Building the Business Case for Your ACS Improvement Efforts

By Chad Whelan, MD

Building the business case is an essential part of quality improvement efforts, particularly those that require significant institutional investments. Remember, investments are not only dollars spent but also time and resources spent. Fortunately, with ACS, as the leader of the performance improvement team, it is not likely that you will have to make the business case. In this clinical area it is much more likely that institutional leaders will be asking you to show improvement rather than to prove the worth of the effort.

Because ACS is such a high-impact diagnosis (high prevalence and high morbidity and mortality) that has a large number of richly data-driven interventions, many external agencies have made ACS quality metrics a cornerstone of their quality assessment. Most important are those managed by the federal government. The CMS hospital core measure set has several AMI quality metrics that are referred to throughout this guide. The Physicians Quality Reporting Initiative (PQRI), also managed federally, has a similar emphasis on measures of patients with coronary artery disease.

Currently, both these initiatives are primarily in the pay-for-reporting phase. Therefore, at this point, all the direct financial incentives are tied only to reporting the measures not performing them well. However, hospital administrators are correctly recognizing that performance does and will have real financial implications. The performance of all hospitals that report their institutional data is published publicly on the Hospital Compare Web site. It is quite simple not only to look at one hospital but also to compare the performance of competing hospitals on these measures of ACS care. No administrator wants his or her hospital to be at the bottom in this sort of high-profile public setting. Additionally, although these initiatives are pay for reporting now, the widely held assumption is that pay for performance is coming soon. When this rolls out, there will be direct financial incentives for hospitals (for the CMS core measures) and physicians (for PQRI) to be at the top of the list.

Additional considerations for the business case for ACS include standard cost-savings measures such as reducing length of stay or cost of care or readmission rates. Although these are areas you may want to consider evaluating at your institution, they may not be optimal targets for many institutions for patients with ACS.