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

Transcription

1 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 and Hospital Value- Based Purchasing April 29, 2014

2 Agenda Topics and Objectives FY 2016 Hospital VBP Program Introduction and Exclusions Domains and Measures/Dimensions Baseline and Performance Periods Evaluating Hospitals Hospital Eligibility Domain Weighing FY 2016 Baseline Report Resources Objectives Identify new and readopted Measures for FY 2016 Review baseline and performance periods Know how to read your FY 2016 Baseline Report 2

3 Hospital VBP Program Introduction Hospital Value-Based Purchasing (VBP) Program Initially required in the Affordable Care Act and further defined in Section 1886(o) of the Social Security Act Quality incentive program built on the Hospital Inpatient Quality Reporting (IQR) measure reporting infrastructure Hospitals will be paid for inpatient acute care services based on the quality of care, not just quantity of the services provided Funded by a 1.75% reduction from participating hospitals base operating Diagnosis-Related Group (DRG) payments for FY 2016 Who is eligible for the program? As defined in Social Security Act Section 1886(d)(1)(B), the program applies to subsection (d) hospitals located in the 50 states and the District of Columbia 3

4 Hospital VBP Program Exclusions Who is excluded from the Hospital VBP Program? Hospitals subject to payment reductions under the Hospital IQR Program Hospitals and hospital units excluded from the Inpatient Prospective Payment System (IPPS) Hospitals cited for deficiencies during the performance period that pose immediate jeopardy to the health or safety of patients Hospitals with less than the minimum number of domains calculated Hospitals paid under Section 1814 (b)(3) and received an exemption from the Secretary of HHS Hospitals excluded from Hospital VBP will not have 1.75% withheld from their base operating DRG payments in FY

5 Domains and Measures/Dimensions FY

6 Domains and Measures/Dimensions Clinical Process of Care AMI-7a: IMM-2: PN-6: SCIP-Inf-2: Fibrinolytic therapy received within 30 minutes of hospital arrival Influenza Immunization Initial antibiotic selection for community-acquired pneumonia in immunocompetent patient Prophylactic antibiotic selection for surgery patients SCIP-Inf-3: Prophylactic antibiotics discontinued within 24- hours after surgery end time SCIP-Inf-9: Urinary catheter removed on post-operative day 1 or post-operative day 2 SCIP-Card-2: Surgical patients on beta-blocker therapy prior to arrival who received a beta-blocker during the perioperative period SCIP-VTE-2: Surgical patients who received appropriate venous thromboembolism prophylaxes within 24-Hours prior to surgery to 24-hours after surgery 6

7 Domains and Measures/Dimensions Patient Experience of Care Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) Dimensions 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 7

8 Domains and Measures/Dimensions Outcome 30-Day Mortality Measures MORT-30-AMI MORT-30-HF MORT-30-PN AHRQ Measure PSI-90 Composite Healthcare Associated Infection (HAI) Measures CLABSI CAUTI SSI: Abdominal hysterectomy and Colon surgery 8

9 Domains and Measures/Dimensions Outcome: Mortality Measures Mortality Measures Claims-Based Measures Utilizes admissions for Medicare Fee-for-Service (FFS) beneficiaries aged 65 years discharged from subsection(d) and Maryland acute care hospitals having a principal discharge diagnosis of Acute Myocardial Infraction, Heart Failure, or Pneumonia, and meeting other measure inclusion criteria Reported as survival rates MORT-30-AMI: MORT-30-HF: MORT-30-PN: Acute Myocardial Infarction (AMI) 30-Day Mortality Rate Heart Failure (HF) 30-Day Mortality Rate Pneumonia (PN) 30-Mortality Rate 9

10 Domains and Measures/Dimensions Outcome: AHRQ PSI-90 Agency for Healthcare Research and Quality (AHRQ) Measure PSI-90 Composite Composite of 8 underlying component patient safety indicators (PSIs) which are sets of indicators on potential in-hospital complications and adverse events during surgeries and procedures Claims-Based Measure PSI 03 PSI 06 PSI 07 PSI 08 PSI 12 PSI 13 PSI 14 PSI 15 Pressure Ulcer Rate Iatrogenic Pneumothorax Rate Central Venous Catheter-Related Bloodstream Infection Rate Postoperative Hip Fracture Rate Postoperative Pulmonary Embolism or Deep Vein Thrombosis Rate Postoperative Sepsis Rate Postoperative Wound Dehiscence Rate Accidental Puncture or Laceration Rate 10

11 Domains and Measures/Dimensions Outcome: HAI Measures Healthcare-Associated Infections (HAI) Measures CLABSI: Central line-associated blood stream infections among adult, pediatric and neonatal ICU patients CAUTI: SSI: Catheter-associated urinary tract infections among adult and pediatric ICUs Surgical site infections specific to Abdominal hysterectomy and Colon surgery 11

12 Domains and Measures/Dimensions Efficiency: MSPB Measure MPSB-1: Medicare Spending Per Beneficiary (MSPB) Claims-Based Measure Includes risk-adjusted and pricestandardized payments for Part A and Part B services provided 3-days prior to hospital admission through 30-days after hospital discharge 12

13 Baseline and Performance Periods FY

14 Evaluating Hospitals Performance Standards Benchmark Average (mean) performance of the top ten percent of hospitals during the baseline period Achievement Threshold Performance at the 50 th percentile (median) of hospitals during the baseline period 14

15 Evaluating Hospitals (1 of 2) A higher rate is better for the following measures/dimensions: Clinical Process of Care Measures Patient Experience of Care Measures 30-Day Mortality Measures* MORT-30-AMI MORT-30-HF MORT-30-PN *Note: The 30-day Mortality Measures are reported as survival rates; therefore, higher values represent a better outcome. 15

16 Evaluating Hospitals (2 of 2) A lower rate is better for the following measures: AHRQ PSI-90 Composite HAI Outcome Measures CLABSI CAUTI SSI Abdominal Hysterectomy Colon Procedure Efficiency Measure* *Note: Unlike other measures, the Efficiency Domain measure, MSPB, utilizes data from the performance period to calculate the benchmark and achievement threshold instead of data from the baseline period. 16

17 Achievement Points Evaluating Hospitals Achievement vs. Improvement Awarded by comparing an individual hospital s rates during the performance period with all hospital s rates from the baseline period Rate equal to or better than benchmark = 10 points Rate lower than the achievement threshold = 0 points Rate equal to or better than the achievement threshold and lower than the benchmark = 1-10 points Improvement Points Awarded by comparing an individual hospital s own rates from the baseline period to the performance period Rate equal to or lower than the baseline period rate = 0 points Rate between the baseline period rate and the benchmark = 0-9 points 17

18 Hospital Eligibility: Clinical Process of Care Domain Clinical Process of Care Domain Measures A measure must have at least 10 eligible cases during the baseline period to have an improvement score calculated on the Percentage Payment Summary Report A measure must have at least 10 eligible cases during the performance period to have either an achievement or improvement score calculated on the Percentage Payment Summary Report The Clinical Process of Care Domain requires at least 4 out of the 8 measures to be scored in order for the domain score to be included in the Total Performance Score (TPS) on the Percentage Payment Summary Report 18

19 Hospital Eligibility: Patient Experience of Care Domain HCAHPS Survey Requires at least 100 completed HCAHPS surveys during the baseline period to have an improvement score calculated on the Percentage Payment Summary Report Requires at least 100 completed HCAHPS surveys during the performance period to have either an achievement or improvement score calculated on the Percentage Payment Summary Report The Patient Experience of Care Domain requires at least 100 completed HCAHPS surveys during the performance period for the domain score to be included in the Total Performance Score (TPS) on the Percentage Payment Summary Report 19

20 Hospital Eligibility Outcome Domain (1 of 4) 30-Day Mortality Measures A measure must have at least 25 eligible cases during the baseline period to have an improvement score calculated on the Percentage Payment Summary Report A measure must have at least 25 eligible cases during the performance period to have either an achievement or improvement score calculated 20

21 Hospital Eligibility Outcome Domain (2 of 4) AHRQ PSI-90 Composite The measure must have at least 3 eligible cases on any one underlying indicator during the baseline period to have an improvement score calculated on the Percentage Payment Summary Report The measure must have at least 3 eligible cases on any one underlying indicator during the performance period to have an either an achievement or improvement score calculated on the Percentage Payment Summary Report 21

22 HAI: CLABSI/CAUTI/SSI Hospital Eligibility Outcome Domain (3 of 4) A measure must have at least 1 predicted infection calculated by the Centers for Disease Control (CDC) during the baseline period to have an improvement score calculated on the Percentage Payment Summary Report A measure must have at least 1 predicted infection calculated by the Centers for Disease Control (CDC) during the performance period to have either an achievement or improvement score calculated on the Percentage Payment Summary Report 22

23 Outcome domain Hospital Eligibility Outcome Domain (4 of 4) Requires at least 2 of the 7 measures to be scored in order for the domain score to be included in the Total Performance Score (TPS) on the Percentage Payment Summary Report 23

24 Hospital Eligibility: Efficiency Domain The measure must have at least 25 eligible episodes of care during the baseline period to have an improvement score calculated on the Percentage Payment Summary Report The measure must have at least 25 eligible episodes of care during the performance period to have either an improvement or achievement score calculated The Efficiency Domain requires at least 25 eligible episodes of care during the performance period to be scored in order for the domain score to be included in the Total Performance Score (TPS) on the Percentage Payment Summary Report 24

25 Hospital Eligibility Total Performance Score Hospitals need scores for at least 2 out of 4 domains to receive a Total Performance Score (TPS) Excluded domain weights are proportionately distributed to the remaining domains to calculate the TPS 25

26 Domain Weighting Sample Scenario A hospital meets minimum case and measure requirements for the Clinical Process, Patient Experience and Outcome domains, but does not meet the minimum number of episodes required for the Efficiency domain 26

27 FY 2016 Baseline Report Clinical Process of Care Clinical Process of Care Measures 8 measure details including benchmarks, achievement thresholds, numerators, denominators and hospital baseline rate Sample Clinical Process of Care Report 27

28 FY 2016 Baseline Report Patient Experience of Care Patient Experience of Care Dimensions 8 dimension details including floor values, benchmarks, achievement thresholds, a hospital s baseline rate and number of completed surveys during the baseline period Sample Patient Experience of Care Report 28

29 FY 2016 Baseline Report Mortality Measures Outcome Measures 30-Day Mortality Measures Measure details, including the number of eligible discharges, benchmarks, achievement thresholds and a hospital s baseline rate AHRQ PSI-90 Composite Measure details, including index value, achievement threshold and benchmark Healthcare Associated Infections Measure details including number of observed infections (numerator), number of predicted infections (denominator), standard infection ratio (SIR), achievement threshold and benchmark Sample Outcome Report 29

30 FY 2016 Baseline Report Efficiency Efficiency Measure MSPB measure details, including MSPB amount (numerator), median MSPB amount (denominator), MSPB measure and number of episodes Sample Efficiency Measure Report 30

31 FY 2016 Baseline Reports Coming Soon When to Expect Your Baseline Measure Reports Notifications will be sent to hospitals and QIOs when the reports are available on My QualityNet Reports are only available on My QualityNet to hospital users who are active, registered QualityNet users and assigned the following My QualityNet roles: Hospital Reporting Feedback Inpatient role (Required to receive the report) File Exchange & Search role (Required to download the report from My QualityNet) 31

32 Questions? 32

33 Resources Technical questions or issues related to accessing the report QualityNet Help Desk address: or call (866) More information on the FY 2016 Baseline Measures Report How to Read Your FY 2016 Percentage Payment Summary Report guide available on QualityNet in the Hospital VBP section on the Hospital Value-Based Purchasing (VBP) page (direct link): %2FQnetTier3&cid= Note: This document will be posted to the QualityNet when the reports are released. Frequently Asked Questions (FAQs) related to Hospital VBP FAQs are available via the Hospital-Inpatient Questions and Answers tool at the following link: Ask Questions related to Hospital VBP Submit questions using the Hospital-Inpatient Questions and Answers tool at the following link: This material was prepared by Telligen, Hospital Inpatient Quality Reporting Program Support Contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. 10SoW-IA-HIQRP-04/