Updates on CMS Quality, Value and Public Reporting

Transcription

1 Updates on CMS Quality, Value and Public Reporting Federation of American Hospitals Policy Conference Kate Goodrich, MD MHS Director, Quality Measurement and Value Based Incentives Group, CMS June 17, 2015

2 Quality Measurement and Value Based Incentives Group Division of Program and Measurement Support Marketplace, NQF, Measure Management, MIDS, CMS quality strategy Division of Health Information Technology Meaningful Use, ehealth Division of Electronic and Clinician Quality PQRS, ecqms, Physician Compare, support for VBM and ACOs Division of Chronic and Post Acute Care IMPACT, LTCH, SNF, IRF, Hospice, Home Health, HH Compare Division of Hospital and Medication Measures Outcome measures (hospital, ACOs, IPF, ASC, etc.), ecqms, Hospital Compare, ESRD, Dialysis Facility Compare Division of Value Based Incentives and Quality Reporting IQR, HVBP, HACRP, HRRP, ASC, OQR, ESRD QIP, IPF, PPS exempt cancer hospitals, MU for EH, SNF VBP

3 Categories of Work Measure Development Public Reporting Lean (Continuous Improvement) Health Assessment Instrument Maintenance Program Policy and Operations 18 quality, value or electronic reporting programs 5 Public Reporting Sites Support for other CMS programs (e.g. Physician VM, ACOs, CMMI models, Medicaid 1115 waivers, etc.) NQF contract all CMS measure endorsement & MAP Lead or support multiple cross HHS efforts on quality

4 CMS support of Health Care Delivery System Reform (DSR) will result in better care, smarter spending, and healthier people Historical state Key characteristics Producer centered Incentives for volume Unsustainable Fragmented Care Systems and Policies Fee For Service Payment Systems Public and private sectors Evolving future state Key characteristics Patient centered Incentives for outcomes Sustainable Coordinated care Systems and Policies Value based purchasing Accountable Care Organizations Episode based payments Medical Homes Quality/cost transparency

5 CMS has adopted a framework that categorizes payment to providers Description Category 1: Fee for Service No Link to Value Payments are based on volume of services and not linked to quality or efficiency Category 2: Fee for Service Link to Value At least a portion of payments vary based on the quality and/or efficiency of health care delivery Category 3: Alternative Payment Models Built on Fee for Service Architecture Some payment is linked to the effective management of a population or an episode of care Payments still triggered by delivery of services, but opportunities for shared savings or 2 sided risk Category 4: Population based Payment Payment is not directly triggered by service delivery so volume is not linked to payment Clinicians and organizations are paid and responsible for the care of a beneficiary for a long period (e.g., 1 year) Medicare examples Limited in Medicare feefor service Majority of Medicare payments now are linked to quality Hospital valuebased purchasing Physician Value Based Modifier Readmissions / Hospital Acquired Conditions Reduction Program Accountable care organization Medical homes Bundled payments Comprehensive primary Care initiative Comprehensive ESRD Medicare Medicaid Financial Alignment Initiative Fee For Service Model Source: Rajkumar R, Conway PH, Tavenner M. CMS engaging multiple payers in payment reform. JAMA 2014; 311: Eligible Pioneer accountable care organizations in years 3 5 Maryland hospitals

6 Delivery System Reform requires focusing on the way we pay providers, deliver care, and distribute information Improving the way providers are incentivized, the way care is delivered, and the way information is distributed will help provide better care at lower cost across the health care system. Focus Areas Pay Providers Description Promote value based payment systems Test new alternative payment models Increase linkage of Medicaid, Medicare FFS, and other payments to value Bring proven payment models to scale Encourage the integration and coordination of clinical care services Deliver Care Improve population health Promote patient engagement through shared decision making Distribute Information Create transparency on cost and quality information Bring electronic health information to the point of care for meaningful use Source: Burwell SM. Setting Value Based Payment Goals HHS Efforts to Improve U.S. Health Care. NEJM 2015 Jan 26; published online first.

7 Target percentage of payments in FFS linked to quality and alternative payment models by 2016 and 2018 Alternative payment models (Categories 3 4) FFS linked to quality (Categories 2 4) All Medicare FFS (Categories 1 4) % 22% 30% 50% 68% 85% 85% 90% Historical Performance Goals

8 CMS will achieve Goal 1 through alternative payment models where providers are accountable for both cost and quality Major APM Categories Accountable Care Organizations Medicare Shared Savings Program ACO Pioneer ACO Comprehensive ESRD Care Model Bundled Payments Bundled Payment for Care Improvement Specialty Care Models Advanced Primary Care Comprehensive Primary Care Multi payer Advanced Primary Care Practice Other Models Maryland All Payer Hospital Payments ESRD Prospective Payment System CMS will continue to test new models and will consider expanding existing models

9 CMS will reach Goal 2 through more linkage of FFS payments to quality or value Hospitals, % of FFS payment at risk Readmissions Reduction Program HVBP (Hospital Valuebased Purchasing) IQR/MU (Inpatient Quality Reporting / Meaningful Use) HAC (Hospital Acquired Conditions) Performance period 2014 (payment FY16) Performance period 2015 (FY17) Performance period 2016 (FY18) Physician / Clinician, % of FFS payment at risk 9 9 Physician VBM (Value Based modifier) 1 MU (Electronic Health Record Meaningful Use) 2 PQRS (Physician Quality Reporting System) Performance period (payment FY16) 2015 Performance period (payment FY17) 2016 Performance period (payment FY18) 3

10 PUBLIC REPORTING AND HOSPITAL COMPARE 10 10

11 Transparency Through Public Reporting Public reporting efforts began in the early 2000 s. CMS began hospital reporting with a starter set of 10 measures, and now publishes data on over 100 quality measures on the Hospital Compare website. Measures include: process of care, outcomes, structural and HCAHPS survey data. 11

12 Transparency Through Public Reporting Future Plans Data is currently available using mobile device technology. CMS is moving towards a 5 star rating system for all of it s Compare sites. Exploring the use of API s to make data readily available. Working on making our site user friendly by creating a one stop shop for all quality needs. 12

13 Affordable Care Act (ACA): Major Expansion of Compare Websites Provided for creation of Physician Compare New reporting requirements, including: Hospital Compare (e.g., value based purchasing measures, measures on hospitalacquired conditions) Nursing Home Compare (e.g., staffing data, complaints, links to state survey and certification websites) 13

14 ACA: Expansion of Online Public Reporting, New Requirements Long term care hospitals Inpatient rehabilitation facilities Hospices Ambulatory surgical centers Certain cancer hospitals Inpatient psychiatric facilities 14

15 Why Star Ratings for Compare Websites? Consumers are the primary audience for Compare websites, along with other important stakeholders The National Quality Strategy envisions effective public reporting as a key driver for improving the health care system as a whole: Consumers consult ratings Consumers choose the care that is best for them and their families Providers are incentivized to improve quality to retain existing patients and to attract new ones. 15

16 Background on Star Ratings : Star Ratings will be introduced on Dialysis Facility Compare, Home Health Compare, and Hospital Compare 2014: Star Ratings introduced early in the year on Physician Compare for certain physician groups 2008: Star Ratings introduced on Nursing Home Compare 16

17 Background on HC Star Ratings The information on Hospital Compare can be technical and intimidating to a lay audience Star Ratings are commonly used to convey summary information Five star ratings are easily recognizable Patients and consumers have reacted favorably to other CMS star ratings efforts 17

18 HCAHPS star ratings Star ratings for HCAHPS measures released April of 2015 CMS began with HCAHPS as these measures are easily understood by consumers and allows hospitals, patients and the public to gain familiarity with star ratings prior to reporting a summary star rating Updated quarterly Not tied to payment through VBP or other program 18

19 Summary star rating Responsive to requests from consumers and others for easily understandable single rating for hospitals Yale convened a TEP to provide input on measures and methodology Goal is to release summary star rating in 2016 CMS also exploring domains for star ratings as well (e.g. safety, outcome, efficiency, etc.) 19

20 Guiding Principles Simplicity and Accessibility Summarize overall hospital quality based on available measures in a single star Convey evidence based information in a straightforward manner Inclusivity Reflect quality at as many hospitals as possible by including most Hospital Compare measures Scientific Rigor Utilize established methods for summarizing scores that maximize information available in existing data Engage Stakeholders Use multiple channels of engagement from start to finish Consistency Align as much as possible with other Compare sites for star ratings display Allow for consistency in approach to measure selection with existing CMS programs and Hospital Compare over time 20

21 QUALITY MEASURES 21 21

22 Principles for Measure Development Measures should explicitly align with the CMS Quality Strategy and its goals and objectives Patient/caregiver input is equally important to provider input in the development of measures Develop measures meaningful to patients/caregivers and providers, focused on outcomes (including patient reported outcomes), safety, patient experience, care coordination, appropriate use/efficiency, and cost Measures should address a performance gap where there is known variation in performance, not just a measure gap Monitor disparities and unintended consequences

23 Principles (cont d) 1. Importance Incidence or Prevalence Morbidity and Mortality 2. Opportunity Useful in Multiple Programs Requires Novel Methods 3. Likelihood of technical success Probability of developing a valid, reliable, feasible measure Ability to implement in CMS quality reporting programs, including consideration of novel methods or data collection needs and stakeholder reception Provider buy in / acceptance 4. Resources required to complete development Length of Development Cycle Cost to develop, maintain and implement 5. Program priorities Focus on ecqms and claims based outcomes measures, particularly for IQR 23

24 Critical Challenges in Measure Development Defining the right outcome/performance gap Engaging patients in the measure development process Advancing the science for critical measure types: PROMs, resource use, appropriate use, etc. Robust feasibility, reliability and validity testing Developing measures that reflect and assess shared accountability across settings and providers Reduction of provider burden and cost to reporting measures Length of time it takes to develop measures

25 Measure Concepts of Interest Sepsis outcomes Global harm Safe Opioid Use Overuse of antipsychotics Patient Safety Culture Measure Quality of informed consent and advance directives PROMs for high volume procedures (e.g. PCI, THR/TKR, etc.) 25

26 Contact Information Kate Goodrich, MD MHS Director, Quality Measurement and Value Based Incentives Group Center for Clinical Standards and Quality