2015 Hospital Measures
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1 2015 Hospital Measures Vicki Tang Olson, Stratis Health David Hesse, Minnesota Department of Health Statewide Quality Reporting and Measurement System (SQRMS) Annual Update January 14, 2015
2 Objectives Review quality measurement statutory requirements and development of the Statewide Quality Reporting and Measurement System Describe 2015 changes to the hospital measures and deadlines for quality data reporting Understand the hospital quality measures recommendation process 1
3 Agenda 12:00 Welcome and introductions 12:05 Overview of the Statewide Quality Reporting and Measurement System 12:15 Hospital Measures recommendations process and changes in the hospital slate of measures for :30 Q & A, future measures under consideration 2
4 Minnesota Department of Health: Protecting, maintaining and improving the health of all Minnesotans Minnesota Statewide Quality Reporting and Measurement System (SQRMS) January 14, 2015 David Hesse, Planner Principal Quality Reform Implementation Unit Health Economics Program
5 State health reform Objectives and goals Annual measures update Use of data Resources Overview
6 Context for State Health Reform High quality in Minnesota relative to other states Wide variation in costs and quality across different health care providers, with no evidence that higher cost or higher use of services is associated with better quality or better health outcomes for patients Health care costs are rising, placing greater share of health care costs on consumers What tools do consumers have to choose how to spend their health care dollars?
7 Health Care Growth Exceeds Growth in Income and Wages 120% Cumulative Percent Change in Key Minnesota Health Care Costs and Economic Indicators 100% 80% 60% 40% 20% 0% Health Care Cost MN Economy Per Capita Income Note: Health care costs is MN privately insured spending on health care services per person, and does not include enrollee out of pocket spending for deductibles, copayments/coinsurance, and services not covered by insurance Sources: MDH/Health Economics Program; U.S. Department of Commerce, Bureau of Economic Analysis; U.S. Bureau of Labor Statistics; MN Department of Employment and Economic Development. Source: MDH analysis of annual health plan reports.
8 Statutory Requirements: Minnesota s 2008 Health Reform Law Statewide Quality Reporting and Measurement System, Minnesota Statutes 62U.02 Establish standards for measuring quality of health care services offered by health care providers, and a standardized set of measures Establish a system for risk adjusting quality measures Physician clinics and hospitals are required to report Health plans use the standardized measure set Issue annual public reports on provider quality 7
9 Objectives and Goals Enhance market transparency by creating a uniform approach to quality measurement Improve health / reduce acute care spending Quality measures must be based on medical evidence and be developed through a participatory process Public reporting quality goals: Make more quality information broadly available Use measures related to either high volume or high impact procedures and health issues Report outcome measures or process measures that are linked to improved health outcomes Not increase administrative burden on health care providers where possible
10 SQRMS Characteristics SQRMS is a critical aspect of heath care reform Measures inform patients of the value of provider care in Minnesota They are a component of assessing overall value for the first time SQRMS processes are intentional and transparent Community input and engagement informs MDH s development of quality measurement and reporting for the state of MN SQRMS is an evolving process Quality measurement and reporting continually evolves based on changes in measurement science, community buy-in and community priorities 9
11 Partnership MDH conducted two competitive procurements in the fall of 2008 and again in 2013, and subsequently entered into contracts with MN Community Measurement (MNCM). Currently, MDH has a 21-month, $1.5 million contract with MNCM as lead member of consortium that includes Stratis Health and the Minnesota Hospital Association (MHA) to carry out key activities.
12 MDH, Stratis Health & MHA Roles and Responsibilities MDH Stratis Health MHA Annually promulgates rules that define the uniform set of measures Obtains input from the public at multiple steps of rulemaking Publicly reports summary data Develops vision for further evolution of SQRMS Develops recommendations for the uniform set of quality measures for the State s consideration Facilitates the Hospital Quality Reporting Steering Committee and subcommittees Develops and implements educational activities and resources Facilitates data collection from hospitals and data management Develops recommendations for the Quality Incentive Payment System for the State s consideration 11
13 Historical Timeline December 2009 First set of administrative rules established SQRMS January 2010 Data collection for publicly reported quality measures began Health plans no longer permitted to require data submission on measures outside the standardized set November 2010 MDH issued its first public report with data on the standardized measures to be publicly reported First update to administrative rules 2011, 2012, 2013, December 2014 Annual updates to administrative rules 12
14 Annual Update of Quality Reporting Rules Jan Feb Mar Apr ❶ ❷ May Jun ❸ ❹ 1. MDH invites interested stakeholders to submit recommendations on the addition, removal, or modification of standardized quality measures to MDH by June 1 2. MDH receives preliminary recommendations from Stratis Health mid-april; MDH opens public comment periods 3. MDH receives final recommendations from Stratis Health by June 1; MDH opens public comment period 4. Measure recommendations are presented at a public forum toward the end of June 5. MDH publishes a new proposed rule, typically by mid-august with a 30-day public comment period 6. Final rule adopted by the end of the year Jul Aug ❺ Sep Oct Nov Dec ❻ 13
15 Reporting Requirements 14
16 Quality Measure Changes Emergency Department Transfer Communication composite measure NEW, aligns with Medicare Beneficiary Quality Improvement Project (MBQIP) Stroke Door to Imaging Performed Time Revised measure name to Door to Imaging Initiated Time Removal of 11 measures to align with Centers for Medicare & Medicaid Services (CMS) Hospital Inpatient and Outpatient Quality Reporting Programs 15
17 Percent of Patients Who Reported That Staff Always Explained About Medicines 100% Before Giving It to Them, % 80% 70% 60% 61% 63% 64% 66% 67% 50% 40% 30% 20% 10% 0% Service year: Service year: January 1 through December 31. Source: MDH Health Economics Program analysis of SQRMS data, HCAHPS Survey 16
18 Percent of Health Care Consumers Who Feel Like They Were Treated as a Whole Person 100% Health Care Consumers Ratings of Hospital Care 80% 80% 83% 73% 73% 60% 40% 20% 0% Nurse-Patient Communication Doctor-Patient Communication Receiving Help When Wanted Patient s Overall Rating of Hospital Source: MDH Health Economics Program analysis of SQRMS data. HCAHPS Survey for discharge dates 01/01/ /31/2013. Nurse-Patient Communication: Percent of patients who reported always to a question about how often nurses explained things clearly, listened carefully to the patient, and treated the patient with courtesy and respect. Doctor-Patient Communication: Percent of patients who reported always to a question about how often doctors explained things clearly, listened carefully to the patient, and treated the patient with courtesy and respect. Receiving Help When Wanted: Percent of patients who reported always to a question about how often they were helped quickly when they used the call button or needed help in getting to the bathroom or using a bedpan. Patient s Overall Rating of Hospital: Percent of patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest). 17
19 State Alignment Office of Health Information Technology Minnesota Stroke Registry Quality Incentive Payment System Accountable Communities for Health DHS Integrated Health Partnerships Demonstration Federal Centers for Medicare & Medicaid Services (CMS) Hospital Inpatient and Outpatient Quality Reporting Programs Hospital Readmission Reduction Program (RRP) Hospital Value-Based Purchasing (VBP) Hospital Acquired Conditions(HAC) Reduction Program The National Healthcare Safety Network (NHSN) Health Information Technology Meaningful Use 18
20 SQRMS Website 19
21 Resources Subscribe to MDH s Health Reform ListServ to receive updates: SQRMS website: Stratis Health: Minnesota Hospital Association (MHA): Minnesota Hospital Quality Reports: Minnesota HealthScores: For questions about SQRMS, contact: Denise McCabe, Supervisor Quality Reform Implementation Unit Denise.McCabe@state.mn.us, David Hesse, Planner Principal David.Hesse@state.mn.us,
22 2015 Hospital Measures Recommendation Process 21
23 Recommendations Process Final Slate of Measures Team discussion MDH focus Request feedback from expert groups Identify potential measures Convene team Aid consumers, employers and other health care purchasers in decisionmaking Use measurement criteria to recommend measures for public reporting and improvement Preference for outcome, patient reported outcome or functional status, and electronic measures 22
24 Recommendations Process MDH focus Final Slate of Measures Team discussion Identify potential measures Convene team Compiled suggestions from previous discussions but did not consider for this year since there was not adequate time to prioritize and solicit feedback from expert groups Request feedback from expert groups 23
25 Recommendations Process Final Slate of Measures MDH focus Identify potential measures Added roles: Hospitalist Minnesota Alliance for Patient Safety (MAPS) leadership Team discussion Request feedback from expert groups Convene team Consumer Employer Health plan MD Nursing Pharmacy Rural Hospital Systems Pt Safety/Risk Management 24
26 Recommendations Process Final Slate of Measures MDH focus Identify potential measures Only feedback was: questioning value of collecting low volume measures for critical access hospitals Team discussion Convene team Request feedback from expert groups 25
27 Recommendations Process 1. Discussed feedback on measures with low volume. 2. Voted on proposal to remove AMI 7a and AMI 8a for CAH Final Slate of Measures MDH focus Identify potential measures Team discussion Convene team Request feedback from expert groups 26
28 Recommendations Process MDH focus Additions/Removals/Modifications Final Slate of Measures Identify potential measures Team discussion Convene team Request feedback from expert groups 27
29 Process after Recommendations Final Recommendations Public Forum Formal Comment Period Final Rule 28
30 2015 Hospital Slate of Measure Changes 29
31 Measures Changed to Voluntary CAH only AMI 7a Fibrinolytic therapy received within 30 minutes of hospital arrival 30
32 Measures Removed AMI-8a Timing of Receipt of Primary Percutaneous Coronary Intervention HF-2 Evaluation of LVS Function PN-6 Initial Antibiotic Selection for CAP in Immunocompetent Patient 31
33 Measures Removed - SCIP SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour Prior to Surgical Incision SCIP-Inf-2 Prophylactic Antibiotic Selection for Surgical Patients SCIP-Inf-3 Prophylactic Antibiotics Discontinued within 24 Hours After Surgery End Time 32
34 Measures Removed - SCIP SCIP-Inf-9 Urinary Catheter Removed on Postoperative Day 1 (POD 1) or Postoperative Day 2 (POD 2) with day of surgery being 0 33
35 Measures Removed - SCIP SCIP-Card-2 Surgery Patients on Beta- Blocker Therapy Prior to Arrival Who Received a Beta-Blocker during the Perioperative Period SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis within 24 Hours Prior to Surgery to 24 Hours after Surgery 34
36 Measures Removed - Outpatient OP-6 Timing of Antibiotic Prophylaxis OP-7 Prophylactic Antibiotic Selection for Surgical Patients 35
37 Measures Added CAH only (CCN numbers beginning in 241xxx) All or none composite of ED Transfer Communication 7 sub measures PPS hospitals (CCN numbers beginning in 240xxx) None 36
38 2016 Hospital Measures Process 37
39 Changes to Process Steering committee will convene throughout the year and will consider feedback from expert groups Preliminary slate of measures will be developed by April 15 each year to match the clinic measures recommendation process 38
40 Recommendations Process MDH focus Final Slate of Measures Identify potential measures Added step Preliminary Slate of Measures Convene team Team discussion Enhanced step Request feedback from expert groups Enhanced step 39
41 Topic areas for potential new/added measures Patient Safety Readmissions Mental/Behavioral Health End of Life Cost/Spending Federal alignment CMS and HRSA 40
42 Questions? Vicki Olson, Program Manager or
43 Stratis Health is a nonprofit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities. Prepared by Stratis Health under contract with Minnesota Community Measurement funded by the Minnesota Department of Health.
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