HCAHPS and Value-Based Purchasing Methods and Measurement. Deb Stargardt, Improvement Services Darrel Shanbour, Consulting Services

Transcription

1 HCAHPS and Value-Based Purchasing Methods and Measurement Deb Stargardt, Improvement Services Darrel Shanbour, Consulting Services

2 Today s Learning Objectives Acquire new knowledge pertaining to: A. Hospital CAHPS Survey and Scoring Methodology (Top Box) B. The Impact of Social Media and Transparency on Consumer Assessment C. Value-Based Purchasing Evolution and Impact on Reimbursement 2

3 Organizational Values 3

4 Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) Consider the key words Consumer Assessment How do consumers assess their patient experience? 4

5 Linking Values to Behaviors Respect Compassion Teamwork What does it look like? What does it look like? What does it look like? Providing Explanations Being Responsive Coordinating Care 5

6 Standards of Behavior Courteous Authentic Competent Cooperative Solutions-Oriented High Achiever Top Performer Team Player Time Manager Financial Steward Goal-oriented Professional Friendly 6

7 Leadership Challenge - Connecting the Dots Standards of Behavior Organizational Values HCAHPS 7

8 CAHPS Mandates a Balanced Equation Compliance Commitment 8

9 The CAHPS Family of Surveys Consumer Assessment of Healthcare Providers and Systems Produce comparable data for public reporting Create incentives to improve Enhance public accountability and transparency Hospital CAHPS Home Health Care CAHPS In-Center Hemodialysis CAHPS Clinician and Group CAHPS Family Evaluation of Hospice Care Health Plan CAHPS Ambulatory Surgery CAHPS (under CMS consideration) Outpatient Diagnostic CAHPS (under CMS consideration) 9

10 Linking Mission to Margin with HCAHPS Mission Measures Points Scores Payments Margin Mission Margin 10

11 Think about it We usually give our patients the correct medication. We usually pull the right patient chart. We probably get the correct label on the tube. Your doctor will usually come by to talk to you. We usually respect your privacy. 11

12 Top Box is Top box is the percent of highest ranked answers on the survey: Percent of Always Responses Percent of Yes Responses Percent of 9 and 10 Responses Percent of Strongly Agree Percent of Definitely All other responses are irrelevant. 12

13 Only the Highest Rank Counts Evaluative Questions Global Rating Questions Top Box Screening Questions Top Box 13

14 Calculating HCAHPS Scores Sample Calculating question scores Each response scored top box (1) or zero (0) Question top-box score is calculated as the total number of top box responses divided by the total number of questions answered. Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6 Patient 7 Patient 8 Patient 9 Patient 10 Nurses treat with courtesy/respect Always (top box) Usually Usually Never Sometimes Always (top box) Usually Sometimes Always (top box) Sometimes 3 top box responses 10 total responses For Nurses treat with courtesy/respect the Top box score is 30% 14

15 Calculating HCAHPS scores Calculating Domain scores Each question has a top box percentage. The top box percentages are added and divided by the number of questions (not the number of responses) in each domain. Question Nurses treated you with courtesy/respect Nursing Domain 30% Nurses listen carefully to you 70% Nurses explained in way you understand 80% ( ) = 180 = The Nursing Domain score is 60% *note: Domain scores are not weighted 15

16 Proposed New HCAHPS Dimensions Five new questions Three care transitions questions Two demographic questions Voluntary use beginning with July 1 discharges Likely required in 2013 Unlikely to affect VBP for several years 16

17 Why More Questions? The new questions CMS must find ways to save money associated with readmissions and has funded initiatives that are taking a community level approach to improving the transition of adult care through various interventional models notably Dr. Eric Coleman s work. Going public with data Today, CMS is sharing Information on 30-day readmission rates for Medicare patients experiencing heart attack, heart failure or pneumonia on Hospital Compare as above average, average or below average compared to other hospitals nationally. Questions with a different scale Three of the new questions come directly from Dr. Coleman s Care Transitions Measure, a copyrighted measurement tool with considerable benchmarked data associated with the response methodology he adopted when the survey was developed. The two about you questions provide some demographic information about the patient that will be helpful in looking at the broader patient experience, i.e., admitted through ER and patient perception of mental health status. Looking forward Every day, 10,000 Baby Boomers (born between ) reach the age of 65 and this will continue for the next 19 years (25% of U.S. population). According to the Medicare Payment Advisory Commission, the government spends an estimated $12 billion a year on potentially preventable readmissions for Medicare patients alone. This will be an era of accountability during which CMS will attempt to hold hospital s to the HHS definition of health care quality getting the right care to the right patient at the right time every time. 17

18 So, how are you really doing? Discharge Communication and Spending Ratio is there a connection? Consider a Patient Experience timeline that starts 3 days before hospital stay and extends until 30 days after discharge from the hospital. 18

19 New: Care Transitions Questions 19

20 Collaborations Across the Nation Introduction to the Triple Aim In October 2007 the Institute for Healthcare Improvement (IHI) launched the Triple Aim initiative, designed to help health care organizations improve the health of a population patients' experience of care (including quality, access, and reliability) while lowering or at least reducing the rate of increase in the per capita cost of care. Pursuing these three objectives at once allows health care organizations to identify and fix problems such as poor coordination of care and overuse of medical services. It also helps them focus attention on and redirect resources to activities that have the greatest impact on health. 20

21 New: Demographic Questions 21

22 Rounding Enables Communication What are your concerns? What would you like to understand? What is your story? Discharge Communication Medication Communication Demographics Rounding Rounding Rounding 22

23 Linking Values through Discharge Calls High-performing organizations commit time and resources to postdischarge phone calls. Reassures patient Identifies service concerns Provides insights for WOW! moments 23

24 Be Proactive Anchor all improvement efforts to organizational mission, vision, values and standards of behavior. Recruit, coach, and train to behavior standards require compliance; inspire commitment. The goal is to improve the perception of care through sound business structure, efficient processes, and rigorous behavior standards that lead to great outcomes. Be proactive in understanding the where, why and when of CMS to better understand how to utilize your survey results. Assessment-Instruments/hospital-value-based- purchasing/index.html?redirect=/hospital-value-based- Purchasing/ 24

25 Our Transparent World More than 25 billion pieces of content (web links, news stories, blog posts, notes, photo albums, etc.) are shared on Facebook each month. Twitter gets more than 300,000 new users every day. 80% of companies use LinkedIn as a recruitment tool. You would need to live for around 1,000 years to watch all the videos currently on YouTube. 77% of Internet users read blogs 25

26 Consumers Assessing Care What do you know about you? 26

27 Provider Comparison January 2011 CMS launches Physician Compare 27

28 Increased Transparency and Measurement CGCAHPS PCMH / CA / MN Initial launch Physician Compare Public Reporting of PQRS Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q Physician Compare Launched Physician Quality Reporting System (PQRS) Data Collection for Public Reporting Payment Modification for those Impacted by Physician VBP 28

29 Value-Based Purchasing (VBP) The Era of Pay-for-Performance

30 CMS-sponsored Quality Performance Programs Inpatient Quality Reporting Requirement (IQR, formerly RHQDAPU) 2% of APU Outpatient Quality Reporting Requirement (OQR, formerly HOPQDRP) 2% of APU Value-based Purchasing (VBP) 1-2% Readmission Reduction Program 1-3% Hospital Acquired Conditions (Nonpayment) HAC Reduction Program 1% Meaningful Use of EHR Meaningful Use 1% Medicare Shared Savings: ACO (MSSP) 2-3+% Phys. Quality Reporting System PQRS PQRS 1.5-2% Voluntary Incentive Penalty 30

31 Example of Potential Hospital Impact Dollars subject to Medicare P4P programs at a 146-bed hospital in Florida Using MedPar 2010 data 31

32 Example of Potential Hospital Impact Dollars subject to Medicare Pay-for-Performance programs at a 541-bed hospital in New Jersey Using MedPar 2010 data 32

33 Value-based Purchasing (VBP): The Race to Top Box Incentive/Penalty Measurement Areas of Interest Considerations 2011 Press Ganey Associates, Inc. 1% of Base DRG operating payment in FY13, rising to 2% in FY17 FFY 2013 FFY 2014 FFY 2015 (proposed) FFY 2016 (proposed) Core Measures Patient Experience Core Measures HCAHPS Outcomes Core Measures Patient Experience Outcomes Efficiency of Care 33 AMI, HF, PN, SCIP HCAHPS (Largely unchanged) (Unchanged) 30d risk- adjusted mortality AMI, HF, PN (Largely unchanged) (Unchanged) Clinical Care Person & Caregiver Experience & Outcomes Safety Efficiency & Cost Reduction Care Coordination Community/Population Health Adding AHRQ PSI composite and CLABSI Average spending per M/care Beneficiary Domain weighting for score calculation changes as new domains added Measures within domains subject to change (additions, deletions) Proposal for FY16 is a realignment of all measures

34 Threshold and Benchmark Established with data from the baseline period Lower scores Higher scores Achievement threshold (Median) Benchmark (Mean of Top Decile) 34

35 FY 2013 Value Based Purchasing 35 (Discharges from October 1, 2012, to September 30, 2013)

36 A New Domain Added in FY

37 2014 Baseline & Performance Periods Each domain has its own baseline and performance period and the periods are not aligned across domains Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q Mortality Baseline Clinical Baseline HCAHPS Baseline Mortality Performance Clinical Performance HCAHPS Performance Payments affected Oct. 1, 2013 Sept. 30,

38 On the Horizon FFY15 (Possible): Four domains Addition of Efficiency Domain (Spending per Medicare Beneficiary) New measures added to Outcomes Domain: AHRQ and HAC composite measures added to Outcomes Domain 38

39 Clinical Performance Misses on 4 patients, Loss $102,493 Misses on 7 patients, Loss $102,493 Misses on 11 patients, Loss $102, Misses on 4 patients, Loss $71,745

40 Satisfaction Performance What you don t see: 19% responded Usually 40

41 Dr. Donald Berwick s Words The problems do not lie in any failure of good will, benign intentions or skills of our doctors, nurses, health care managers or staffs. With rare exceptions, they are doing their best. The problems lie in the design of the care systems in which they work, systems never built for the levels of reliability, safety, patient centeredness, efficiency or equity that we owe to ourselves and our neighbors. 41

42 How Will It Help the Patient? (A sign that sat on the desk of Dr. Berwick during his tenure as CMS Administrator.)