HEN 2.0 Kickoff. Jessica Rowden, Clinical Quality Improvement Manager August 19, 2015

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1 HEN 2.0 Kickoff Jessica Rowden, Clinical Quality Improvement Manager August 19,

2 Agenda Current HEN 2.0 contract status Potential HEN 2.0 strategy Aligning MHA strategies Potential contract deliverables for hospitals Potential HEN measures Potential HEN upcoming events 2

3 HEN 1.0 Grossed an estimated $91.7 million in savings from unrealized patient harm Equates to almost $1 million savings per hospital for the 93 participating organizations Over 100 site visits Almost 500 educational opportunities More than $650,000 in financial support for scholarships and data stipends all free to Missouri hospitals 3

4 HEN Project Report 4

5 Current HEN Contract Status 5

6 Waiting MHA is currently waiting to hear of the official contract award to AHA/HRET 6

7 CMS AHA/HRET ~30 other National HENs MHA ~30 other State Hospital Associations Center for Patient Safety ~90 hospitals 7

8 HEN 2.0 Project Goals Reduce preventable harm by 40% Reduce readmissions by 20% 8

9 Potential HEN 2.0 Implementation Structure 9

10 Education Strategy Reaching key role-based players in a short time frame Aligning education with improvement drivers Hospital level HEN 2.0 Immersion Projects Transparency

11 Improvement Drivers Senior Leadership and Governance Immersion Projects Patient and Family Engagement DATA Data Physician Leadership HEN 2.0 Unit-based Engagement Transparency Initiative 11

12 Missouri Hospital Association SQI Staff Hospital Leadership Senior Leadership & Governance Hospital Support HRET/National Subject Matter Experts Physician Leadership Unit-based Staff Patients & Families 12 12

13 Emphasis on Implementation Prioritize DOING work over PLANNING to do work Prioritize time in units, at the gemba, making things happen Predictable schedules 12 months = (only) 260 working days! 13

14 Tentative Education Touch Points Webinars Immersion Projects Transparency Initiative Monthly- WUW, HEN Quarterly- Quality Two national scientific in-person meetings Three in-person MO state meetings HEN Action Leader Fellowship (ILF) Bimonthly rural/cah affinity group Site Visits Consultation Biweekly-90 minute topicspecific HOSPITAL- LEVEL IMPROVEMENT 14

15 Improved Resources Updated change packages, checklists and implementation guide Website MHA HRET HEN YouTube Network on Linked In 15

16 Roles-based Strategy 16

17 Hospital Level Deliverables 17

18 Enrollment Process Timeframe = 2 weeks MHA sends Commitment Letters to CEOs and CC s Quality Directors Hospital CEO and HEN lead completes form and submits to MHA Hospital completes the needs assessment and baseline data submission Enrollment complete 18

19 Hospital Commitment Letter Commitment will require Focus on readmission and CAUTI reductions CEO and HEN lead signatures and contact information Commitment to: Work on all applicable topics Participate in an immersion pilot project Submit data on all applicable topics Collaborate and share 19

20 Needs Assessment Data/answers to be submitted through CDS; hospital will continue to have access to their submission throughout the project Needs assessment will include submission of baseline data for some measures 20

21 HEN 2.0 Data Approach 21

22 Data Approach No utilization of CDS for data submission HIDI Quality Collections HIDI Analytic Advantage 22

23 Data Support Data submission Quality Collections data entry Templates Upload electronically (preferred) Printable reminders Focused data submission phone calls 23

24 Potential HEN Data Measures Topic Measure(s) CAUTI Standardized Infection Ratios : CDC NHSN (NQF 0138) Catheter utilization: CDC NHSN CLABSI Standardized Infection Ratios : CDC NHSN (NQF 0139) Central line utilization: CDC NHSN Falls Falls w/injury 4 (NQF 0202) OB/EED Early elective deliveries (PC-01, NQF 0469) OB trauma vaginal delivery w/ instrument (AHRQ PSI 18) OB trauma vaginal delivery w/out instrument (AHRQ PSI 19) Pressure ulcers Pressure ulcer stage 3+ (AHRQ PSI 03) Pressure ulcer stage 2+ (NQF 0201) Surgical site infections Venous thromboembolism Ventilator associated events Adverse Drug Events Standardized Infection Ratios : ACS-CDC (NQF 0753) Colon surgery, abdominal hysterectomy, total hip replacements, total knee replacements Post-operative pulmonary embolism or DVT (AHRQ PSI 12) Ventilator-associated complication (VAC) rate CDC NHSN 1 2 Infection-related ventilator-associated complication (IVAC) rate CDC NHSN 1 2 All adverse drug events Focus on opioid safety, anticoagulation safety and glycemic management Readmissions All cause 30 day readmissions Pending CMS Feedback: Additional outcome measures Process measures Baseline measurement timeframe 1 Hospitals using NHSN may confer rights to MHA/HIDI 2 For hospitals not reporting to NHSN, hospital submitted infection rates will be used 3 All inpatient locations except NICU 4 All acute care units 5 Hospitals should report on all surgeries 24

25 HEN TOPICS Manual data submission? Transparency Topic Transparency measure alignment Immersion Project CAUTI CLABSI Falls EED OB Pressure Ulcer SSI VAP DVT ADE Readmission 25

26 Aligning Measures with CMS Payment Models 26

27 VBP Priority Weighting FY 2017 and FY 2018 Federal Fiscal Year Proposed 2018 Percent of Program 1.00% 1.25% 1.50% 1.75% 2.00% 2.00% Contribution Process of Care 70% 45% 20% 10% 5% Removed Outcome 25% 30% 40% 25% 25% Patient Experience 30% 30% 30% 25% 25% 25% Safety 20% 25% Efficiency and Cost Reduction 20% 25% 25% 25% 27

28 Newly Finalized Performance and Baseline Periods for the FFY 2017 VBP Program Domain Measure Baseline Period Safety PSI 90 Oct 1, 2010 June 30, 2012 Clinical Care Outcomes Clinical Care Process Efficiency & Cost Reduction CAUTI, CLABSI, SSI, C.DIFF, MRSA AMI, HF, Pneumonia, 30 day Mortality AMI-7a, IMM-2, PC-01 Jan 1, 2013 Dec 31, 2013 Oct 1, 2010 June 30, 2012 Jan 1, 2013 Dec 31, 2013 Jan 1, 2013 Dec 31, 2013 Performance Period Oct 1, 2013 June 30, 2015 Jan 1, 2015 Dec 31, 2015 Oct 1, 2013 June 30, 2015 Jan 1, 2015 Dec 31, 2015 Jan 1, 2015 Dec 31, 2015 Patient & Caregiver Centered Experience of Care/Care Coordinator Jan 1, 2013 Dec 31, 2013 Jan 1, 2015 Dec 31,

29 Domain 1: PSI-90 35% Measure Weight PSI-3 (Pressure ulcer rate) 2.3% PSI-6 (Iatrogenic pneumathorax rate) 7.1% PSI-7 (Central venous catheter-related blood stream infections rate) 6.5% PSI-8 (Postoperative hip fracture rate) 0.1% PSI-12 (Postoperative PE/DVT rate) 25.8% PSI-13 (Postoperative sepsis rate) 7.4% PSI-14 (Wound dehiscence rate) 1.7% PSI-15 (Accidental puncture & laceration rate) 49.2% Domain 2: CDC HAI Measures Apply to Proposed Approach and Alternative Approach (Multiple FYs) 65% Measure Weight Central Line-associated Blood Stream Infection (CLABSI) (FY 2015 onward) 33.3% Catheter-associated Urinary Tract Infection (CAUTI) (FY 2015 onward) 33.3% Surgical Site Infection (SSI): SSI Following Colon Surgery (FY 2016 onward) SSI Following Abdominal Hysterectomy (FY 2016 onward) 33.3% Methicillin-resistant Staphylococcus aureus (MRSA) Bacterem (FY 2017 onward) Clostridium difficile (FY 2017 onward) 29

30 Setting Readmission Goals Measure National Average MO Risk Adjusted Lowest Readmission Penalty Threshold MO Risk Adjusted Highest Readmission Penalty Threshold AMI 19.9% 14.8% 23.1% HF 24.8% 19.5% 25.4% PN 18.3% 14.3% 20.6% Total Hip / Knee 6.2% 4.4% 7.0% COPD 21.3% 17.0% 24% 30

31 Potential Inpatient Operating Payments at Risk Type VBP 1% 1.25% 1.5% 1.75% 2% ReADM 1% 2% 3% 3% 3% HAC 0% 0% 1% 1% 1% At Risk 2.00% 3.25% 5.50% 5.75% 6.00% APU * * Annual percentage update is reduced for those who do not submit quality data. Proposed for FY 2016, reduction to the update is applied 31

32 NHSN Data Confer your NHSN rights. Why? To provide you the most robust data portfolio To better assist you with more improvement opportunities See the Instructional Guide Decrease the amount of time spent submitting data! 32

33 Aligning MHA Strategies with HEN

34 Immersion Project Rapid-process improvement model Pilot project Data submission Quarterly guided participant calls and deliverables Ability to network across group participants End-of-project report out TOPICS CAUTI* Readmission* Falls OB Sepsis ED/EMS 34

35 Immersion Project Methodology Rapid Process Improvement Model designed to seek incremental changes towards an end improvement goal. Cycles of 90 days will be utilized consisting of learning and action components based on the IHI s Breakthrough Series Model Learning session/huddle webinar Quarterly informational and coaching webinars with the following purposes. Review and discuss data outcomes relative to the project Provide a platform for shared learning, barrier mitigation and sharing of successes Inform project participants of next quarter s interventions Provide resources and opportunity for Q&A 35

36 Immersion Projects CAUTI AIM Reduce Catheter-Associated Urinary Tract Infections by 40 percent from organizational baseline performance to increase Safety Across the Board. SEPSIS AIM Increase awareness and education for early recognition and intervention of sepsis setting the stage for future development of a program similar to a time critical diagnosis process with opportunities to build a chain of survival from dispatch to discharge. FALLS AIM Reduce falls with or without injury by 40 percent from organizational baseline performance in order to increase safety across the board. READMISSION AIM Reduce all-cause readmissions by 20 percent. Clinical condition focus may include those diagnoses tied to the Hospital Readmission Reduction Program congestive heart failure, acute myocardial infarction, pneumonia, chronic obstructive pulmonary disease and hip and knee replacements. OB AIM Reduce morbidity and mortality from maternal preeclampsia by implementing evidence-based practice criteria to improve management of maternal hypertension. 36

37 Manuals will be available next month Pilot projects to begin in October 37

38 Transparency MHA has launched a transparency initiative that will publically report hospital level data according to 23 selected measures. 7 transparency topics align with HEN transparency measures align with HEN 2.0 This initiative is based on voluntary participation and will go-live January 2016 Goals of this initiative: Demonstrate consistent, measureable outcomes Identify and share Missouri patient safety and quality improvement best practices Increase organizational effectiveness and efficiencies 38

39 39

40 2015 Missouri Quality Outcome Measures

41 Where is the Data Stored? The state aggregate price and quality data will be posted on MHA s website, Focus on Hospitals.

42 Transparency Resource MHA has developed a tutorial to assist quality staff with accessing and understanding their quality data

43 HEN TOPICS Manual data submission? Transparency Topic Transparency measure alignment Immersion Project CAUTI CLABSI Falls EED OB Pressure Ulcer SSI VAP DVT ADE Readmission 43

44 HEN 2.0 Immersion Projects Transparency 44

45 Upcoming Events August 26, from Noon to 1 p.m. - MHA Clinical Quality Quarterly Webinar (register, then dial 866/ , Conf. ID# ) August 26, from 1:30-2:30 p.m. - HEN Data Webinar (register, then dial 866/ , Conf. ID# ) September 2, from Noon to 1 p.m. - Lunch & Learn: What's Up Wednesday (register, then dial 855/ , Conf. ID# ) September 9, from 11 a.m. to Noon - HEN Data Webinar (register, then dial 866/ , Conf. ID# ) September 15, from 11 a.m. to Noon - HEN Data Webinar (register, then dial 866/ , Conf. ID# ) September 25, from 11 a.m. to Noon - HEN Data Webinar (register, then dial 866/ , Conf. ID# ) 45

46 Upcoming Events September 25, from 2-3 p.m. - MHA's Price and Quality Outcome Transparency Initiative (register, then dial 866/ , Conf. ID# ) October 7, from Noon to 1 p.m. - Lunch & Learn: What's Up Wednesday (register, then dial 855/ , Conf. ID# ) October 15 HEN/Immersion Project Launch; Hilton Garden Inn, Columbia, MO (registration coming soon) 46

47 Fall Regional Meetings September 16, Marriott West, 660 Maryville Centre Dr., St. Louis (Register) September 17, Ste. Genevieve County Community Center, MO-32, Ste. Genevieve, Mo. (Register) September 22, Courtyard KC/Blue Springs, 1500 NE Coronado Dr., Blue Springs, Mo. (Register) September 24, Hilton Garden Inn, 4155 South Nature Center Way, Springfield, Mo. (Register) 47

48 Pencil me in IP webinars: December 3 rd Sepsis Immersion Project webinar December 3 rd 1-2 Falls Immersion Project webinar January 4 th Readmission Immersion Project webinar January 5 th CAUTI Immersion Project webinar January 5 th 1-2 OB Immersion Project webinar March 22 nd Sepsis Immersion Project webinar March 22 nd 1-2 Falls Immersion Project webinar March 23 rd Readmission Immersion Project webinar March 24 th CAUTI Immersion Project webinar March 24 th 1-2 OB Immersion Project webinar June 14 th Sepsis Immersion Project webinar June 14 th 1-2 Falls Immersion Project webinar June 15 th Readmission Immersion Project webinar June 16 th CAUTI Immersion Project webinar June 16 th 1-2 OB Immersion Project webinar 48

49 Pencil me in Monthly HEN webinars Scheduled soon to correlate with data updates Monthly What s Up Wednesday First Wednesday of the month at noon 49

50 Pencil me in HEN 2.0 mid-year conference March 9, Hilton Garden Inn, Columbia, MO HEN 2.0 end-of-year conference August 25, Hilton Garden Inn, Columbia, MO Because this is a federal grant, food/drinks cannot be provided at conferences. At the time of registration, you have the option to pay for your lunch that will be provided on-site. 50

51 Please visit our website for recent publications and resources 51

52 Contact Information Jessica Rowden, R.N., BSN, MHA Clinical Quality Improvement Manager Missouri Hospital Association (573) , ext

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