Winning at Quality and Safety: Do You Need a Chief Quality Officer?

Abstract

In the past several months, healthcare organizations have been inundated with results from a variety of quality-rating agencies. The Centers for Medicare & Medicaid Services (CMS) released star ratings for hospitals, announced reimbursement penalties for high readmission rates, and issued draft regulations for new mandatory cardiac bundles. And as if that were not enough, U.S. News & World Report updated its hospital ratings and the Leapfrog Group released its newest Hospital Safety Scores.QUALITY AND SAFETY AGENDA EXPLODESThese developments highlight the fact that (a) the nation's quality and safety agenda continues to expand; (b) more aspects of healthcare organizations' performance are readily available in the public domain than ever before; and (c) more hospital revenue than ever before is tied directly to providers' performance on clinical outcomes, patient safety, and the patient experience. In fact, 70% to 80% of inpatient performance metrics (mortality and complication rates) is reported to the public via I lealthgrades (https://www.healthgrades.com), almost every hospital receives a patient safety rating in the form of a letter grade from the Leapfrog Group (http:// www.leapfroggroup.org), and CMS recently converted hospital performance reporting to star scores on I lospital Compare for patients to easily assess hospital quality rankings (https://www.medicare.gov/hospitalcompare/search.html).Indeed, CMS plans to update the star ratings quarterly. Of the 4,559 hospitals listed, 133 currently have received one star, 723 have two stars, 1,770 have three stars, 934 have four stars, and 102-only 2.2% of hospitals-have five stars (Medicare.gov, 2016).The Move to Pay-for-ValueThe link between quality and financial performance is by now undisputed. Furthermore, because the move from pay-for-volume to pay-for-value is well under way, an institution's performance on clinical quality and patient safety now has multimillion-dollar consequences. Consider the following:* The federal government's readmission penalties on hospitals have hit a new high as Medicare withholds more than a half billion dollars in payments for fiscal year 2017. 'The government expects to penalize more than half of U.S. hospitals-a total of 2,597-in 2017 (Rau, 2016).* Most commercial insurance pay-for-performance programs and rate increases are now tied to quality, safety, patient satisfaction, or all of these factors.* Commercial payers have begun to exclude poor-quality, high-cost hospitals from their networks-some markets in Tennessee and Kentucky are host to such exclusive networks, for example.* The Medicare Access and QIIP Reauthorization Act of 2015 and its related initiatives, such as CMS's Merit-Based Incentive Payment System and Comprehensive Primary Care Plus, will link more and more of physician outpatient performance to reimbursement (Beaulieu, 2016).* By 2018, 90% of Medicare reimbursement will be linked to quality or value, according to the U.S. Department of Health & Human Services (2015).THE QUESTIONAll healthcare organizations have dedicated executives for finance, human resources, and IT, but many have failed to place the same level of importance on quality and safety leadership by recruiting a full-time chief quality officer (CQO). In these organizations, quality and safety are considered a part-time job-one often assigned to the chief medical officer or chief nursing officer as just two of many important responsibilities. With millions of dollars at risk and patient well-being hanging in the balance, hasn't the time come to install a full-time CQO-someone who lies awake at night worrying only about quality and safety?Influence of Physician LeadershipMany of us have debated the need for a CQO, but once we make the decision to invest in one, we move to the next consideration: Does the position require a physician, a nurse, a pharmacist, a nonclinician? …