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How to Present Your Hospital CMS Star Rating to Your C Suite and Board

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Presenting your hospital's CMS Star Rating to the C Suite and Board involves a strategic approach that includes a thorough analysis of past performance and a forward-looking plan for improvement. In Part 1, hospitals should analyze past data to identify domains and measures that have improved or declined, delve into specific measures to understand their nuances, illustrate how small changes can have significant impacts, and bridge the gap between internal hospital data and out-of-hospital impacts. Part 2 focuses on establishing a comprehensive improvement plan, emphasizing the necessity of simulation-based improvements, setting SMART goals, developing intervention plans, and maintaining a monthly cadence for progress reporting. Utilizing Dexur’s AI-powered tools, hospitals can effectively identify improvement areas, simulate outcomes, set specific objectives, track interventions in real-time, and ensure continuous alignment with quality improvement goals through regular updates and early warning alerts.

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How are Hospital CMS Star Rating & VBP Programs Co-related?

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Introduction

The Centers for Medicare & Medicaid Services (CMS) Star Rating and the Value-Based Purchasing (VBP) Program are pivotal in shaping healthcare quality and reimbursement. Both programs aim to improve patient care by incentivizing hospitals based on performance metrics. This article delves into the potential correlation between a facility's CMS Star Rating and its financial impact under the VBP Program, hypothesizing that there may be a tangible link between the two.

Background

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If Your 2024 Published Readmissions and Mortality Measures Are Lower than 2023, then 2025 Could Be Even Worse

Hospital performance metrics for readmissions and mortality under CMS Quality Programs are critical for improving CMS Star Rating, VBP, HRRP, and other programs. These metrics are evaluated using data from a rolling three-year period, which shifts annually to include the most recent data while excluding the oldest.

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Case Study: Dexur’s AI Quality Platform and NRC's Patient Experience Partnership Enhances Quality at Good Samaritan

Good Samaritan, a community healthcare Hospital in Vincennes, Indiana, in collaboration with Dexur and National Research Corporation (NRC), has advanced its capabilities in measuring and improving patient experience and quality metrics. This case study delves into the transformative effects of integrating Dexur’s data analytics with NRC’s patient survey expertise, enhancing Good Samaritan’s performance across various critical healthcare quality metrics.

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Why Your Internal Hospital Quality Metrics Are Likely To Be Inaccurate and How Dexur’s Data Audit Can Help Validate Them

Imagine you're in a routine leadership meeting, presenting your hospital's latest quality metrics from your internal dashboard—readmission rates, and mortality metrics, all seemingly well under control. The team is satisfied and confident in the data's accuracy and the hospital’s performance. Fast forward to the release of the Centers for Medicare & Medicaid Services (CMS) final results, and the situation unfolds quite differently. Suddenly, there’s a stark contrast—CMS data indicates a decline in performance. The board is stunned, the C-suite is questioning the data, and you're left wondering where the discrepancy lies.

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Risk Factors Impacting Specific Readmission and Mortality Measures Can Be Leveraged by Medical Coding and Quality Improvement Teams

Medical coding and quality improvement teams can effectively leverage data on risk factors that influence specific readmission and mortality measures to enhance healthcare outcomes. By ensuring accurate medical coding, these teams can identify discrepancies and opportunities for improvement, leading to more precise documentation and better resource allocation. Quality improvement teams can utilize this data to target interventions for high-risk patient cohorts, thereby reducing readmission rates and improving care quality. Collaboration between coding and quality teams, informed by comprehensive risk factor analysis, is crucial in driving operational efficiencies and enhancing patient care. This synergy not only supports financial performance through improved coding and reimbursement accuracy but also fosters a culture of continuous quality improvement within healthcare organizations.

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Dexur Overview and Demo Video: Healthcare’s Unified AI Quality, Safety, Risk & Incident Software

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The video overviews Dexur, an AI-driven unified software for quality, safety, risk, and incident management, highlighting how it helps healthcare organizations save costs, improve efficiency, and enhance patient outcomes. It features Dexur's comprehensive capabilities, which include data ingestion, cross-program integration, AI Advisor Reports, predictive analytics, quality program management, and advanced simulations. It demonstrates Dexur's ability to streamline processes, provide actionable insights, and support decision-making across various healthcare programs.

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48% of SSI Colon Hospital Acquired infections are likely to occur within 10 days of Admission

Importance and Background on Surgical Site Infections in the Colon

Surgical Site Infections (SSI) following colon surgery present a significant challenge in healthcare. They adversely affect patient recovery and impact hospital quality metrics. These infections not only lead to longer hospital stays and increased costs but can also result in severe, life-threatening complications. Therefore, it is essential to focus on enhancing infection control measures and implementing robust post-surgical care protocols to effectively prevent and manage these infections.

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Dexur White Paper: How CEOs, CFOs, CMOs, & CQOs Can Cut Technology Costs And Improve CMS Star Ratings and Quality Programs

This white paper highlights how healthcare organizations can significantly reduce costs and enhance operational efficiency by consolidating multiple functions into a single platform with Dexur's AI Unified Quality and Risk Management software. Dexur offers an AI-powered unified system for managing quality, safety, risk, and incidents. By adopting Dexur's integrated software, healthcare providers can streamline their operations and achieve a higher standard of care at a reduced expense.

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Key Pathogens Influencing CAUTI Infections in Hospitals

Catheter-associated Urinary Tract Infections (CAUTI) greatly influence both patient outcomes and the financial aspects of healthcare, with Dexur being a key contributor in data analytics to improve healthcare safety and quality. Leveraging hospital data reported to the CDC's NHSN, Dexur identifies key pathogens contributing to CAUTI, highlighting the top five: Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus faecalis, and Proteus mirabilis. Each of these pathogens poses distinct challenges in their treatment and prevention. Through Dexur's detailed analysis, the development of targeted infection control protocols is facilitated, and the process supports both Root Cause Analysis (RCA) and the implementation of Corrective and Preventive Actions (CAPA). Such a strategy is crucial for the effective management of CAUTI, with the ultimate goal of enhancing patient outcomes and the efficiency of healthcare services.

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Texas Hospital Association Endorses Dexur to Provide Quality, Safety, and Risk Solutions to Texas Hospitals

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The Texas Hospital Association (THA) has endorsed Dexur, an AI-driven unified Quality, Safety, Risk, and Incident Management software, to support its member hospitals. This partnership is highlighted by THA's Alex Huff and Dexur's CEO, Nik Rao, who emphasize the alignment of Dexur's advanced technological capabilities, including AI-driven analytics and comprehensive data management, with THA's goals for enhancing healthcare quality and efficiency. Dexur's platform will offer THA hospitals a suite of tools for detailed program-to-case analysis, predictive insights, and strategic planning aimed at improving patient care outcomes and operational performance at a dramatically cost-effective price.

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A Significant Portion of Readmitted Patients Stay for only 1 or 2 Days

Readmissions are a critical quality metric for hospitals, significantly impacting financial and reputational outcomes under the Hospital Readmissions Reduction Program (HRRP) and the Centers for Medicare & Medicaid Services (CMS) Star Rating system. The HRRP imposes penalties on hospitals with higher-than-expected readmission rates for specific conditions, aiming to incentivize improvements in hospital discharge planning and post-discharge care. Similarly, the CMS Star Rating system evaluates hospitals on various performance measures, including readmission rates, to help consumers compare hospitals more easily. High readmission rates can lead to reduced Medicare payments and lower star ratings, which may influence patient choice and hospital revenue.

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How Clinical Peer Reviews Can Not Only Meet Accreditation Requirements but Also Drive Improvements in Quality Program Outcomes

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Peer review is a critical component in the accreditation and quality assurance processes for healthcare organizations. The Joint Commission (TJC), the Centers for Medicare & Medicaid Services (CMS), Det Norske Veritas (DNV), and the National Committee for Quality Assurance (NCQA) each have specific expectations regarding peer review processes.

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Webinar: Dexur Releases its Annual 2024 CMS Star Rating Predictions

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Dexur makes its annual predictions on CMS Star Ratings before CMS Star Ratings are published in July of every year. In 2023, Dexur had a 98% accuracy rate in its annual prediction rate. To get an understanding of your Hospital’s increase in decrease of your Star Rating, you can search for your Hospital’s prediction via the Hospital Search Function or you can also go through any Hospital’s CMS Star Rating predictions direction by browsing through state pages. To get the actual Star Rating prediction and a glimpse of the key drivers of the performance, you can also reach out to Dexur by email dexur@dexur.com.

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Emergency Departments Play a Critical Role In Managing Readmissions

Readmissions to hospitals, particularly within 30 days of discharge, serve as a critical measure for evaluating the quality and effectiveness of healthcare services. The Hospital Readmission Reduction Program (HRRP) and the Centers for Medicare & Medicaid Services (CMS) Star Rating system place significant emphasis on readmission rates as indicators of hospital performance. These measures directly impact hospitals' financial health through penalties and influence their reputation through public reporting.

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Why are Inpatient THA / TKA Readmissions and Complications Increasing?

Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are critical measures in assessing the quality of care provided by healthcare facilities, particularly in the context of Medicare's value-based care models. These procedures are common among the elderly population, who are the primary beneficiaries of Medicare. The rates of 30-day readmission and complications after THA/TKA are significant indicators of the quality and effectiveness of perioperative care, postoperative management, and the overall health system's ability to provide coordinated care. These metrics directly impact various Centers for Medicare & Medicaid Services (CMS) Quality Programs, such as CMS Star Rating and the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with higher than expected readmission rates for certain conditions and procedures, including THA/TKA.

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How the SEP1 Chart Abstraction Measure can be Integrated into CMS Star Ratings and VBP

The SEP1 chart abstraction measure, a critical component in healthcare quality assessment, plays a pivotal role in evaluating the efficiency and effectiveness of sepsis management in healthcare facilities. Sepsis, a life-threatening response to infection leading to tissue damage, organ failure, and potentially death, requires timely and precise treatment. The SEP1 measure is designed to quantify the quality of this treatment by tracking various parameters, such as the timeliness of antibiotic administration and the completeness of sepsis care.

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Dexur Quality Measure Regulatory and Compliance Reporting

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Dexur’s Quality Measure reporting includes Chart Abstraction Software, which eliminates repetitive data entry, centralizing these functions into a single, efficient platform. With the unified approach, the primary focus shifts from data entry to improving quality outcomes. The Dexur’s Quality Reporting Module's original basis came from acquiring IHA’s Chart Abstraction software. Senior Vice President of IHA, Matt Browning, commented on the acquisition: "Dexur stands out as the best AI-driven solution to scale quality and risk management for hospitals. In the healthcare sector, there's a repetitive cycle of managing quality events, risk/incident management, and evaluating performance in programs like CMS Star Ratings. Dexur's innovative platform is uniquely positioned to unify these activities, offering a modern and efficient approach to managing these critical healthcare functions."

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What are the Top Pathogens Impacting CLABSI Infections in Hospitals

Central Line-Associated Bloodstream Infections (CLABSI) remain a significant challenge in healthcare settings, directly influencing patient outcomes and healthcare costs. CLABSI, a severe infection occurring in patients with central venous catheters, poses risks that extend beyond immediate health concerns, impacting hospital ratings and reimbursement rates.

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Dexur Acquires Chart Abstraction Software and Operations from Indiana Hospital Association, Enhancing AI-Driven Quality and Risk Management

Dexur, a leading provider of AI-driven unified quality and safety, risk, and incident management software, will acquire the Comparative Outcome Profile (COP) chart abstraction software from the Indiana Hospital Association (IHA). This strategic move aims to bolster Dexur's capabilities in offering comprehensive, AI-powered solutions to healthcare organizations.

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