Value-Based Purchasing Program Overview. Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012

Size: px
Start display at page:

Download "Value-Based Purchasing Program Overview. Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012"

Transcription

1 Value-Based Purchasing Program Overview Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012

2 Presentation Overview Background and Introduction Inpatient Quality Reporting Program Value-Based Purchasing Program IQR and VBP Evolution and History CMS FY13 VBP Final Scores Process Measures Analysis Core Measure All or None Bundles Value-Based Purchasing Program Measures Status of FY14 VBP Performance Current data collection Addition of Outcome Measures CMS VBP in FY16 and Beyond 2

3 3 Background and Introduction

4 IQR Program Department of Health and Human Services developed Hospital Inpatient Quality Reporting (IQR) Program which requires hospitals to submit quality IQR measures. and VBP Evolution and History Conditions include: acute myocardial infarction (AMI), heart failure (HF), pneumonia (PNE), surgical care improvement project (SCIP) Indicators include: process measures and patient experience 30-day mortality and readmission rates, patient safety indicators Eligible hospitals that do not participate will receive an annual market basket update with a 2.0 percentage point reduction.

5 VBP Program: Background Congress authorized the hospital inpatient Value-Based Purchasing (VBP) Program through the Affordable Care Act. Built on the Hospital IQR measure reporting infrastructure. Uses Hospital IQR measures that have had results published on Hospital Compare* for at least one year Funded by a 1% reduction from participating hospitals base operating diagnosis-related group (DRG) payments for FY 2013, increasing to 2% by FY *

6 VBP Program: Purpose VBP Program seeks to encourage hospitals to improve the quality and safety of care for Medicare beneficiaries and all patients receive during acutecare inpatient stays by: 1) Eliminating or reducing occurrence of adverse events 2) Adopting evidence-based care standards and protocols that result in the best outcomes for the most patients 3) Improve patients experience of care 6

7 VBP Program: Domain Overview VBP Fiscal Year % Program Contribution 1.00% 1.25% 1.50% 1.75% *Six Domains: 1 Process of Care 70% 45% 20% 2 Patient Experience 30% 30% 30% 3 Outcome - 25% 30% 4 Efficiency: Medicare Spending per Beneficiary % Reclassification of Domains: National Quality Strategy* 1) Clinical Care 2) Person- and Caregiver- Centered Experience and Outcomes 3) Safety 4) Efficiency and Cost Reduction 5) Care Coordination 6) Community/ Population Health CMS Shift for Quality Measurement: Clinical Process Measures Outcomes and Efficiency Measures (not risk-adjusted) (risk-adjusted) 7

8 FY13 VBP: Performance Periods BASELINE Performance Period: July 2009 March 2010 FY13 Performance Period: July 2011 March 2012 Payment Impact Period: October 2012 September

9 National Targets *Data collection period for national baseline targets: July 2009 March

10 10 Achievement Points

11 11 Achievement Points

12 12 Improvement Points

13 13 Improvement Points

14 Final Points Each measure is worth 10 points CMS takes the higher of either the achievement or improvement points FY13 VBP: 12 process measures (120 total points) FY14 VBP: 13 process measures (130 total points) Add urinary catheter on post operative day 1 or 2 Measures with fewer than 10 reported cases are considered to have insufficient data and will not be scored for that hospital. 14

15 15 CMS FY13 VBP Final Scores

16 CMS FY13 VBP: Process of Care Clinical Process of Care Measures Heart Attack National Baseline Benchmark Achievement Threshold Baseline % Performance Period: July March 2012 Current % Green Achievement Points 1 Fibrinolytic therapy within 30 minutes 91.91% 65.48% PCI within 90 minutes % 91.86% Improvement Points Final Points Insufficient Data Insufficient Data Heart Failure 3 Discharge instructions % 90.77% 92.67% % Pneumonia 4 Blood cultures in ED before antibiotic % 96.43% 97.56% Appropriate antibiotic selection 99.58% 92.77% 93.22% 97.73% Insufficient Data 6 Prophylactic antibiotic received within one hour prior to surgical incision 99.98% 97.35% 99.00% % Prophylactic antibiotic selection for surgical patients % 97.66% 99.67% % Surgical Care Improvement Project 8 9 Prophylactic antibiotics discontinued within 24 hours after surgery end time Cardiac surgery patients with controlled 6AM postoperative serum glucose 99.68% 95.07% 94.79% 99.67% % 94.28% % 98.85% Recommended VTE prophylaxis ordered % 95.00% 98.18% % Received appropriate VTE prophylaxis within 24 hours prior - 24 hours after surgery Patients on beta blocker therapy prior to admit who received a beta blocker during perioperative period 99.85% 93.07% 96.36% % % 93.99% 96.90% 98.97% Score: 91.11% 16

17 CMS FY13 VBP: Patient Experience of Care Patient Experience of Care* National Baseline Performance Period: July March 2012 Green Bench mark Achievement Threshold Floor Baseline % Current % Achievement Points Improvement Points Final Points 1 Nurses always communicated well 84.70% 75.18% 38.98% 79% 81% Doctors always communicated well 88.95% 79.42% 51.51% 83% 86% Patients always received help quickly from hospital staff 77.69% 61.82% 30.25% 63% 67% Patients' pain was always well controlled 77.90% 68.75% 34.76% 70% 75% Staff always explained about medicines before giving them to patients 70.42% 59.28% 29.27% 63% 66% Patients' rooms and bathrooms were always kept clean and quiet 77.64% 62.80% 36.88% 63% 65% Patients were definitely given information about what to do during their recovery at home Patients who gave their hospital a rating of 9 or higher on a scale of 0 to % 81.93% 50.47% 81% 85% % 66.02% 29.32% 79% 81% Consistency Points: Score: % 17 * Patient experience data is adjusted by CMS for certain patient-mix variables. These include: service line, age, response percentile, and self-reported level of education, health, and primary language.

18 Total VBP Score: State Average = 52.83% National Average = 55.46% CMS FY13 VBP: FINAL Scores* FY13 VBP Encinitas Green La Jolla Mercy FINAL VBP Scores Process 87% 91% 74% 62% Patient Experience** 42% 63% 50% 25% Total VBP Score 74% 83% 67% 51% 18 * Source: CMS Hospital Value Based Purchasing - Actual Percentage Summary Report, released 10/31/12. ** Patient experience data is adjusted by CMS for certain patient-mix variables. These include: service line, age, response percentile, and self-reported level of education, health, and primary language.

19 CMS FY13 VBP: Performance Periods and Timeline FY13 VBP Data Collection Periods: Baseline Performance: July 2009 March 2010 Current Performance: July 2011 March 2012 October 31, 2012: CMS sent hospitals the Actual Payment Percentage Summary Report January 1, 2013: Incorporate 1% reduction and value-based incentive payment simultaneously 19

20 CMS FY13 VBP: Estimated Financial Impact Measure Encinitas Green La Jolla Mercy Scripps Hospitals ACTUAL POTENTIAL* 1 FINAL VBP Scores 74% 83% 67% 51% ESTIMATED FY13 IPPS Operating Payments 1% Reduction (Pay-In Amount into VBP Pool) 1% Reduction + Value-based Incentive (Total Payment from VBP Pool) $24,110,800 $47,430,600 $47,576,100 $70,942,000 $190,059,500 $190,059,500 ($241,108) ($474,306) ($475,761) ($709,420) ($1,900,595) ($1,900,595) $325,606 $720,512 $581,702 $661,801 $2,289,621 $3,491,393 5 Net Loss/Gain $84,498 $246,206 $105,941 ($47,619) $389,026 $1,590,798 6 Total Reimbursement for FY13 IPPS Operating Payments $24,195,298 $47,676,806 $47,682,041 $70,894,381 $190,448,526 $191,650,298 *POTENTIAL reimbursement: if all sites had VBP score of 100% 20

21 CMS FY13 VBP: Example for Green Example for an FY13 Claim: 1 FINAL VBP Score Measure Measure Description Based on performance period: July March 2012 Green 83% 2 Operating Payment Claim Billed to Medicare For inpatient stay in FY13 $ % Reduction Pay-in amount into VBP pool ($1.00) 4 1% Reduction + Value-based Incentive Total payment from VBP pool $ Net Loss/Gain - $ Total Reimbursement for Claim - $

22 22 Process Measures Analysis

23 Core Measures System-wide: All or None Bundle Scores 100% 80% Bundle Compliance (%) 60% 40% Heart Attack Heart Failure Pneumonia SCIP 20% 23 0% FY 03 FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12

24 Core Measures System-wide: Heart Attack Bundle Scores 100% Bundle Compliance (%) 90% 80% 70% 60% Scripps Top Decile Top Quartile Median Bottom Quartile Bottom Decile # Hospitals for percentile ranks = %

25 Core Measures System-wide: Heart Failure Bundle Scores 100% 80% Bundle Compliance (%) 60% 40% Scripps Top Decile Top Quartile Median Bottom Quartile Bottom Decile 20% # Hospitals for percentile ranks = %

26 Core Measures System-wide: Pneumonia Bundle Scores 100% 80% Bundle Compliance (%) 60% 40% 20% Scripps Top Decile Top Quartile Median Bottom Quartile Bottom Decile # Hospitals for percentile ranks = %

27 Core Measures System-wide: SCIP Bundle Scores 100% 80% Bundle Compliance (%) 60% 40% Scripps Top Decile Top Quartile Median Bottom Quartile Bottom Decile # Hospitals for percentile ranks = %

28 28 VBP Process Scores: System-wide Performance

29 VBP Process Scores: System-wide Performance Objectives 3-year Goal = 78% Systemwide (National Predicted Top Decile) Scripps Health Yearly Goals 72.5% 75.3% 76.6% 78% Baseline performance* (FY14 VBP Benchmarks) FY13 Goal (FY14 VBP Benchmarks) FY14 Goal (FY15 VBP Benchmarks) FY15 Goal (FY16 VBP Benchmarks) 29 *Based on system aggregate scores for the performance period of April to July 2012.

30 Process Scores: Site Performance National top decile for process bundle FY13 VBP 30

31 FY12 VBP Board Objective (using CMS FY13 Targets) Value-Based Purchasing Measures: Clinical Process of Care Heart Attack National Baseline Benchmark Achievement Threshold Current % 1 Fibrinolytic therapy within 30 minutes 91.9% 65.5% - 0 Current n Final Points Insufficient Data Current % Performance Period: FY12 (August July 2012) Scripps Hospitals Encinitas Green La Jolla Mercy Current n - 0 Final Points Insufficient Data Current % Current n PCI within 90 minutes 100.0% 91.9% 95.4% % % 7 Final Points Insuf f icient Data Insuf f icient Data Current % Current n - 0 Final Points Insufficient Data Current % Current n - 0 Final Points Insufficient Data 97.0% % 84 6 Heart Failure 3 Discharge instructions 100.0% 90.8% 99.3% % % % % Pneumonia Surgical Care Improvement Project 4 Blood cultures in ED before antibiotic 100.0% 96.4% 99.2% % % 8 Insuf f icient Data 100.0% % Appropriate antibiotic selection 99.6% 92.8% 99.0% % % % % Prophylactic antibiotic received within one hour 6 prior to surgical incision Prophylactic antibiotic selection for surgical 7 patients Prophylactic antibiotics discontinued within 24 8 hours after surgery end time Cardiac surgery patients with controlled 6AM 9 postoperative serum glucose 100.0% 97.4% 99.6% % % % % % 97.7% 99.5% % % % % % 95.1% 99.1% % % % % % 94.3% 96.0% Insufficient Data 99.2% % % Recommended VTE prophylaxis ordered 100.0% 95.0% 99.1% % % % % Received appropriate VTE prophylaxis within hours prior - 24 hours after surgery 99.9% 93.1% 98.5% % % % % Patients on beta blocker therapy prior to admit who 12 received a beta blocker during perioperative period 100.0% 94.0% 98.7% % % % % FY12 Score Goal 65.9% 67.0% 90.6% 67.7% 65.9% FY12-to-date Score 75.5% 87.0% 91.1% 76.4% 67.3% 31 Legend: = M aximum of either achievement or improvement points = Current performance meeting FY12 Value-Based Purchasing Goal = Current performance below FY12 Value-Based Purchasing Goal

32 Green s Performance: CMS FY13 vs. FY14 Targets Value-Based Purchasing Measures: Clinical Process of Care Heart Attack CMS FY13 VBP National Baseline Benchmark Achievement Threshold Performance Period: FY12 (August July 2012) Current % 1 Fibrinolytic therapy within 30 minutes 91.91% 65.48% PCI within 90 minutes % 91.86% % 7 Current n Final Points Benchmark Achievement Threshold Current % Current n Insufficient Data 96.30% 80.66% - 0 Insufficient Data % 93.44% - 0 Heart Failure 3 Discharge instructions % 90.77% % % 92.66% % Green CMS FY14 VBP National Baseline Performance Period: FY13 (August 2012) Green Final Points Insufficient Data Insufficient Data 32 Pneumonia Surgical Care Improvement Project 4 Blood cultures in ED before antibiotic % 96.43% % 8 Insufficient Data % 97.30% Appropriate antibiotic selection 99.58% 92.77% 98.18% % 94.46% % Prophylactic antibiotic received within one hour prior to surgical incision 99.98% 97.35% 99.75% % 98.07% 96.88% Prophylactic antibiotic selection for surgical patients % 97.66% % % 98.13% % Prophylactic antibiotics discontinued within 24 8 hours after surgery end time Cardiac surgery patients with controlled 6AM 9 postoperative serum glucose Postoperative urinary catheter removal on post 10 operative day 1 or day % 95.07% 99.00% % 96.63% 96.88% % 94.28% 99.19% % 96.34% % 8 10 n/a n/a n/a n/a n/a 99.89% 92.86% % Recommended VTE prophylaxis ordered % 95.00% % % 95.65% % 8 10 Received appropriate VTE prophylaxis within hours prior - 24 hours after surgery Patients on beta blocker therapy prior to admit who 13 received a beta blocker during perioperative period 99.85% 93.07% % % 94.62% % % 93.99% 99.28% % 94.92% % FY12 Score GOAL 90.6% FY13 Score GOAL 91.00% FY12 Score ACTUAL 91.1% FY13 Score ACTUAL 81.00% Insufficient Data

33 Green s Performance: Indicator Drilldown SCIP Antibiotic within 1 hour Green s score: 9 (99.8%) 0 (96.9% = 1 OFI*) Site performance National performance Gap between top decile and median scores decreases and the VBP achievement range narrows FY13: 97.4% - 100% FY14: 98.1% - 100% 33 *OFI = Opportunity for improvement

34 FY 2014 Baseline and Performance Periods

35 CMS FY14 VBP Performance: Update for Green Heart Attack ACTUAL Performance Period: Apr 2012 Dec 2012 CURRENT Performance Period: Apr 2012 Sep 2012 Benchmark Achievement Threshold 1 Fibrinolytic therapy within 30 minutes 96.30% 80.66% PCI within 90 minutes % 93.44% % 5 Heart Failure 3 Discharge instructions % 92.66% % Pneumonia Value-Based Purchasing Measures: Clinical Process of Care National Baseline Performance Period: FY13 (Apr Sep 2012) 4 Blood cultures in ED before antibiotic % 97.30% % 1 Current % Green 5 Appropriate antibiotic selection % 94.46% % Prophylactic antibiotic received within one hour prior to surgical incision % 98.07% 99.04% Prophylactic antibiotic selection for surgical patients % 98.13% % Prophylactic antibiotics discontinued within 24 hours after surgery end time 99.96% 96.63% 98.04% Current n Final Points Insufficient Data Insufficient Data Insufficient Data Surgical Care Improvement Project 35 9 Cardiac surgery patients with controlled 6AM postoperative serum glucose % 96.34% % Postoperative urinary catheter removal on post operative day 1 or day % 92.86% % Recommended VTE prophylaxis ordered % 95.65% % Received appropriate VTE prophylaxis within 24 hours prior - 24 hours after surgery % 94.62% % Patients on beta blocker therapy prior to admit who received a beta blocker during perioperative period 99.83% 94.92% % Score: 89.00%

36 CMS FY14 VBP How Will Hospitals Be Evaluated? Total Performance Score

37 About the same as our last VBP report so far Patient Experience

38 Outcome: Current Performance OUTCOME MEASURES 30-day Mortality Rate (displayed as survival rate) Heart Attack Heart Failure Pneumonia AHRQ PSI-90 Composite for selected indicators (n = # outcomes) 2014 National Baseline Benchmark Achievement Threshold 2015 National Baseline Benchmark Achievement Threshold not included National Baseline Benchmark Achievement Threshold 86.73% 84.77% 86.24% 84.75% 86.24% 84.75% 90.42% 88.61% 90.03% 88.15% 90.03% 88.15% 90.21% 88.18% 90.42% 88.27% 90.42% 88.27% 0.62 Performance 86.4% (N) 91.2% (N) 89.9% (N) 0.89 (W) Green Data Collection Period Jul Jun 2011 PSI-90 Measures: Publicly Reported PSI-90 Measures: NOT Publicly Reported PSI 6: Iatrogenic pneumothorax PSI 12: Postoperative VTE PSI 14: Postoperative wound dehiscence 0.42 (N) 5.88 (N) 0.41 (N) PSI 15: Accidental Puncture or Laceration Part of PSI-90 Part of PSI-90 Part of PSI (W) PSI 3: Pressure Ulcer Composite Composite Composite 0.01 PSI 7: Central Venous Catheter-Related Bloodstream Infections PSI 8: Postoperative Hip Fracture 0.06 PSI 13: Postoperative Sepsis Jul Jun 2011 Central line-associated blood stream infection (shown as a Standardized Infection Ratio) not included not included 1.35 (W) Jul Mar B = Better than U.S. National Rate N = No different than U.S. National Rate W = Worse than U.S. National Rate

39 39 VBP in FY16 and Beyond

40 VBP Program: Domain Overview VBP Fiscal Year % Program Contribution 1.00% 1.25% 1.50% 1.75% *Six Domains: 1 Process of Care 70% 45% 20% 2 Patient Experience 30% 30% 30% 3 Outcome - 25% 30% 4 Efficiency: Medicare Spending per Beneficiary % Reclassification of Domains: National Quality Strategy* 1) Clinical Care 2) Person- and Caregiver- Centered Experience and Outcomes 3) Safety 4) Efficiency and Cost Reduction 5) Care Coordination 6) Community/ Population Health CMS Shift for Quality Measurement: Clinical Process Measures Outcomes and Efficiency Measures (not risk-adjusted) (risk-adjusted) 40

41 VBP FY16: Example of Reclassification Heart Attack PROPOSED FY 2015 Measures PROPOSED FY 2015 Domain PROPOSED FY 2016 Domain Clinical Care Heart Failure - Discharge instructions Pneumonia Surgical Care Improvement Project HCAHPS Questions 30-day Mortality - Heart Attack, Heart Failure, Pneumonia PSI-90 Composite - Patient safety for selected indicators Central line-associated blood stream infection Medicare spending per beneficiary Clinical Process of Care Patient Experience of Care Outcome Efficiency Care Coordination Clinical Care Clinical Care Person- and Caregiver- Centered Experience and Outcomes Clinical Care Safety Safety Efficiency and Cost Reduction 41

42 SUMMARY The CMS VBP is how Medicare is paying us from here on out The top performers make money the poor performers have money taken away SGH is performing well but did not receive full opportunity payment Even 1 OFI impacts our final score The bar keeps increasing as the nation improves and as the measures evolve

43 43 Appendix

44 FY12 vs FY13 VBP Board Objective for Green Heart Attack Value-Based Purchasing Measures: Clinical Process of Care CMS FY13 VBP Targets National Baseline Benchmark Achievement Threshold Performance Period: FY12 (August July 2012) Green Current % 1 Fibrinolytic therapy within 30 minutes 91.91% 65.48% PCI within 90 minutes % 91.86% % 7 Current n Final Points CMS FY14 VBP Targets National Baseline Benchmark Achievement Threshold Performance Period: FY13 (August - September 2012) Green Current % Current n Insufficient Data 96.30% 80.66% - 0 Insufficient Data % 93.44% % 2 Heart Failure 3 Discharge instructions % 90.77% % % 92.66% % Final Points Insufficient Data Insufficient Data Pneumonia Surgical Care Improvement Project 44 4 Blood cultures in ED before antibiotic % 96.43% % 8 Insufficient Data % 97.30% Appropriate antibiotic selection 99.58% 92.77% 98.18% % 94.46% % Prophylactic antibiotic received within one hour prior to surgical incision 99.98% 97.35% 99.75% % 98.07% 98.65% Prophylactic antibiotic selection for surgical patients % 97.66% % % 98.13% % Prophylactic antibiotics discontinued within 24 hours 8 after surgery end time Cardiac surgery patients with controlled 6AM 9 postoperative serum glucose Postoperative urinary catheter removal on post 10 operative day 1 or day % 95.07% 99.00% % 96.63% 98.65% % 94.28% 99.19% % 96.34% % n/a n/a n/a n/a n/a 99.89% 92.86% % Recommended VTE prophylaxis ordered % 95.00% % % 95.65% % Received appropriate VTE prophylaxis within 24 hours 12 prior - 24 hours after surgery Patients on beta blocker therapy prior to admit who 13 received a beta blocker during perioperative period 99.85% 93.07% % % 94.62% % % 93.99% 99.28% % 94.92% % FY12 Score GOAL 90.6% FY13 Score GOAL 91.0% FY12 Score ACTUAL 91.1% FY13 Score ACTUAL 89.0% Insufficient Data

45 VBP Board Objective: Indicator Drilldown for Green SCIP Antibiotic within 1 hour Green s score: 9 (99.75%) 3 (98.65% = 1 OFI*) Site performance National performance Gap between top decile and median scores decreases and the VBP achievement range narrows FY13: 97.35% - 100% FY14: 98.07% - 100% 45 *OFI = Opportunity for improvement

46 VBP Program: Performance Periods Overview VBP Fiscal Year 2013 VBP 2014 VBP 2015 VBP % Program Contribution 1.00% 1.25% 1.50% weight 70% 45% 20% Process of Care All except AMI-10 Jul 1, Mar 31, 2012 Apr 1, Dec 31, 2012 Jan 1, Dec 31, 2013 Patient Experience of Care Outcome Efficiency Only AMI Apr 1, Dec 31, 2013 weight 30% 30% 30% HCAHPS Jul 1, Mar 31, 2012 Apr 1, Dec 31, 2012 Jan 1, Dec 31, 2013 weight 0% 25% 30% Mortality - Jul 1, Jun 30, 2012 Oct 1, Jun 30, 2013 AHRQ - - Oct 15, Jun 30, 2013 CLABSI - - Jan 26, Dec 31, 2013 weight 0% 0% 20% MSPB - - May 1, Dec 31,

47 Efficiency: Medicare Spending per Beneficiary Medicare Spending per Beneficiary (MSPB): CMS claims based efficiency measure Evaluates cost to Medicare of services performed by hospitals and other healthcare providers during an MSPB episode Start Date = 3 days prior to an inpatient index admission End Date = 30 days post-hospital discharge MSPB Amount = Risk-adjusted Spending for All Episodes # Episodes 47 MSPB Measure = Hospital s Average MSPB Amount National Median MSPB Amount

48 Efficiency: Measure Methodology 48 Price-standardization Removes sources of variation that are due to geographic payment differences Variables: wage index, geographic practice cost differences, disproportionate share hospital (DSH) payments for the poor and uninsured population Risk-adjustment Accounts for variation due to patient health status Variables: age and severity of illness

49 Efficiency: Site Performance Performance Period: May 2011 December 2011 # Eligible Admissions Cost per case (Risk-adjusted) VBP Performance Standards Achievement Threshold Scripps Performance Benchmark Encinitas Green La Jolla Mercy - - 1,062 1,413 1,686 3,034 $18,307 $14,495 $18,666 $17,112 $17,931 $19,312 MSPB Score Median 0.99 Mean of Top Decile * Source: CMS Hospital-Specific Report, released September

50 Efficiency: National Percentile Categories Green 0.93 La Jolla 0.98 Mercy 1.05 Encinitas 1.02 Top 5% Top 10% Top 25% Median Bottom 25% Bottom 10% Bottom 5% MSPB Scores

National Provider Call: Hospital Value-Based Purchasing (VBP) Program

National Provider Call: Hospital Value-Based Purchasing (VBP) Program National Provider Call: Hospital Value-Based Purchasing (VBP) Program Fiscal Year 2016 Overview for Beneficiaries, Providers and Stakeholders Cindy Tourison, MSHI Lead, Hospital Inpatient Quality Reporting

More information

Hospital Value-based Purchasing Specifications 2016 Updated August 2015

Hospital Value-based Purchasing Specifications 2016 Updated August 2015 Description Methodology Measurement Period Allowable Exclusions Total Performance Score Individual measures CMS incentive program for PPS hospitals. The purpose is to achieve value by tying payment to

More information

CMS Office of Public Affairs 202-690-6145 MEDICARE PROPOSES NEW HOSPITAL VALUE-BASED PURCHASING PROGRAM

CMS Office of Public Affairs 202-690-6145 MEDICARE PROPOSES NEW HOSPITAL VALUE-BASED PURCHASING PROGRAM For Immediate Release: Friday, January 07, 2011 Contact: CMS Office of Public Affairs 202-690-6145 MEDICARE PROPOSES NEW HOSPITAL VALUE-BASED PURCHASING PROGRAM OVERVIEW: Today the Centers for Medicare

More information

Overview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017

Overview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017 Overview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017 Bethany Wheeler Hospital VBP Program Support Contract Lead HSAG February 17, 2015 2 p.m. ET Purpose This event will provide an

More information

Value-Based Purchasing

Value-Based Purchasing Emerging Topics in Healthcare Reform Value-Based Purchasing Janssen Pharmaceuticals, Inc. Value-Based Purchasing The Patient Protection and Affordable Care Act (ACA) established the Hospital Value-Based

More information

Value Based Purchasing Hospital Program FY 13 Final Rule

Value Based Purchasing Hospital Program FY 13 Final Rule SPECIAL REPORT: Value Based Purchasing Hospital Program FY 13 Final Rule August 7, 2012 Washington Strategic Consulting 1825 Eye Street, NW, Suite #600 Washington, DC 20006 www.wscdc.com www.wscblog.com

More information

what value-based purchasing means to your hospital

what value-based purchasing means to your hospital Paul Shoemaker what value-based purchasing means to your hospital CMS has devised an intricate way to measure a hospital s quality of care to determine whether the hospital qualifies for incentive payments

More information

Evidence Based Practice to. Value Based Purchasing. Barb Rogness BSN MS Building Bridges May 2013

Evidence Based Practice to. Value Based Purchasing. Barb Rogness BSN MS Building Bridges May 2013 Evidence Based Practice to Value Based Purchasing Barb Rogness BSN MS Building Bridges May 2013 Why this topic? Value based Purchasing is here and not going away. It will grow by leaps and bounds. The

More information

Chapter Seven Value-based Purchasing

Chapter Seven Value-based Purchasing Chapter Seven Value-based Purchasing Value-based purchasing (VBP) is a pay-for-performance program that affects a significant and growing percentage of Medicare reimbursement for medical providers. It

More information

Healthcare Reform & Value Based Purchasing: Are You Ready?

Healthcare Reform & Value Based Purchasing: Are You Ready? Healthcare Reform & Value Based Purchasing: Are You Ready? Premier, Inc Jan Englert, Director-QUEST Poudre Valley Health System Sonja Wulff, VP Center for Performance Excellence Federal Register Statement:

More information

Medicare s Hospital Value-Based Purchasing Program, a New Era in Medicare Reimbursement by Daniel J. Hettich

Medicare s Hospital Value-Based Purchasing Program, a New Era in Medicare Reimbursement by Daniel J. Hettich Medicare s Hospital Value-Based Purchasing Program, a New Era in Medicare Reimbursement by Daniel J. Hettich Medicare s new hospital inpatient value-based purchasing ( VBP ) program, mandated by the Affordable

More information

Value Based Purchasing and You

Value Based Purchasing and You Value Based Purchasing and You David Gourley, RRT, MHA, FAARC Director of Clinical Services and Risk Management Millennium Respiratory Services Whippany, New Jersey Value Based Purchasing and You Overview

More information

Patient Experience. The Cleveland Clinic Journey. American Medical Group Association Orlando, Florida March 14, 2013

Patient Experience. The Cleveland Clinic Journey. American Medical Group Association Orlando, Florida March 14, 2013 Patient Experience The Cleveland Clinic Journey American Medical Group Association Orlando, Florida March 14, 2013 James Merlino, MD Chief Experience Officer Overview How did Cleveland Clinic change their

More information

HCAHPS, Value-Based Purchasing and A Culture of Always

HCAHPS, Value-Based Purchasing and A Culture of Always Objectives HCAHPS, Value-Based Purchasing and A Culture of Always Karen Cook, RN BSN www.studergroup.com 1. Describe the history and current usage of the CAHPS family of surveys and other relevant outpatient

More information

Value Based Care and Healthcare Reform

Value Based Care and Healthcare Reform Value Based Care and Healthcare Reform Dimensions in Cardiac Care November, 2014 Jacqueline Matthews, RN, MS Senior Director, Quality Reporting & Reform Quality and Patient Safety Institute Cleveland Clinic

More information

Value-Based Purchasing An Opportunity for Clinical Nurse Leaders

Value-Based Purchasing An Opportunity for Clinical Nurse Leaders Value-Based Purchasing An Opportunity for Clinical Nurse Leaders Marjorie S. Wiggins, DNP, MBA, RN, FAAN, NEA-BC Senior Vice President, Patient Care Services/Chief Nursing Officer AACN-CNL Summit, Long

More information

Value Based Purchasing (VBP) Awareness Brief. FY 2018 Value Based Purchasing Program Domain Weighting

Value Based Purchasing (VBP) Awareness Brief. FY 2018 Value Based Purchasing Program Domain Weighting Value Based Purchasing (VBP) Awareness Brief This Awareness Brief provides a high level summary understanding of value based purchasing. The Hospital Value Based Purchasing (VBP) Program adjusts hospitals

More information

HOSPITAL VALUE- BASED PURCHASING. Initial Results Show Modest Effects on Medicare Payments and No Apparent Change in Quality-of- Care Trends

HOSPITAL VALUE- BASED PURCHASING. Initial Results Show Modest Effects on Medicare Payments and No Apparent Change in Quality-of- Care Trends United States Government Accountability Office Report to Congressional Committees October 2015 HOSPITAL VALUE- BASED PURCHASING Initial Results Show Modest Effects on Medicare Payments and No Apparent

More information

Time for a Cool Change Measure and Compare

Time for a Cool Change Measure and Compare Time for a Cool Change Measure and BRENDA BARTKOWSKI, CMA, CCA, BS HPA M ANAGER, C LINICAL D ATA A BSTRACTION About Amphion Dedicated core measure staff Experienced leadership in healthcare technology

More information

2015 Hospital Measures

2015 Hospital Measures 2015 Hospital Measures Vicki Tang Olson, Stratis Health David Hesse, Minnesota Department of Health Statewide Quality Reporting and Measurement System (SQRMS) Annual Update January 14, 2015 Objectives

More information

June 22, 2012. Dear Administrator Tavenner:

June 22, 2012. Dear Administrator Tavenner: Submitted Electronically Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G Hubert H. Humphrey Building 200 Independence Avenue

More information

The Centers for Medicare & Medicaid Services (CMS) Acute Care Hospital Fiscal Year (FY) 2018 Quality Improvement Program Measures

The Centers for Medicare & Medicaid Services (CMS) Acute Care Hospital Fiscal Year (FY) 2018 Quality Improvement Program Measures ID Me asure Name NQF # - (HRRP) ID Me asure Name NQF # - (HRRP) ID Me asure Name NQF # - (HRRP) CMS Measures Fiscal Year 2018 The Centers for Medicare & Medicaid Services (CMS) Acute Care Fiscal Year (FY)

More information

Three-Star Composite Rating Method

Three-Star Composite Rating Method Three-Star Composite Rating Method CheckPoint uses three-star composite ratings to enable consumers to more quickly and easily interpret information about hospital quality measures. Composite ratings combine

More information

FY 2015 Inpatient PPS Proposed Rule Quality Provisions Webinar

FY 2015 Inpatient PPS Proposed Rule Quality Provisions Webinar FY 2015 Inpatient PPS Proposed Rule Quality Provisions Webinar June 2, 2014 AAMC Staff: Scott Wetzel, swetzel@aamc.org Mary Wheatley, mwheatley@aamc.org The AAMC has moved. New Address: 655 K Street, Washington

More information

Hospital Inpatient Quality Reporting (IQR) Program

Hospital Inpatient Quality Reporting (IQR) Program Clinical Process Measures Program Changes for Fiscal Year 2014 Beginning with January 1, 2012 discharges; hospitals will begin data collection and submission for 4 new measures. Hospitals will not be required

More information

Hospital Compare Downloadable Database Data Dictionary

Hospital Compare Downloadable Database Data Dictionary System Requirements Specification Hospital Compare Downloadable Database Data Dictionary Centers for Medicare & Medicaid Services https://data.medicare.gov/data/hospital-compare of Contents Introduction...

More information

Quality and Business Intelligence in Healthcare

Quality and Business Intelligence in Healthcare Quality and Business Intelligence in Healthcare John Neider Siemens Healthcare Solutions Agenda Overview of Quality and Financial Impact. What is the Hospital Impact? Where is Quality Headed? How can Finance

More information

What Value Are We Gaining from Value-Based Purchasing?

What Value Are We Gaining from Value-Based Purchasing? WHITE PAPER: What Value Are We Gaining from Value-Based Purchasing? Authors: Brooke Palkie, EdD, RHIA and David Marc, MBA, CHDA Copyright 2015 Panacea Healthcare Solutions, Inc. All Rights Reserved Executive

More information

Current Medicare Fee-for-Service Pay-for-Performance Initiatives for Hospital and Physician Services. July 13, 2015

Current Medicare Fee-for-Service Pay-for-Performance Initiatives for Hospital and Physician Services. July 13, 2015 Current Medicare Fee-for-Service Pay-for-Performance Initiatives for Hospital and Physician Services July 13, 2015 Broad Overview of Payment Policy Direction Current State Future State Current mandatory

More information

Hospital Inpatient Quality Reporting Program: Part 1 of 4: A Detailed Review of the Final CMS FY 2014 IPPS Rule

Hospital Inpatient Quality Reporting Program: Part 1 of 4: A Detailed Review of the Final CMS FY 2014 IPPS Rule Hospital Inpatient Quality Reporting Program: Part 1 of 4: A Detailed Review of the Final CMS FY IPPS Rule - 1 - Welcome and Introductions Vicky Mahn DiNicola RN, MS, CPHQ VP Research and Market Insights

More information

Relevant Quality Measures for Critical Access Hospitals

Relevant Quality Measures for Critical Access Hospitals Policy Brief #5 January 0 Relevant Quality Measures for Critical Access Hospitals Michelle Casey MS, Ira Moscovice PhD, Jill Klingner RN, PhD, Shailendra Prasad MD, MPH University of Minnesota Rural Health

More information

Mar. 31, 2011 (202) 690-6145. Improving Quality of Care for Medicare Patients: Accountable Care Organizations

Mar. 31, 2011 (202) 690-6145. Improving Quality of Care for Medicare Patients: Accountable Care Organizations DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Media Affairs MEDICARE FACT SHEET FOR IMMEDIATE RELEASE

More information

Everything you ever wanted to know about Value-Based Purchasing* *But were afraid to ask

Everything you ever wanted to know about Value-Based Purchasing* *But were afraid to ask Everything you ever wanted to know about Value-Based Purchasing* *But were afraid to ask TAHFM - April 10, 2013 John Murray, MBA Director, Patient Experience Deric Hebert Director, Engineering Services

More information

HCAHPS and Value-Based Purchasing Methods and Measurement. Deb Stargardt, Improvement Services Darrel Shanbour, Consulting Services

HCAHPS and Value-Based Purchasing Methods and Measurement. Deb Stargardt, Improvement Services Darrel Shanbour, Consulting Services HCAHPS and Value-Based Purchasing Methods and Measurement Deb Stargardt, Improvement Services Darrel Shanbour, Consulting Services Today s Learning Objectives Acquire new knowledge pertaining to: A. Hospital

More information

Hospital Report Card Reporting Manual

Hospital Report Card Reporting Manual Vermont Department of Health Hospital Report Card Reporting Manual (REVISED May, 206) Issued: May 206 206 HOSPITAL REPORT CARD REPORTING MANUAL TABLE OF CONTENTS INTRODUCTION 3 REPORTING SPECIFICATIONS

More information

Overview and Legal Context

Overview and Legal Context Impact of ACOs on Physician/Provider Membership Decisions 0 Overview and Legal Context Michael R. Callahan Katten Muchin Rosenman LLP Vice Chair, Medical Staff Credentialing and Peer Review Practice Group

More information

Understanding Patient Satisfaction Reporting in the Era of HCAHPS Robert J. Ogden

Understanding Patient Satisfaction Reporting in the Era of HCAHPS Robert J. Ogden Understanding Patient Satisfaction Reporting in the Era of HCAHPS Robert J. Ogden Consultant, HealthStream Research HCAHPS & Patient Satisfaction Reporting Robert J. Ogden, Jr. Consultant HealthStream

More information

PYA. PYALeadership Briefing. Beyond Tactics: Building a Value-Based Culture

PYA. PYALeadership Briefing. Beyond Tactics: Building a Value-Based Culture PYA PYALeadership Briefing Beyond Tactics: Building a Value-Based Culture May 2012 Beyond Tactics: Building a Value-Based Culture Perhaps because CMS launched the Hospital Compare website over five years

More information

Department of Health and Human Services

Department of Health and Human Services Vol. 76 Thursday No. 9 January 13, 2011 Part II Department of Health and Human Services Centers for Medicare & Medicaid Services FR.EPS VerDate Mar 15 2010 21:14 Jan 12, 2011 Jkt 223001 PO 00000 Frm 00002

More information

Overview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017

Overview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017 Overview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017 Audio for this event is available via INTERNET STREAMING. No telephone line is required. Computer speakers or headphones are

More information

Value Based Purchasing: Combining Cost and Quality

Value Based Purchasing: Combining Cost and Quality Value Based Purchasing: Combining Cost and Quality Michael T. Rapp, MD, JD, FACEP Director, Quality Measurement and Health Assessment Group Office of Clinical Standards & Quality Centers for Medicare &

More information

FY 2016 Inpatient PPS Proposed Rule Quality Issues May 21, 2015

FY 2016 Inpatient PPS Proposed Rule Quality Issues May 21, 2015 FY 2016 Inpatient PPS Proposed Rule Quality Issues May 21, 2015 AAMC Staff: Scott Wetzel, swetzel@aamc.org Mary Wheatley, mwheatley@aamc.org Agenda Summary of key quality and payment IPPS provisions Cross-cutting

More information

June 25, 2012. Dear Acting Administrator Tavenner,

June 25, 2012. Dear Acting Administrator Tavenner, June 25, 2012 Marilyn B. Tavenner, RN, Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1588-P P.O. Box 8011 Baltimore, MD 21244-1850

More information

HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE

HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE Cepheid s Government Affairs Department Advocating for Patient Access to Molecular Diagnostics in the Era of Healthcare Reform A TEAM APPROACH Legislative

More information

Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P)

Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P) Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P) Date 2015-04-17 Title Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and

More information

Linking Quality to Payment

Linking Quality to Payment Linking Quality to Payment Background Our nation s health care delivery system is undergoing a major transformation as reimbursement moves from a volume-based methodology to one based on value and quality.

More information

Partnership for Healthcare Payment Reform Total Knee Replacement Pilot Quality Report Quarter 1 Quarter 4, 2013

Partnership for Healthcare Payment Reform Total Knee Replacement Pilot Quality Report Quarter 1 Quarter 4, 2013 Partnership for Healthcare Payment Reform Total Knee Replacement Pilot Quality Report Quarter 1 Quarter 4, 2013 Introduction This report outlines the total knee replacement pilot quality results for care

More information

HCAHPS and Hospital Value-Based Purchasing (Hospital VBP)

HCAHPS and Hospital Value-Based Purchasing (Hospital VBP) Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov HCAHPS and Hospital Value-Based Purchasing (Hospital VBP) Agency for Healthcare Research and Quality Centers

More information

Patient Care Services Quality Report Evaluation of 2013 Outcomes August 2014

Patient Care Services Quality Report Evaluation of 2013 Outcomes August 2014 Patient Care Services Quality Report Evaluation of 2013 Outcomes August 2014 Submitted by, Carol A Dwyer, MSN, MM, RN, CENP Vice President, Patient Care Services Chief Nursing Officer 1 Index INTRODUCTION...3

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES & 42 CFR 412 45 CFR

DEPARTMENT OF HEALTH AND HUMAN SERVICES & 42 CFR 412 45 CFR 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 412 Office of the Secretary 45 CFR Part 170[CMS-1632-P] RIN-0938-AS41 Medicare Program; Hospital Inpatient

More information

Using Data to Understand the Medicare Spending Per Beneficiary Measure

Using Data to Understand the Medicare Spending Per Beneficiary Measure Using Data to Understand the Medicare Spending Per Beneficiary Measure Mary Wheatley, AAMC Jacqueline Matthews, Cleveland Clinic Keely Macmillan, Partners Healthcare December 17, 2013 Webinar Details The

More information

Hospital Value-Based Purchasing (VBP) Program

Hospital Value-Based Purchasing (VBP) Program Medicare Spending per Beneficiary (MSPB) Measure Presentation Question & Answer Transcript Moderator: Bethany Wheeler, BS Hospital VBP Program Support Contract Lead Hospital Inpatient Value, Incentives,

More information

convey the clinical quality measure's title, number, owner/developer and contact

convey the clinical quality measure's title, number, owner/developer and contact CMS-0033-P 153 convey the clinical quality measure's title, number, owner/developer and contact information, and a link to existing electronic specifications where applicable. TABLE 20: Proposed Clinical

More information

OVERALL IMPLEMENTATION CONSIDERATIONS

OVERALL IMPLEMENTATION CONSIDERATIONS Donald Berwick, M.D., M.P.H. Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Hubert H. Humphrey Building 200 Independence Avenue, S.W., Room 445-G Washington,

More information

U.S. Department of Health and Human Services. REPORT TO CONGRESS: Plan to Implement a Medicare Hospital Value-Based Purchasing Program

U.S. Department of Health and Human Services. REPORT TO CONGRESS: Plan to Implement a Medicare Hospital Value-Based Purchasing Program U.S. Department of Health and Human Services REPORT TO CONGRESS: Plan to Implement a Medicare Hospital Value-Based Purchasing Program November 21, 2007 Acknowledgements Prepared by the CMS Hospital Value-Based

More information

Office of Rural Health Policy MEDICARE BENEFICIARY QUALITY IMPROVEMENT PROJECT

Office of Rural Health Policy MEDICARE BENEFICIARY QUALITY IMPROVEMENT PROJECT Office of Rural Health Policy MEDICARE BENEFICIARY QUALITY IMPROVEMENT PROJECT Paul Moore, DPh Senior Health Policy Advisor Office of Rural Health Policy Health Resources and Services Administration Department

More information

ANNALS OF HEALTH LAW Advance Directive VOLUME 20 SPRING 2011 PAGES 134-143. Value-Based Purchasing As a Bridge Between Value and Access

ANNALS OF HEALTH LAW Advance Directive VOLUME 20 SPRING 2011 PAGES 134-143. Value-Based Purchasing As a Bridge Between Value and Access ANNALS OF HEALTH LAW Advance Directive VOLUME 20 SPRING 2011 PAGES 134-143 Value-Based Purchasing As a Bridge Between Value and Access Erin Lau* I. INTRODUCTION By definition, the words value and access

More information

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION At the end of this session, you will be able to: Identify ways RT skills can be utilized for

More information

America s Hospitals: Improving Quality and Safety

America s Hospitals: Improving Quality and Safety America s Hospitals: Improving Quality and Safety The Joint Commission s Annual Report 2014 Top Performer on Key Quality Measures America s Hospitals: Improving Quality and Safety The Joint Commission

More information

Department of Health and Human Services. Part V. Centers for Medicare & Medicaid Services

Department of Health and Human Services. Part V. Centers for Medicare & Medicaid Services Vol. 76 Friday, No. 88 May 6, 2011 Part V Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 422 and 480 Medicare Program; Hospital Inpatient Value-Based Purchasing

More information

Data Analysis Project Summary

Data Analysis Project Summary of Introduction The notion that adverse patient safety events result in excess costs is not a new concept. However, more research is needed on the actual costs of different types of adverse events at an

More information

UNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM: FINANCIAL REPORT AND SYSTEM DASHBOARDS May 29, 2013

UNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM: FINANCIAL REPORT AND SYSTEM DASHBOARDS May 29, 2013 UNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM: FINANCIAL REPORT AND SYSTEM DASHBOARDS May 29, 2013 Office of the Vice President for Health Affairs Board of Trustees Spring Chicago Meeting UI

More information

MU Stage 2: Domains and Details. Anita Karcz MD Chief Medical Officer Institute for Health Metrics February 5, 2014 anita@healthmetrics.

MU Stage 2: Domains and Details. Anita Karcz MD Chief Medical Officer Institute for Health Metrics February 5, 2014 anita@healthmetrics. MU Stage 2: Domains and Details Anita Karcz MD Chief Medical Officer Institute for Health Metrics February 5, 2014 anita@healthmetrics.org Welcome to the Webinar If you cannot hear any sound or if you

More information

Advancing Risk Capability in 2015: MACRA and 2016 Medicare Proposed Rule. May 26, 2015 // 12:00 P.M. 1:00 P.M. EST

Advancing Risk Capability in 2015: MACRA and 2016 Medicare Proposed Rule. May 26, 2015 // 12:00 P.M. 1:00 P.M. EST Advancing Risk Capability in 2015: MACRA and 2016 Medicare Proposed Rule May 26, 2015 // 12:00 P.M. 1:00 P.M. EST Center For Industry Transformation The DHG Healthcare Center for Industry Transformation

More information

Value Based Purchasing: New Tools for Hospitals

Value Based Purchasing: New Tools for Hospitals Value Based Purchasing: New Tools for Hospitals The Value Based Purchasing Score Estimator & HANYS Quality Reports Overview of CMS Value Based Purchasing Program Brian Potter, Vice-President, Finance &

More information

VALUE-BASED PURCHASING-CHANGES IN 2014 OPTIMIZING HEALTHCARE

VALUE-BASED PURCHASING-CHANGES IN 2014 OPTIMIZING HEALTHCARE VALUE-BASED PURCHASING-CHANGES IN 2014 OPTIMIZING HEALTHCARE FEBRUARY 26, 2014 Donna Jennings, RRT, MBA, CPHQ, CPHRM Senior Consultant Nashville, TN HEALTH & LIFE SCIENCES Oliver Wyman CHI-HLC11401-003

More information

Telligen Quality Innovation Network Quality Improvement Organization. We See Where the Health Care Reform Bus is Taking Us How Do We Get On?

Telligen Quality Innovation Network Quality Improvement Organization. We See Where the Health Care Reform Bus is Taking Us How Do We Get On? Telligen Quality Innovation Network Quality Improvement Organization We See Where the Health Care Reform Bus is Taking Us How Do We Get On? Telligen QIN QIO Telligen: Quality Innovation Network-Quality

More information

Quality Provisions Ordered by Implementation Date

Quality Provisions Ordered by Implementation Date 1 3006, 10301 2 1311 3 3006, 10301 by Secretary 10/1/2011 Ambulatory Surgery Centers 10/1/2011 Providers in HBE shall be accredited with respect to local performance on clinical quality measures (e.g.,

More information

100 TOP HOSPITALS. 15 Top Health Systems Study

100 TOP HOSPITALS. 15 Top Health Systems Study 100 TOP HOSPITALS 15 Top Health Systems Study 5th Edition April 15, 2013 Truven Health Analytics 777 E. Eisenhower Parkway Ann Arbor, MI 48108 USA +1.800.366.7526 Truven Health 15 Top Health Systems, 2013

More information

NQS Priority #1: Making Care Safer by Reducing the Harm Caused in the Delivery of Care

NQS Priority #1: Making Care Safer by Reducing the Harm Caused in the Delivery of Care NQS Priority #: Making Care Safer by Reducing the Harm Caused in the Delivery of Care Measure: Hospital-acquired Conditions (HAC) Incidence of measurable hospital-acquired conditions 45 HACs per,000 admissions

More information

AnMed Health Disparities Dashboard

AnMed Health Disparities Dashboard AnMed Health Quick Facts 588 Bed Acute Care System Level II Trauma Center Emergency Department visits: 112,329 Admissions: 23,489 Active Medical Staff: 455 Employees: 3,511 Source : CY2013 Setting the

More information

Article reprinted from Patient Safety & Quality Healthcare, July/August 2012 VALUE-BASED PURCHASING

Article reprinted from Patient Safety & Quality Healthcare, July/August 2012 VALUE-BASED PURCHASING Article reprinted from Patient Safety & Quality Healthcare, July/August 2012 VALUE-BASED PURCHASING Outperform the Competition: Hospital Value-Based Purchasing By Jeffrey Robbins JULY/AUGUST 2012 WWW.PSQH.COM

More information

Medicare Design Part A: Inpatient care, hospice, and some home health care Part B: Physician services + outpatient care Part C ( Medicare Advantage

Medicare Design Part A: Inpatient care, hospice, and some home health care Part B: Physician services + outpatient care Part C ( Medicare Advantage Medicare Design Part A: Inpatient care, hospice, and some home health care Part B: Physician services + outpatient care Part C ( Medicare Advantage ): Private plan alternative to Parts A and B Part D:

More information

Interventional Cardiology Peripheral Interventions Rhythm Management

Interventional Cardiology Peripheral Interventions Rhythm Management FY2016 Hospital Inpatient Rule (IPPS) Interventional Cardiology Peripheral Interventions Rhythm Management On April 17, 2015 the Centers for Medicare and Medicaid Services (CMS) released the Hospital Inpatient

More information

How To Improve A Hospital'S Performance

How To Improve A Hospital'S Performance FY 16 MHAC Methodology Redesign HSCRC Performance Measurement Work Group February 20, 2014 1 Presentation Contents Background: Reason to change, guiding principles, timing Measurement Methodology Payment

More information

Preventing Readmissions

Preventing Readmissions Emerging Topics in Healthcare Reform Preventing Readmissions Janssen Pharmaceuticals, Inc. Preventing Readmissions The Patient Protection and Affordable Care Act (ACA) contains several provisions intended

More information

Decoding Medicare Spending Per Beneficiary (MSPB) Management and Physician Opportunities Together

Decoding Medicare Spending Per Beneficiary (MSPB) Management and Physician Opportunities Together Decoding Medicare Spending Per Beneficiary (MSPB) Management and Physician Opportunities Together Dale N. Schumacher THE TRANSFORMATION TO CONSUMER-DRIVEN HEALTHCARE Decoding Medicare Spending Per Beneficiary

More information

IDENTIFYING CLINICAL RESEARCH QUESTIONS THAT FIT PRACTICE PRIORITIES. Module I: Identifying Good Questions

IDENTIFYING CLINICAL RESEARCH QUESTIONS THAT FIT PRACTICE PRIORITIES. Module I: Identifying Good Questions 1 IDENTIFYING CLINICAL RESEARCH QUESTIONS THAT FIT PRACTICE PRIORITIES Module I: Identifying Good Questions Objective Describe how to find good clinical questions for research. 2 ntifying good clinical

More information

CLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL ACCESS HOSPITALS BEGINNING WITH FY 2014

CLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL ACCESS HOSPITALS BEGINNING WITH FY 2014 CLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL ACCESS HOSPITALS BEGINNING WITH FY 2014 e 55 0495 2 Emergency Department (ED)- 1 Emergency Department Throughput Median time from

More information

100 TOP HOSPITALS. 15 Top Health Systems Study

100 TOP HOSPITALS. 15 Top Health Systems Study 100 TOP HOSPITALS 15 Top Health Systems Study 6th Edition April 21, 2014 Truven Health Analytics 777 E. Eisenhower Parkway Ann Arbor, MI 48108 USA +1.800.366.7526 Truven Health 15 Top Health Systems, 2014

More information

The Flex Program MEDICARE BENEFICIARY QUALITY IMPROVEMENT PROJECT

The Flex Program MEDICARE BENEFICIARY QUALITY IMPROVEMENT PROJECT Office of Rural Health Policy 2012 Rural Health Information Technology Network Development Grantee Meeting The Flex Program MEDICARE BENEFICIARY QUALITY IMPROVEMENT PROJECT Paul Moore, DPh Senior Health

More information

Improving Hospital Performance

Improving Hospital Performance Improving Hospital Performance Background AHA View Putting patients first ensuring their care is centered on the individual, rooted in best practices and utilizes the latest evidence-based medicine is

More information

EHR Meaningful Use 2014 (Stage 1 & 2) DR Reporting Strategies

EHR Meaningful Use 2014 (Stage 1 & 2) DR Reporting Strategies EHR Meaningful Use 2014 (Stage 1 & 2) DR Reporting Strategies International MUSE Conference 2013 Educational Session: #1179 Date: Friday May 31 at 3:30 pm Presenter: Glen D Abate Session Agenda CMS EHR

More information

Accident & Emergency Department Clinical Quality Indicators

Accident & Emergency Department Clinical Quality Indicators Overview This dashboard presents our performance in the new A&E clinical quality indicators. These 8 indicators will allow you to see the quality of care being delivered by our A&E department, and reflect

More information

What is an ACO? What forms of organizations may become an ACO? IAMSS 30 th Annual Education Conference Pearls of Wisdom

What is an ACO? What forms of organizations may become an ACO? IAMSS 30 th Annual Education Conference Pearls of Wisdom IAMSS 30 th Annual Education Conference Pearls of Wisdom The Impact of Accountable Care Organizations (ACOs) and Health Care Reform on Credentialing, Privileging and Peer Review April 28-29, 2011 Michael

More information

The Impact of Accountable Care Organizations (ACOs) on Credentialing and Privileging

The Impact of Accountable Care Organizations (ACOs) on Credentialing and Privileging The Impact of Accountable Care Organizations (ACOs) on Credentialing and Privileging Michael R. Callahan Katten Muchin Rosenman LLP 525 W. Monroe Chicago, Illinois 312.902.5634 michael.callahan@kattenlaw.com

More information

Adding Value to. Provider Compensation. June 13, 2016. Healthcare Strategy Group OHA Presentation 2016. Adding Value to. Physician Compensation

Adding Value to. Provider Compensation. June 13, 2016. Healthcare Strategy Group OHA Presentation 2016. Adding Value to. Physician Compensation Provider Compensation June 13, 2016 1 Who are We? About (HSG) Hospital-physician integration specialists since 1999 Strategic, best practice approach to employed physician networks and independent physician

More information

Hospital Quality Initiative Overview CENTERS FOR MEDICARE & MEDICAID SERVICES December 2005

Hospital Quality Initiative Overview CENTERS FOR MEDICARE & MEDICAID SERVICES December 2005 Hospital Quality Initiative Overview CENTERS FOR MEDICARE & MEDICAID SERVICES December 2005 Background Quality health care is a high priority for the Bush administration, the Department of Health and Human

More information

June 10, 2015. Dear Mr. Slavitt:

June 10, 2015. Dear Mr. Slavitt: 1275 K Street, NW, Suite 1000 Washington, DC 20005-4006 Phone: 202/789-1890 Fax: 202/789-1899 apicinfo@apic.org www.apic.org June 10, 2015 Andrew M. Slavitt Acting Administrator Centers for Medicare &

More information

The Medicare Readmissions Reduction Program

The Medicare Readmissions Reduction Program The Medicare Readmissions Reduction Program Impact on Rural Hospitals Harvey Licht Varela Consulting Group August, 2013 CMS Readmissions Reduction Program: Authority Section 3025 of the Patient Protection

More information

FY2015 Final Hospital Inpatient Rule Summary

FY2015 Final Hospital Inpatient Rule Summary FY2015 Final Hospital Inpatient Rule Summary Interventional Cardiology (IC) Peripheral Interventions (PI) Rhythm Management (RM) On August 4, 2014, the Centers for Medicare & Medicaid Services (CMS) released

More information

U.S. Department of Health & Human Services May 7, 2014. New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings

U.S. Department of Health & Human Services May 7, 2014. New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings U.S. Department of Health & Human Services May 7, 2014 New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings The data in this report shows a substantial nine percent

More information

This proposed rule clarifies and makes updates to details regarding this program that were finalized in

This proposed rule clarifies and makes updates to details regarding this program that were finalized in 2014 Ambulatory Surgery Center (ASC) and Outpatient Prospective Payment System (OPPS) A Summary of the Quality Provisions of the Proposed Rule Overview On July 8, 2013, the Centers for Medicare and Medicaid

More information

Medical Billing, Emar & Prescription Safety

Medical Billing, Emar & Prescription Safety Medication Quality and Health Information Technology Prescribing CPOE Ajit Appari, Ph.D. Postdoctoral Research Fellow Center for Digital Strategies Tuck School of Business, Dartmouth College Hanover, NH

More information

The Impact of Value- Based Purchasing in the Healthcare Industry

The Impact of Value- Based Purchasing in the Healthcare Industry The Impact of Value- Based Purchasing in the Healthcare Industry Presented By: Kim Charland, BA, RHIT, CCS Senior Vice President Clinical Innovation for Panacea Healthcare Solutions and Editor of VBPmonitor

More information

AGENCY-SPECIFIC PLAN FOR THE NATIONAL QUALITY STRATEGY

AGENCY-SPECIFIC PLAN FOR THE NATIONAL QUALITY STRATEGY AGENCY-SPECIFIC PLAN FOR THE NATIONAL QUALITY STRATEGY Adult Medicaid Quality Grants Program The Adult Medicaid Quality Grants Program is a 2-year funding opportunity designed to support grantee Medicaid

More information

FY2015 Proposed Hospital Inpatient Rule Summary

FY2015 Proposed Hospital Inpatient Rule Summary FY2015 Proposed Hospital Inpatient Rule Summary Cardiac Rhythm Management (CRM) Electrophysiology (EP) Interventional Cardiology (IC) Peripheral Intervention (PI) On April 30, 2014, the Centers for Medicare

More information

Patient Experience/ Satisfaction What s at Stake? Customer Service at UAMS

Patient Experience/ Satisfaction What s at Stake? Customer Service at UAMS Patient Experience/ Satisfaction What s at Stake? Customer Service at UAMS Why Do We Care? We started measuring patient satisfaction about 11 years ago because we care what our patients are saying. We

More information

Proposed FY 2012 Medicare-Severity Diagnosis-Related Group (MS-DRG) Documentation and Coding Adjustment.

Proposed FY 2012 Medicare-Severity Diagnosis-Related Group (MS-DRG) Documentation and Coding Adjustment. Ms. Marilyn Tavenner Administrator Centers for Medicare & Medicaid Services Department of Health & Human Services Room 445-G Herbert H. Humphrey Building 200 Independence Avenue, SW Washington, DC 20201

More information

FINANCIAL IMPLICATIONS OF EXCESS HOSPITAL READMISSIONS JOSESPH B. HENDERSON, J.D.

FINANCIAL IMPLICATIONS OF EXCESS HOSPITAL READMISSIONS JOSESPH B. HENDERSON, J.D. FINANCIAL IMPLICATIONS OF EXCESS HOSPITAL READMISSIONS JOSESPH B. HENDERSON, J.D. Executive MHA Candidate, 2013 University of Southern California Sol Price School of Public Policy Abstract A 2007 Medicare

More information