8 Steps for CNOs to Translate VBP Indicators

Nurse executives are responsible for the delivery of high quality care and the financial health of their organization. As a nurse leader and nursing advocate, you should be confident in your knowledge and understanding of value-based purchasing and its intersection with nurse sensitive indicators.

VBP is a snapshot of how hospitals are performing on quality indicators of patient care, quality, efficiency, and well-being. If you are informed on issues, you can create and communicate an improvement plan to both organization leadership and point of care nurses.

These are steps to consider when analyzing and relaying important information to stakeholders about nurse sensitive indicators.

1. See What Changes are Being Considered
Review proposed measures under consideration when published (check NQF website weekly for the various program measures – https://www.qualityforum.org) As an advocate for nurses and patients, keep yourself up to date on all new measures that might affect the daily work/patient outcomes so you can either advocate for or against changes. Encourage your staff to also become more aware and involved in learning about this process and how their voices can be heard.

2. See What Changes are Final
Review CMS and NQF websites for final decisions or updates on next year’s measurements. Staying ahead is the best way to ensure that your organization will be prepared when those changes go into effect. In 2018, safety will be weighted 5% higher toward VBP, so you may need to designate more time or resources for safety classes and training in the near future. Include and develop both staff and leaders in planning for the changes so they can become champions who help to lead this work.

3. Evaluate the Implications of New Measures
In your strategy meetings, discuss the measures that affect your organization. Determine what the measures mean for the organization’s budget and have an open discussion with other nurse leaders about what needs to be changed to best meet new requirements. Make sure to have a strategy to evolve with changes. It also is a great way to reinforce what the value of nursing is for the organization.

4. Connect the Dots between Nursing and Outcomes
Articulate the impact that the point of care or direct provider nurse has on the outcomes to be achieved and the overall success of the organization. Help nurses understand they are not a cost center, but rather contributors to VBP revenue streams. You can show them how their reactions to high-risk situations directly impact the patient satisfaction category of value based purchasing, so they can see their contribution. Translate that impact into “financial language” for C Suite colleagues.

5. Make Necessary Updates
Develop or revise your nursing performance scorecard to align with updated measures. There’s no point in evaluating performance against old standards. As the regulations change, so should your evaluation processes. For example, many scorecards still include a “process” section, but in 2018, processes won’t be considered toward VBP at all. Consider incorporating the improvements into performance development plans and incentive plans when possible.

6. Meetings with Clinical Stakeholders
Share in formal meetings with clinical stakeholders so they are aware of how the organization’s measures align with the national objectives of pay for performance. Emphasize any adjustments in how care for patients, especially exceptional care, translates into revenue for the organization.

7. Share Results with Staff and Leadership
Present monthly results to C Suite and to nursing bedside associates. Depending on who you’re relating results to, adjust the lens in which you view the information. When presenting to C suite, emphasize data, moving information to the C-suite about the impact of nurses to the bottom line. But when you’re presenting to your nurses, be sure to emphasize how those results relate to what they’re doing every day. In your organization, do you think most nurses understand the relationship between their actions and how the organization is funded? Keep communication open with nurses. Do they get feedback from you on how their ideas and opinions improved your organization? How are you gathering and using data from your nurses observations and patient care experiences?

8. Celebrate Success!
Make sure nurses are aware and proud of achievements! Show them the direct correlation between exceptional care and patient experience scores with the organization’s financial health. Showing point of care nurses the impact their hard work has on the entire organization will inspire them to continue to improve.

Have an understanding of the relationships among payment strategies, value-based reimbursement, and bedside nursing. If you can communicate your plan to leaders and nurses, and share the impact that point of care nurses make to reimbursement, it will help with transparency and morale in the organization. Bob Dylan once sang “The times, they are a changing!” And that has never been more relevant than in nursing today.

Article summary from AONE 2017 presentation “Follow the Money: Value Based Purchasing and Nurse Sensitive Indicators.” Rhonda Anderson RN, DNS (h), FAAN, FACHE, CEO of Cardon Children’s Medical Center (Banner Health System in AZ), RMA Consulting, past JCAHO commissioner, and President of AONE from 1993-1994; Anne McNamara Rn, PhD, past Dean of Nursing at Galen College of Nursing (KY)