shared across the organization.
What types of improvement work should be submitted? All improvement work is welcome, and we encourage them to align with our True North pillars.
