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

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1 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 provided in The data presented in this report was primarily provided to the Partnership for Healthcare Payment Reform (PHPR) by the hospitals and surgery center participating in the pilot; however, there are several instances where data from other sources is used. Due to data lags, there may be some inconsistency between measures in the number of patients included in the measure denominators. Please view the appropriate footnotes in the Appendix to learn more about the additional data sources. The measures included in this report were selected during the pilot development process. Pilot participants agreed to submit data for public reporting as part of their participation in the pilot. Benchmark data was provided by the Wisconsin Health Information Organization and the Wisconsin Hospital Association. The report was prepared by the Wisconsin Collaborative for Healthcare Quality in collaboration with pilot participants. Measures Beta Blocker During Preoperative Period The Beta Blocker During Preoperative Period measure assesses the proportion of total knee replacement patients who have received a beta blocker prior to undergoing surgery. The measure is stratified into two groups; those total knee replacement patients aged 18-64, and all total knee replacement patients. Beta Blocker During Preoperative Period Manitowoc Surgery Center Meriter Hospital UW Hospital 0% 20% 40% 60% 80% 100% Age All Patients WI Benchmark 1

2 Pilot Participant Age (N) All Patients (N) Manitowoc Surgery Center 100% (46) 100% (46) Meriter Hospital 100% (10) 100% (24) UW Hospital 100% (4) 100% (14) WI Benchmark 1-99% Surgery Patients Receiving Appropriate VTE Prophylaxis Patients who undergo total knee replacement are at an increased risk of developing a venous thromboembolism (VTE). This measure assesses the proportion of total knee replacement patients who receive a prophylaxis to prevent a VTE from developing post-surgery. This measure stratifies total knee replacement patients into two groups; those aged 18-64, and all total knee replacement patients. Surgery Patients Receiving Appropriate VTE Prophylaxis Manitowoc Surgery Center Meriter Hospital UW Hospital 0% 20% 40% 60% 80% 100% Age All Patients WI Benchmark Pilot Participant Age (N) All Patients (N) Manitowoc Surgery Center 100% (46) 100% (46) Meriter 100% (33) 100% (80) UW Hospital 100% (42) 100% (71) WI Benchmark 1-98% 2

3 Length of Stay (LOS) Decreased length of stay after a hospitalization is strongly associated with improved patient outcomes. The Length of Stay measure looks at the average and median length of stay for bundled payment patients, and all total knee replacement patients. Pilot Participant Bundled Payment Patients Number of Patients Average Median Manitowoc Surgery Center Meriter Hospital UW Hospital WI Benchmark 2 5, Pilot Participant All Total Knee Replacement Patients 2 Number of Patients Average Median Manitowoc Surgery Center Meriter Hospital UW Hospital WI Benchmark 2 5, Day Readmission Rate The 30-Day Readmission Rate Measure assesses the proportion of individuals in the total knee replacement bundled payment population who have been readmitted to the hospital with a condition related to the total knee replacement procedure within 30 days of that procedure. Pilot Participant Rate (N) Manitowoc Surgery Center 0% (9) Meriter Hospital 0% (34) UW Hospital 0% (88) WI Benchmark - 3

4 90-Day Revision or Re-operation The 90-Day Revision or Re-operation measure determines the proportion of total knee replacement patients that had a revision or re-operation on their surgically repaired knee within 90 days of the original surgery. This measure is stratified by those patients within the total knee replacement bundled payment pilot and all total knee replacement patients. Pilot Participant Bundled Payment Patients (N) All Patients (N) 3 Manitowoc Surgery Center 0% (9) - Meriter 0% (34) - UW Hospital 0% (88) - WI Benchmark 3-0.7% (910) 30-Day Complication Rate The 30-Day Complication Rate measure assesses the proportion of total knee replacement patients who have had a complication within 30 days of surgery. Complications include: infections, deep vein thrombosis, and pulmonary embolisms. The results are stratified by those total knee replacement patients in the bundled payment pilot, and all total knee replacement patients. Patient Experience Pilot Participant Bundled Payment Patients (N) All Patients (N) 3 Manitowoc Surgery Center 0% (9) - Meriter Hospital 0% (34) - UW Hospital 0% (90) - WI Benchmark 3-1.5% (910) The patient experience scores are for all patients who were determined to have a total knee replacement without major complications. The patient experience score for hospital ratings are the percentage of patients who rated a hospital a 9 or 10 on a 10-point scale. The four other domains are composite scores that indicate the percentage of patients who Always had their pain well controlled, received discharge instructions, and had good communication with their nurses and physicians. The Wisconsin Benchmark is the average patient experience score for all surgical patients across Wisconsin. 4

5 Patient Experience Composite Score Hospital Rating Pain Always Well Controlled Discharge Instructions Nurse Communication Score Physician Communication Score 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Manitowoc Surgery Center Meriter Hospital UW Hospital WI Benchmark Pilot Participant Hospital Rating (n) Pain Always Well Controlled (n) Discharge Instructions (n) Nurse Communication Score (n) Physician Communication Score (n) Manitowoc 100% 100% 50% 100% 100% Surgery Center Meriter Hospital 61.1% (9) 64.7% (9) 92.4% (9) 52.6% (9) 85.2% (9) UW Hospital 85.8% (-) 77.3% (-) 97.8% (-) 87.3% (-) 90% (-) WI Benchmark 1 74% 72% 89% 82% 83% Patient Reported Outcomes There are several different surveys currently in use for patients with a total knee replacement that measure patient reported outcomes like pain, stiffness, and functional ability. While these patient reported outcome surveys are generally similar, they differ in the questions that are asked and the scale that is used. Currently, Manitowoc Surgery Center, Meriter, and UW are using three different surveys for tracking patient outcomes, and are at different stages of implementing those surveys. Below is an update on the progress of each of the three organizations with regards to patient reported outcomes. 5

6 Meriter Hospital Patient reported outcome data was collected by Meriter Hospital, who elected to utilize the KOOS Functional Survey which did not cross-walk to the WOMAC. A pre-op baseline was compared to a 3- month post-surgery. University of Wisconsin Hospitals and Clinics Changes in functional outcome between pre and post knee replacement at UW Health is not available for the time frame of the bundled payment pilot. UW Health orthopedics was midstream in transitioning how functional outcomes were captured during the TKR bundled payment pilot. The process moved from a non-integrated manual process with inconsistent functional outcome data capture to an integrated electronically supported process. The availability of pre and post data from the manual process proved to be inconsistent and unreliable while the integrated electronically supported data was not implemented in time for post care scores to be identified. Manitowoc Surgery Center Manitowoc Surgery Center has developed a proprietary survey to track patient reported outcomes. The survey used by Manitowoc Surgery Center is a 22 question 10-point survey, with scores nearer to 0 indicating higher function. Manitowoc Surgery Center administered their proprietary survey throughout 2013, but did not have a large enough sample of completed pre-op and post-op survey results to publicly report their results. Appendix Quality data in this report is provided primarily by hospitals participating in the Partnership for Healthcare Payment Reform Total Knee Replacement pilot. However, there are several instances where data was provided by the Wisconsin Hospital Association, the Wisconsin Hospital Association Information Center, or the Wisconsin Health Information Organization. Below you will find descriptions of those data sources and the measures referenced in the report above. 1) Wisconsin Hospital Association PHPR has elected to assign a Wisconsin benchmark for many of the quality measures used in this report. For two measures, Beta Blocker During Preoperative Period, and Surgery Patients Receiving VTE Prophylaxis there is no benchmark data available for the total knee replacement population. Therefore, PHPR has elected to use data for all eligible surgical patients in Wisconsin, not just those who underwent total knee replacement, as the benchmark for these two measures. Data used to calculate the benchmark for these two measures are collected by the Center for Medicaid and Medicare Services (CMS) from all hospitals in Wisconsin, which in turn sends the data to the Wisconsin Hospital Association (WHA) for public reporting on their Checkpoint website. Data used for these benchmarks are from 1/1/2013 through 12/31/2013. In addition, PHPR is also using H-CAHPS patient experience data in this quality report. Much like the surgery data, Wisconsin hospitals send H-CAHPS patient experience data to CMS, which is then 6

7 transferred to WHA for public reporting. PHPR uses a Wisconsin average of H-CAHPS results, provided by WHA, for all patients with an inpatient stay as a benchmark in this report. Data used for these benchmarks are from 1/1/2013 through 12/31/2013 2) Wisconsin Hospital Association Information Center For the purpose of this report PHPR participants have submitted length of stay data only on those total knee replacement patients who are included in the bundled payment pilot. In order to create benchmarks for the length of stay measure, PHPR used length of stay data calculated by the Wisconsin Hospital Association Information Center (WHAIC) for all total knee replacement patients within participating hospitals, as well as all total knee replacement patients in Wisconsin. The WHAIC is a subsidiary of the Wisconsin Hospital Association and collects patient-level data from hospitals throughout Wisconsin on patient characteristics, diagnoses, procedures, and charges. The WHAIC applied the IHA total knee replacement bundle definition to all patients in Wisconsin, and then calculated the length of stay benchmarks for the participating hospitals and the state. The application of the IHA total knee replacement bundle definition creates a like comparison between those knee replacement patients in the bundled payment pilot and those total knee replacement patients in the general population. In the calculation of the hospital and state benchmarks, WHAIC used 3M APR DRG software to include only those total knee replacement patients who were either Severity 1 or Severity 2. Data used for these benchmarks are from 1/1/2013 through 12/31/ ) Wisconsin Health Information Organization For the calculation of benchmarks for the 90-Day Revision/Reoperation measure and the 30-Day Complication rate measure PHPR used data from the Wisconsin Health Information Organization (WHIO). WHIO is an all-payer claims database, which collects claims data from health plans throughout Wisconsin. WHIO applied the IHA total knee replacement bundle definition to all Wisconsin patients in their database, and calculated the Revision/Reoperation and Complication rate benchmarks for the participating hospitals and the state. The application of the IHA total knee replacement bundle definition creates a like comparison between those knee replacement patients in the bundled payment pilot and those total knee replacement patients in the general population. Data used for these benchmarks are from 7/1/2012 through 6/30/

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