Healthcare Reform & Value Based Purchasing: Are You Ready?

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1 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: Public reporting and value-based payment systems should rely on a mix of standards, process, outcomes, and patient experience measures, including measures of care transitions and changes in patient functional status. 1

2 Medicare value based purchasing Healthcare reform provisions 1% of DRG tied to performance on quality & outcomes measures (FY 2013) Incentive pool scales to 2% of DRGs (FY 2017) Budget neutral (unallocated funds kept in the system) Quality measures from Hospital Compare measure set AMI, heart failure, pneumonia, SCIP, patient satisfaction; efficiency and others Reward for attainment (benchmark) and improvement Value-Based Purchasing Establish demo for CAHs, and for hospitals excluded from VBP program. (Not later than 2 years after enactment) Value-Based Purchasing Establish hospital VBP program under IPPS. Measure hospitals quality performance standards. ( ) Value-Based Purchasing Payments begin to be affected by standards measured in FY2012. (FY2013) Value-Based Purchasing Comptroller General submits interim report on program. (FY2015) Value-Based Purchasing Comptroller General submits evaluation. (FY2017) Proposed Inpatient Value Based Purchasing Rule Announced January 7, 2011 with comments sent by March 8 Rewards for achievement or improvement Budget neutral py payment changes begin October 1, 2012 by reducing base operating payments for each discharge by 1% in FY 2013, 1.25% in FY 2014, 1.5% in FY 2015, 1.75% in FY 2016, and 2% in FY Quality measures from Hospital Compare measure set 25 measures (17 process/8 HCAHPS dimensions) in FY 13, and Adds 20 measures (3 mortality, 8 HACs, and 9 IQI/PSIs) in FY 14 2

3 Purpose and Goals Purpose: move toward better value, outcomes and innovations instead of merely volume Goals: Mix of process, outcomes, patient experience transitions of care and functional status measures; Align measures across Medicare and Medicaid to extent possible; Align with meaningful use of EHR adoption; Nationally endorsed measures; Score based on achievement compared to national or other appropriate benchmarks; Move toward emphasis in weighting on outcomes, patient experience, and functional status over time; and Reliable, straightforward and stable scoring methodology. 7 Exclusions Hospitals Excluded: Subject to a penalty under Hospital IQR program, Receiving immediate jeopardy sanctions, Too few cases or measures (must meet all), At least 100 HCAHPs surveys At least 10 cases per measure At least 4 measures. Critical Access Hospitals, Inpatient Rehabilitation Facilities, Inpatient Psychiatric Facilities, Long-term Care Hospitals, Children s hospitals Cancer hospitals, and Maryland hospitals? (state must apply for continued waiver). 8 Criteria for VBP Performance Measures Measure Selection Criteria: Part of the Hospital IQR program Publicly reported on Hospital Compare for one year prior to the performance period Measure performance is not topped out Difference between 75 th and 90 th percentile is statistically insignificant Truncated coefficient of variation < 0.10 Measure has little or no unintended consequences Readmissions measures statutorily excluded CMS declines to use structural measures at present No notice and comment in future after measures in Hospital IQR for a year and meet criteria 3

4 2013 Measures and Timeline 25 measures for FFY Clinical Process measures AMI, HF, PN and SCIP (SCIP 1,2,3 and 4 considered HAI) 8 Patient Experience measures (HCAPHS) Communication with Nurses Communication with Doctors Responsiveness of Hospital Staff Pain Management Communication about Medicines Cleanliness and Quietness of Hospital Environment Discharge Information Overall Rating of Hospital Weighted 70% Weighted 30% Clinical Process and Patient Survey Timeline Baseline July 1, 2009 to March 31, 2010 Performance July 1, 2011 to March 31, Proposed 2013 VBP Measures AMI AMI 2 ASA Prescribed at Discharge AMI 7a Fibrinolytic Therapy Received w/n 30 Min of Hospital Arrival AMI 8aPrimaryPCI PCI Receivedw/n90Minof Hospital Arrival Heart Failure HF 1 Discharge Instructions HF 2 Evaluation of LVS Function HF 3 ACEI or ARB for LVSD Pneumonia PN 2 Pneumococcal Vaccination PN 3b Blood Cultures Performed in the ED Prior to Initial ABX Received in Hospital PN 6 Initial Antibiotic Selection PN 7 Influenza Vaccination Healthcare associated infections SCIP Inf 1 Prophylactic ABX Received w/n 1 Hr Prior to Surgical Incision SCIP Inf 2 Prophylactic ABX Selection for Surgical Patients SCIP Inf 3 Prophylactic ABX Discontinued w/n 24 Hrs After Surgery End Time SCIP Inf 4 Cardiac Surgery Patients with Controlled 6AM Postop Serum Glucose Surgeries SCIP Card 2 Surgery Pts on a BB Prior to Arrival That Received a BB During the Perioperative Period SCIP VTE 1 Surgery Patients with Recommended VTE Prophylaxis Ordered SCIP VTE 2 Surgery Patients Who Received Appropriate VTE Prophylaxis w/n 24 Hrs Prior to Surgery to 24 Hrs After Surgery 11 Proposed 2013 VBP Measures cont d Nurse communication (% Always) Nurse Explain Doctor Courtesy/Respect Doctor Listen Doctor communication (% Always) Doctor Explain Cleanliness and quietness (% Always) Cleanliness Quietness Overall Rating (% 9 or 10) Survey Measures HCAHPS Responsiveness of hospital staff (% Always) Bathroom Help Call Button Pain management (% Always) Pain Control Help with Pain Communication about medications (% Always) New Medicine Reason New Medicine Side Effects Discharge information (% Yes) Discharge Help Discharge Systems 4

5 Proposed 2014 VBP Measures and Timeline Adds 3 Mortality Outcome Measures AMI 30 day HF 30 day PN 30 day Outcome Measures Baseline and Performance Use 18 months of data Baseline July 1, 2008 to December 31, 2009 Performance Measurement July 2011 to December 31, 2012 FY 2014 VBP Measures and Timeline cont d Adds 8 Hospital Acquired Conditions Foreign Object Retained After Surgery Air Embolism Blood Incompatibility Pressure Ulcer Stages III and IV Falls and Trauma Vascular Catheter Associated Infections Manifestations of poor glycemic control Timeline will be included in future rulemaking (follow mortality?) CMS notes on QualityNet that it expects to post these measures on Hospital Compare in 2011 FY 2014 VBP Measures and Timeline cont d Adds AHRQ Patient Safety and Inpatient Quality Indicators PSI 06 Iatrogenic pneumothorax, adult PSI 11 Post Operative Respiratory Failure PSI 12 Post Operative PR or DVT PSI 14 Postoperative wound dehiscence PSI 15 Accidental puncture or laceration IQI 11 Abdominal aortic aneurysm repair mortality rate IQI 19 Hip fracture mortality rate Complication/patient safety for selected indicators Mortality for selected medical conditions Timeline will be included in future rulemaking (follow mortality?) CMS notes on QualityNet that it expects to post these measures on Hospital Compare in

6 Performance Standards Announced at least 60 days prior to performance period Must take into account: Practicalexperience with measure, Historical performance, Improvement rates, and Opportunity for continued improvement. 16 Performance Standards (cont d) Process & Outcome achievement standards Threshold at median hospital performance during baseline. Benchmark at mean of top decile during baseline Patient Experience achievement standards Threshold at median hospital performance during baseline. Benchmark at 95 th percentile during baseline 17 Performance Standards (cont d) Process & Outcomes improvement standards Threshold is hospital s improvement baseline score Benchmark at mean of top decile during baseline Patient Experience improvement standards Threshold is hospital s improvement baseline score Benchmark at 95 th percentile during baseline 18 6

7 How Does Baldrige Fit With VBP Proposals? Alignment to national benchmarks Improvement is rewarded Cohorts / collaboratives improvement efforts important Goalsareset are set to achieve or exceed Brings all aspects of systems into the quality of care focus Leadership remains #1 key to success Incentives are beyond awards and tied to real patient care improvement How is Premier Supporting Members for Reform Readiness Reform calculator QUEST collaborative ACO ACC Development Advocacy Group in DC Blair Childs, Director Picture of how this looks! Systematic improvement (Inpatient value) Population total value Payer Partners Process Improvement (Evidence-Based Care) States Insurers Employers CMS 2.0 Journey to High-Value Healthcare 7

8 WA1 How will you deliver high quality care while safely reducing your costs? QUEST members are currently setting a national standard in six core dimensions of care Standard measurement Transparent data sharing Best practices/ Know how Innovation testing and exchange Focused process interventions 22 Premier Collaborative Methodology Success Story: PVHS National top 10% for: Clinical outcomes Patient satisfaction Employee satisfaction Physician loyalty Financial performance Molly 4th generation treated at PVH 8

9 Providing a World Class Patient Experience Customer focused strategy Criteria based oversight Using data to engage front line staff What s next? Craig Trauma patient Poudre Valley Health System Private, locally owned, not for profit based in Fort Collins, Colorado Full spectrum of healthcare services 2 tertiary hospitals (420 beds), outpatient campus, numerous satellite clinics Joint ventures: Home care, sub acute care, third party administrator Service area: Northern Colorado, Wyoming & Nebraska 5,300 employees, 600 physicians & 1,000 volunteers $1+ billion in annual revenue Where Our Journey Started (1997) Community hospital serving Fort Collins, Colorado 1,500 employees, 300 independent physicians & 575 volunteers 5 CEOs in 4 years 24% annual employee turnover 40 th percentile for patient satisfaction 9

10 Customer Service Steering Committee (CSSC) Senior management leadership & active participation Representation from all facilities, disciplines, customer groups & workforce groups, including volunteers & physicians Originial role Organizational self assessment Respond to feedback report Current role Scheduled review of VOC data & initiatives Prioritization of system initiatives Review of key approaches Nikki, oncology patient Using Data to Engage Staff Use Balanced Scorecard system Monitor system, facility & department performance, take action if not performing to goal Link system goals to Optional Performance Plan Financial performance Customer satisfaction Employee survey participation Identify unit specific goals, initiatives, action plans Make information transparent to engage staff & share best practices 10

11 Unit Initiatives Share Results Prioritize Develop Action Plan Transparency of Information Transparency of Information 11

12 Transparency of Information Transparency of Information Recognizing Achievements Penguin Awards Most improvement in overall Top Box scores from previous month Sustained Top Box score of 90% or higher for 3 consecutive months 12

13 Customer Focused Outcomes Top Box Scores for Patient Satisfaction 8 years of consistent improvement Customer Focused Outcomes HCAHPS* *Hospital Consumer Assessment of Healthcare Providers & Systems Next Step: Redefining Key Customers PARTCIPANTS Chief Nursing Officers Chief Operating Officers Chief Medical Officer VP, Marketing VP, Ancillary Services Quality Improvement INTEREST/EXPERTISE Inpatient Customer Service Steering Committee Outpatient, Emergency Departments (ED) Inpatient, outpatient, ED, clinics IP, OP, ED, clinics, community Clinics Baldrige Criteria All performance excellence teams 13

14 PVHS Customers, 2011 PATIENT & STAKEHOLDER GROUPS PRIMARY SERVICE AREA Patients (Inpatient, Outpatient, Emergent/Urgent, Clinics) Community Referring Clinicians SECONDARY SERVICE AREA Patients (Inpatient, Outpatient, Emergent/Urgent, Clinics) Community Referring Clinicians Questions? 14