Hospital Quality Measures: Value Based Purchasing 2.0 (The Funny Version).

For years, hospital quality measures have been tracked by private and government insurance programs to try and improve the healthcare services received by their beneficiaries.  The most recent example is the Value-Based Purchasing Program (VBP) initiative by The Centers For Medicare & Medicaid Services (CMS).  How does CMS describe VBP?

"Under the Program, CMS will make value-based incentive payments to acute care hospitals, based either on how well the hospitals perform on certain quality measures or how much the hospitals' performance improves on certain quality measures from their performance during a baseline period. The higher a hospital's performance or improvement during the performance period for a fiscal year, the higher the hospital's value-based incentive payment for the fiscal year would be."

This complex program has many different elements that require hospitals and doctors to excel against their peers or face penalties and payment cuts. What are some hospital quality measures  being tracked under VBP?  There are Process of Care measures and  HCAHPS patient satisfaction surveys.    There are 30-Day Outcome Mortality measures and Patient Safety Indicators.  There are  the tracking of Healthcare Associated Infections (HAI) and hospital readmissions.  There's even efficiency measures that track spending per beneficiary.

Other programs track 30 day this and 90 day that.  There are DRGs, MS-DRGs, comorbid conditions (CC) and major complicating or comorbid conditions (MCC).  There is  PQRS for physicians and ICD-10 and CPT and E/M and Oh, Lordy, when does this madness end?

You'd think by now we would have enough hospital quality measures to track everything, right?  Think again.  The Happy Hospitalist has learned VBP Version 2.0 will include the following A-Z list of new and clinically relevant quality measures that will help computer algorithms take data mining to the next level in an effort to risk stratify hospitals, patients and doctors.  This newest Medicare effort is like VBP on steroids.  In line with all previous Medicare efforts to reduce costs by simply stopping payment to doctors and hospitals, success with VBP 2.0 will be difficult.  Happy Hospitalist sources deep inside CMS have confirmed failure by hospitals to score in the top 0.01% of every single hospital quality measure listed below will result in an automatic assumption of crappy care and a return of 99% of all payments made for the prior fiscal year.   Medicare says VBP Version 2.0 succeeds in their unstated but obvious goal of simply not paying for care anymore.

Frank, a retired physician turned top CMS data entry technician, who became a master typist when physician order entry went live at his hospital last year, says his hommies in control of the CMS checkbook hope to have Medicare costs down to about $50 a year by 2017.  "Because, frankly, we don't even have fifty bucks to pay you guys anymore", he said.

So here you are folks.  I present to you the newest collection of hospital quality measures being tracked by CMS in an effort to eliminate hospital and doctor payments for good.  If you don't yet have software programs in place to track all this data, you can purchase it for a ton of money from the AMA.  They are currently providing a 3% multiple policy discount when purchased in combination with disability insurance, life insurance, Pass Your ABIM Test insurance and You Picked The Wrong CPT® Code And Now You're Screwed insurance.

CMS is interested in your opinion and will have 14 public periods of comment to hash out the details.  If you'd like to leave any of your own suggestions for new hospital quality measures under VBP 2.0, leave a comment here or on The Happy Hospitalist Facebook Page and CMS will give your opinion thoughtful consideration.

A

• Acting Like An Asshole-to-Anesthesiologist Consult time
• Alcohol-to-Afib time
• Alzheimer's Agitation-to-Angry Family time
• AMA-to-Angry Letter time
• Ambulance-to-Ambulate time
• Anxiety-to-Ativan time
• Attitude-to-Ativan time

B

• Bad Breath-to-Brushing time
• Bad-Heart-to-Bacon time
• Barefoot-to-Banana Bag ratio
• Bedridden-so-Bring to the ER time
• Belligerent-to-B52 time
• Beta Blocker-to-Bradycardia time
• Bilateral Cellulitis-to-Been There For Years ratio
• Biting-to-Benzo time
• Blood Loss-to-BS ratio (a Surgical Care Improvement Project (SCIP))
• Bowel Movements-Bounce Back Ratio

C

• Call Light-to-Crackers time
• Call Light-to-Code Blue time
• Chatty-to-Charting ratio
• Clean Catch-to-Clean Catch ratio
• Cold Sore-to-Consult Hospitalist time
• Colon Cancer-to-Colostomy time
• Combative-to-Clonazepam time
• Common Sense-to-Complete BS time
• Complaint-to-Call the Hospitalist time
• Constipation-to-Colace time
• Crappy Day-to-Call Light Fatigue ratio
• Crazy-to-Clonazepam time
• Critical Care-to-Coroner time
• Cyanosis to-CPAP time

D

• Debilitated-to-Depends time
• Delirium-to-Discharge time
• Dementia-to-DNR time
• Demerol-to-Discharge time
• Dialysis-to-Denny's Discharge time
• Diarrhea-to-Distressed Nurse time
• Dilaudid-to-Dessert time
• Dilaudid-to-Doughnut time
• Distress-to-Dilaudid time
• Distress-to-Doughnut time
• DNR-to-Don't Be Agressive But CPR Is OK ratio
• DJD-to-Disability Request time
• Door-to-Dilaudid time
• Drug-to-Doughnut time
• Drug Rash-to-Dermatology Consult time
• Drunk-to-Discharge time

E

• Ear Ache-to-ER time
• Emaciated Elderly In the ER rate
• ER-to-Empathy ratio
• Ethanol-to-Entertainment time
• Extubation-to-Exiting ICU time

F

• Faking It-to-Full Workup ratio
• Fall-to-Freakout time
• Fentanyl-to-French Fries time
• Fever-to-Full Workup ratio
• Fibromyalgia-to-FMLA Request time
• Fibromyalgia-to-Funny Allergies ratio
• Frailty-to-Foley time
• Frequent Flyer-to-Full Of It ratio
• Full Code-to-Frailty ratio

G

• Gangrene-to-Guillotine time
• Gastric Bypass-to-Gimme Seconds time
• Giving It Up-to-Gonorrhea time
• Going Off Call-to-Go To The ER ratio
• GOMER-to-Getting a Ride Home time

H

• Haldol-to-Happy Nurse ratio
• Haldol-to-Hope This Works time
• Hot Meal In the ER-to-Hotel Discharge Time
• Head Trauma-to-Haldol time
• Healthy-to-Hospital Acquired Half Dead time
• Hip Fracture-to-Heaven time
• Histrionic-to-Haldol time
• Homeless-to-Hypothermia ratio
• Half Dead-to-Hotel Discharge rate
• Hospitalist Consult-to-Hospice time
• Hyperglycemia-to-Humalog time
• Hyperventilation-to-Haldol time

I

• Impatience-to-iPhone ratio
• Intoxication-to-Intubation time
• Irritation-to-ICU Transfer time
• Irritation-to-Intubation time
• IV-to-Infiltration time

J

• Jailed-to-Jacked-Up-In-The-ER time
• Jelly Doughnut At Nurses Station-to-Joint Commission Arrival time 
• Jim Beam-to-Jaundice time
• Joblessness-to-Just Fill Out My Disability Papers time
• Joint Pain-to-Job Note Request time
• Junkie-to-Jugular Line ratio

K

• Ketosis-to-Kayexalate time
• Kegger-to-Ketosis time
• Kleenex-to-Klonipin time 
• Knucklehead-to-Knife Injury ratio

L

• Lactulose-to-Look Out Below time
• Leg Edema-to-Lasix time
• Leaving AMA before Lunch percentage
• Leopard Tights Leaving AMA percentage
• Lethargic-to-Lipstick time
• Loculated-to-Levaquin time
• Lipping Off-to-Lorazepam time
• LOL Leaving AMA-to-LMAO ratio
• Lung Cancer Diagnosis-to-Lighting Up time

M

• Medicaid-to-Manicure ratio
• Melena-to-Misty Autumn Sunrise Spray time
• Melena-to-Morgue time
• Migraine-to-MRI time
• Migraine-to-Morphine time
• Morphine-to-Manwich time

N

• Narcotics-to-Narcan time
• Narcotics-to-Nausea time
• Narcotics-to-Needs Admitting time
• Nasty-to-Nystatin time
• Nausea-to-Nasogastric Tube time
• Norco-to-Naked time
• Nothing Is Still Wrong-to-No Need To Go To The ER Again time

O

• Out Of Control-to-Olanzapine time
• Overdose-to-OMG Really? time

P

• Pain In My Ass-to-PCA time
• PEG Tube-to-Palliative Care time
• Pen Pal-to-Four Point Restraint time
• Percocet-to-Perfect Press Ganeys ratio
• Percocet-to-Pork Sandwich time
• Phenergan-to-Feel Good time
• Psychosis-to-Sitter time
• Polypharmacy-to-Palliative Care time

Q

• Questionable-to-Quality ratio

R

• Respiratory Rate-to-Record 20 ratio
• Rest Home-to-Resuscitate ratio
• Restlessness-to-Restraints time

S

• Sedation-to-Shaving It Off time
• Seizure-to-Spazzing Out ratio
• Sterile-to-Staph aureus time
• Sedation-to-Somnolence ratio
• Sometin' Really Bad-to-Steroids time
• Sometin' Really Bad-to-Surgery Consult time
• Spit-to-Sputum Sample ratio
• Stick Around For 3 Midnights-to-SNF ratio
• Stupid-to-Sedation time

T

• 10/10 Pain-to-Tylenol ratio
• Tachycardia-to-Telemetry time
• Too Obese For Ortho Consult rate
• Too Old For Ortho Consult rate
• Tourniquet-to-Transfusion ratio 
• Train Wreck-to-Transfer time
• Trash Talking About Transfers To Other Floors ratio
• Trauma-to-Transfer time 
• Trauma Drama-to-Totally Unnecessary Admission ratio

U

• UTI-to-Urology Consult ratio
• Urine Output-to-U Don't  Have To Worry About It ratio
• Urosepsis-to-You've Got To Be Kidding Me ratio

V

• Vague Complaints-to-Van time
• Vanishing Vein-to-Victory time
• Venereal-to-Valcyclovir time
• Very Sick-to-Vital Signs time
• Very Sick-to-Ventilator time
• Veteran-to-Viagra ratio
• Vindictive-to-Ventilator time
• Violent-to-Versed time
• Virgin-to-Venereal Disease ratio
• Vocal-to-Ventilator time
• Vomiting-to-Vital Signs time
• Vulgar-to-Versed time

W

• Waiting at the Nurses Station For Discharge-to-WTF time
• Walking the Halls-to-Won't Go Home ratio
• Weakness-to-Wonder If We'll Find Something This Time ratio
• Weakness-to-Worthless Workup ratio
• Weekend-to-Waiting time
• Worthless Workup-to-Work Note Request time

X

• X ray-to-Expect Result time

Y

• Yeast-to-You Need a Nursing Home ratio
• Your Baby Daddy Sent You-to-You're Not Getting A Pregnancy Test On My Time time 
• Young-to-You're Making Me Yawn time
• You're Irritating Me-to-Yankhauer time

Z

• Zonked-to-Xanax ratio

"My ER has the highest Percocet-to-Perfect Press Ganeys in the country.  Just so you know."

"We have the fastest Dialysis-to-Denny's Discharge time in the country.  Just so you know."

"My floor has the best anxiety to Ativan time in the country.  Just so you know."

"At my hospital we have the best irritation to intubation time in the country.  Just so you know."

"At my ER, we have the fastest Percocet-to-Pork Sandwich time in the country.  Hurray!"

You can find hundreds of other original medical e-cards on Pinterest from The Happy Hospitalist too.

This post is for entertainment purposes only.  It contains humor that may only be understood by some healthcare professionals.  Read at your own risk.  If you believe any of this is real, we have a hospital quality measure that's just right for you.  It's called Geodon-to-God Made You Special Too ratio.

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