Overview

The opportunity of the moment is to apply AI to every industry and every sector. Clinical risk management is no exception. This applies both to managing the risk of serious harm within a delivery system as well as managing claims of medical malpractice after an incident.

Quantifying ROI from patient safety improvement requires timely patient safety and risk data and the ability to link such safety and risk outcomes to financial outcomes at the patient-specific level. Fortunately, innovative solutions like Pascal’s Virtual Patient Safety (VPS) solution are emerging, revolutionizing the way hospitals approach patient safety.

The good news is that this is among the many capabilities of Pascal’s VPS solution, resulting in Pascal being able to demonstrate a business case that is considered “CFO-grade.” The sources of what is really adverse event-based ROI (versus patient safety, which typically connotes only the patient safety organizational function) flow from three key functions: patient safety, risk management, and revenue cycle.

Takeaways

Patient Safety: One of the primary challenges in building a patient safety business case lies in quantifying the impact of initiatives. VPS finds 10x more serious harm than currently captured by event reporting and Pascal clients reduce over 25% of that greater harm. Health system boards and leadership are now enabled by VPS with powerful data analytics and standardized metrics to accurately measure financial outcomes related to the incidence of adverse events such as excessive length of stay (XLOS).

Specifically, both peer-reviewed published and real-world evidence from Pascal’s Community Collaborative have validated that patient harm can extend patient hospital stays by an average consistent with what the landmark Harvard study in the NEJM published, i.e., 5.1 XLOS days. Based on validated patient harm reduction with the VPS solution, hospitals have demonstrated tangible financial benefits of adverse event reduction initiatives, generating over 3x ROI annually from XLOS reduction alone.

Risk Management: Recent experience shows a material opportunity emerging in risk management which has also long relied on event reporting. With Pascal identifying 10x the level of serious harm and potentially compensable events (PCEs) within 24 hours, a vista of opportunity opens up in a domain that revolves around the axial principle of “early identification” – which the medical professional liability industry defines as up to 90 days.

In an industry where “time is money”, Pascal’s VPS, offers an unprecedented opportunity to save both.  By leveraging clinically validated adverse event outcomes based on real-time EHR data (“AE Outcomes”), VPS can enable the reduction of indemnity payouts, legal expenses, and overall financial exposure resulting from legal liability.

Revenue Cycle: As CMS shifts towards value-based care (VBC), hospital reimbursement is increasingly tied to EHR-based harm measures. Hospitals must focus on minimizing harm incidents to protect reimbursement. Pascal VPS is a valuable asset in this regard, as CMS’ use of clinical data enables hospitals to avoid the choice of using claims data to meet CMS measures and get paid versus using clinical data and improving outcomes. For the first time, health systems can do both!

CMS has used what is fundamentally the same underlying method of EHR data elements as used by Pascal’s trigger-based methodology to develop the first EHR-based hospital harm measures tied to reimbursement: hyperglycemia, hypoglycemia, and opioid-related adverse events – with reportedly many new such measures in the measurement development pipeline.

While a multitude of companies can apply CMS’ logic on discharged patients, very few can continuously fire algorithms upstream while the patient is in the hospital on an existing clinically integrated workflow – i.e., Pascal VPS – to identify patients who are “candidates for a measure,” i.e., those patient stays that will receive less reimbursement. This is yet another way in which Pascal client investments can achieve higher ROI while not requiring a completely new investment (or fixed cost).

Conclusion

Historically, hospitals and healthcare organizations have largely relied on administrative or billing data, which is after the patient has left the hospital and is highly retrospective, or voluntary event reporting data, which can be more timely but miss 95% of the events and underlying patterns of harm.

Researchers, regulators, and Pascal Metrics’ health system partners are showing that trigger-based methodology can be operationalized at scale and deliver a materially significant CFO-grade business case – measured as an at least 3x annual ROI.