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PIP first quarter results reflect growing pains

Results for fiscal year 2013, which ended December 30, 2012, indicate that employees are continuing to hold steady while working to adjust to new goals and measures incorporated in this year's PIP program.

If PIP were paid today, eligible employees would receive a payout of up to 2 percent of their salary. If all goals are achieved at maximum, the potential PIP maximum payout is 3 percent for FY13.

This year, PIP results are measured in four hospitalwide areas of performance: patient safety and quality, patient experience, Epic implementation and financial.

PIP first quarter goals and results

Category Measure Threshold Target Max Actual
Patient Safety and Quality (30%) Joint Commission Extension Survey Accreditation Received TBD
DPH Licensure Survey License Renewed TBD
30-day Readmissions 16.9% 16.2% 15.5% 14.6%
Patient Experience (30%) Overall rating (HCAHPS) 74 75 76 73.6
Medication communica- tion (HCAHPS) 62 63 66 63.6
Environment (HCAHPS) 60 64 71 58.2
Inpatient Pediatrics 88 88.5 89 88.5
Inpatient Behavioral Health 80.9 81.5 82.1 79.8
Ambulatory Surgery 92.5 92.7 92.9 92.2
Emergency Department 84.2 84.4 84.6 83.8
Epic Implementation (10%) Successful go-live York St.– 2/1/13 Successful go-live Chapel St. 6/1/13 Threshold + 90% trained 3 weeks prior to go-live Threshold + 95% trained 1 week prior to go-live TBD
Financial (30%) Net Operating Margin 1.9% 2.1% 2.3% 2.6%

KEY: red – below threshold; yellow – met threshold; green – met target; blue – met maximum

Patient Safety and Quality

The patient safety and quality category includes three measures which, together, account for 30 percent of PIP:

  • Joint Commission extension survey
  • Department of Public Health licensure survey
  • 30-day readmissions

Surveyors from The Joint Commission, the regulatory agency that accredits healthcare organizations throughout the United States, visited the Saint Raphael Campus in February for an accreditation survey. The extension survey, which was required because YNHH has extended services on the SRC, also included the Smilow Cancer Care Centers. Although YNHH passed the survey, the results will be accounted for in the second quarter PIP results.

Similarly, the Connecticut Department of Public Health (DPH) will also survey YNHH for license renewal in late spring or summer of 2013. In light of the importance of the DPH survey, this metric has been deemed to be a "circuit breaker," meaning that failure to obtain DPH licensure will automatically result in zero points for the patient safety and quality category.

The result of this measure, as well, is to be determined. The 30-day readmissions metric measures the percentage of patients who are readmitted to the hospital within 30 days of their discharge for the same — or a related — condition. The result was 14.6 percent, above the maximum goal.

Patient Experience

The patient experience category measures a patient's complete experience from pre-admission through postdischarge follow-up. It includes seven measures related to patient satisfaction as reported in HCAHPS (Hospital Consumer Assessment of Health Providers and Systems) and Press Ganey surveys. Together, patient experience measures account for 30 percent of PIP.

HCAHPS surveys:

  • Overall rating of hospital just missed the threshold goal of 74 coming in at 73.6;
  • Medication communications met its target goal at 63.6;
  • Environment of care, which includes cleanliness and quiet, fell short of the threshold goal of 60 with a score of 58.2.

Press Ganey surveys:

  • Inpatient Pediatrics reached its target goal of 88.5;
  • Inpatient Behavioral Health fell below threshold at 79.8;
  • Ambulatory Surgery narrowly missed its threshold goal of 92.5 coming in at 92.2;
  • Emergency Department results also fell short of the threshold goal coming in at 83.8.

Epic Implementation

The Epic implementation goal is based on the successful integration of the electronic medical records system on the York Street Campus, which occurred on February 1; the Saint Raphael Campus is scheduled for June 1. The target goal is that 90 percent of appropriate staff be trained three weeks prior to each go-live date. Epic implementation accounts for 10 percent of PIP and results will be determined during the third quarter.

Financial Performance

The sole financial measure is the hospital's net operating margin, which accounts for 30 percent of PIP. For the first quarter, the net operating margin was 2.6 percent exceeding the maximum goal.

"While employees are clearly working hard at meeting the challenges and demands that offering top quality patient care brings, there is still work to do," said Richard D'Aquila, president and COO. "As we continue to move throughout the year, if we sustain momentum in areas where we are meeting our goals, reinforce best practices and control spending, we still have a very real opportunity to reach our maximum PIP goals as well as the maximum PIP payout for this year."

Yale-New Haven Hospital news release

Yale-New Haven Hospital is a nationally recognized, 1,541-bed, not-for-profit hospital serving as the primary teaching hospital for the Yale School of Medicine. Yale-New Haven was founded as the fourth voluntary hospital in the U.S. in 1826. Today, the hospital's two New Haven-based inpatient campuses include Yale-New Haven Children's Hospital, Yale-New Haven Psychiatric Hospital and Smilow Cancer Hospital. YNHH has a combined medical staff of about 4,500 university and community physicians practicing in more than 100 specialties. YNHH's York Street campus and associated ambulatory sites are Magnet-designated by the American Nurses Credentialing Center.

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