Value Based Purchasing: New Tools for Hospitals

Transcription

1 Value Based Purchasing: New Tools for Hospitals The Value Based Purchasing Score Estimator & HANYS Quality Reports Overview of CMS Value Based Purchasing Program Brian Potter, Vice-President, Finance & Operations Wisconsin Hospital Association Introduction to the VBP Tools on the Quality Center website Stephanie Sobczak, MS, MBA Manager, Quality Improvement Wisconsin Hospital Association

2 Today s Agenda 1. Intro - Bringing Finance and Quality Together 2. Overview of CMS Value Based Purchasing Program 3. Overview of Hospital Reports section of the WHA Quality Center website 4. Introduction to the Value Based Purchasing Score Estimator Tool 5. Review of HANYS Quality Reports 6. Questions?

3 Bringing Finance and Quality Together On October 19 th, Over 100 CFO s, CNO s and QI leaders from across Wisconsin came together to find common ground in the new Value Based Purchasing world. Based on member feedback from that event, new tools are available to hospitals to help navigate Value Based Purchasing.

4 Purpose of the WHA VBP Reports and Tools Objectives: 1. To provide reports and tools for hospital Quality & Finance leaders as the VBP implementation approaches. 2. To offer WHA member hospitals secure access to reports on the WHA Quality Center website. 3. To address WHA member needs as hospitals consider the impact of Value Based Purchasing.

5 VBP Program Overview Goals according to CMS Transition Acute Care hospitals to Medicare Pay for Performance Align payment incentives (and penalties) to promote both: Achievement of high quality care Improvement in care quality Program was outlined in the PPACA Secretary of HHS and CMS are charged with implementation Key Exclusions Critical Access Hospitals (NOTE: Nov CAH and small volume rural hospital VBP demonstration will be established) Specialty Hospitals Hospitals with small numbers Fewer than 4 useable Process measures or Fewer than 100 HCAHPS survey response

6 Funded by Medicare IPPS payment reductions: 1.0% reduction in FFY 2013, increasing each year by.25% to 2.0% for FFY 2017 and beyond Budget-neutral: VBP Program Funding each year s pool fully distributed to hospitals in that same year Payment adjustments applied to base operating amount: excluding IME, DSH, low-volume adjustments, and outliers Percent Carve-Out for VBP Pool Source: HANYS

7 First Year VBP Implementation Timeline Oct. Nov. Dec. Jan. Feb. Mar. Apr. May June July Aug. Sept. FFY Proposed Baseline Period (reflects quality data from Dec Hospital Compare release --most recent release) FFY We are FFY here FFY FFY Medicare IPPS payment adjusted based on hospital performance Release of Final Rule (by law, VBP performance standards must be published 60- days prior to start of performance period) Proposed Performance Period (will reflect quality data from Dec Hospital Compare release) Source: HANYS

8 Proposed Measures FFY 2013 Clinical Process of Care Domain (70% weight) 17 process measures Patient Experience of Care Domain (30% weight) HCAHPS Survey (8 HCAHPS dimensions) FFY 2014 All of the above plus: Outcome of Care Domain (weighting TBD) Mortality, AHRQ measures, HACS Possible efficiency measures Medicare spending per beneficiary Internal hospital efficiency Others Possible nursing sensitive care measures

9 VBP Scoring Overview Determine points for each measure Higher of achievement or improvement Combine each measure s points into domain scores Sum of points earned divided by total possible points for domain Combine domain scores Weight clinical process by 70% Weight patient experience by 30% Determine VBP distribution based on Exchange Function Points for Each of the 17 process measures that apply to the hospital Each of the 8 HCAHPS measures plus consistency Scores for Clinical process of care domain Patient experience of care domain Total Performance Score Percent of contribution (through rate reduction) that will be returned as a VBP distribution 9

10 Linear Scoring Model Sample Hospital FFY 2013 FFY 2014 FFY 2015 FFY 2016 FFY 2017 Process Domain Score: 31% 1% Carve-Out 1.25% Carve-Out 1.5% Carve-Out 1.75% Carve-Out 2% Carve-Out HCAHPS Domain Score: 6% Dollars Contributed to VBP $147,000 $184,000 $221,000 $258,000 $294,000 Overall VBP Score (70% Process, 30% HCAHPS): 24% Estimated Payment from VBP Pool $82,075 $102,733 $123,391 $144,050 $164,150 Payment Percentage: 56% Dollars Left in the VBP Pool for Redistribution ($64,925) ($81,267) ($97,609) ($113,950) ($129,850) Linear Payment Scenario 260% 240% 220% 200% Payment Percentage 180% 160% 140% 120% 100% 80% 60% 40% 20% 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Payment Conversion Linear Function Score Sample Hospital

11 Detailed Scoring Explanations Additional documents are posted on the Quality Center Reports page for detail on the VBP scoring method: Choose Reports tab:

12 Any Questions, so far? Brian Potter, VP Finance and Operations Continuing.

13 Accessing Tools & Quality Reports

14 NEW Secure Hospital Reports Area Resources

15 Accessing Secure Reports Area 1. Enter your hospital s MedicareID# 2. Default password is Pass_MedicareID# 3. Once in, you may change the password NOTE: This login is Hospital Specific; not for an individual user

16 Your Hospital s Tools and Reports Page ABC Hospital Select a button to choose a report, then hit Get Report Text in blue is supplementary information such as: Instructions Help with Interpretation Scoring detail

17 Introduction to the VBP Score Tool Developed by the South Carolina Hospital Association (and generously shared with WHA) Provides hospitals more current estimates of VBP scores than CMS Hospital Compare reports.

18 What is the VBP Tool? A pre-programmed spreadsheet that allows much more timely analysis of a hospitals VBP Score (compared to the lag present in Hospital Compare) Features: 1. Based in MS Excel v Macro enabled calculations and graphing throughout the tool. 3. One page for data entry very user friendly. 4. Easy to update with most current data. 5. No small number flagging great for CAH s. 6. Includes a scorecard/dashboard format red, yellow, green flags 7. Analyzes (1) acute myocardial infarction (AMI); (2) heart failure; (3) pneumonia; (4) surgeries; and (5) health care-associated infections.

19 What the VBP Score Estimating Tool is not These reports ARE NOT intended to provide actual results as most variables in the final models have not yet been determined by CMS. THESE REPORTS ARE INTENDED ONLY TO ASSIST HOSPITALS IN PREDICTING POTENTIAL CASH IMPACT BASED ON THE BEST AVAILABLE DATA AT THE TIME OF THE REPORT OR THE MOST RECENT UPDATED MODEL. The Benefit: You get a head start on watching your trends and focusing your improvements to move the dial on measures that may have a bottom line impact when VBP is in effect.

20 Using the VBP Template Value Based Purchasing Score Estimator Tool Instructions for Use Print these out for easy reference; located on your hospital s reports page Step 1: Open the VPB Excel Spreadsheet. (Requires MS Excel 2007) Check for this Security Warning just above the data entry section

21 Using the VBP Spreadsheet Step 2: Enable the embedded Macros in the spreadsheet. Select the Options box as below In the Security Alert dialogue box, select the Enable this content, and Choose OK to proceed. (See the red arrows below). If this step is not complete, selecting the Medicare ID will not be possible, and the spreadsheet will default to the ABC Hospital.

22 Using the VBP Spreadsheet Step 3: Quality Measure Inputs After completing the steps to enable embedded Macros, select the Quality Measures Input tab You will see a spreadsheet that allows entry of numerators and denominators for the proposed VBP quality measures. At the top is a selection box in which you will choose your hospital s Medicare ID number. You will see your hospital s name reflected on each page, and calculations will be based on publicly available baselines for your facility. NOTE: Not selecting your Medicare ID will either default to ABC Hospital or another hospital s name.

23 Measures for the VBP Template

24 Using the VBP Spreadsheet Step 4: Data Entry At first, manual entry of numerators or denominators is needed for a 13 month period. If data is available on a similarly formatted spreadsheet, a cut and paste function will work. In addition, other data parameters are needed in the section at the upper right, such as most recent month, number of cases, etc.

25 Using the VBP Spreadsheet Step 5: Reviewing the data After data entry, the remaining tabs in the workbook will automatically populate to display tables, charts, and graphs, which estimate your hospital s Value Based Purchasing Score according to the linear model, and shows performance trends for the process measures.

26 Feature: VBP Dashboard

27 Feature: Automatic Trend Charts

28 Using the VBP Spreadsheet Step 6: Customize the Dashboard feature An option available to hospitals is to pre-determine the thresholds for Green Light and Red Light designation for the CMS Hospital Compare data. This option is provided to allow hospitals to align the VBP tool with scorecard metrics or other internally developed targets. Simply add the values to the Hospital Benchmark fields on the Hospital Metric Results tab.

29 Updating the VBP Estimator Tool Ongoing Use of the VPB Tracker Each month, as your quality measures numerators and denominators become available, simply select the Advance 1 Month button, and the next month s column will appear on the right side of the spreadsheet. Simply enter data for the new month and save your document. All measures and scores will adjust accordingly.

30 Using HANYS Quality Reports HANYS is the Healthcare Association of New York State, from which WHA obtains numerous financial reports. The HANYS reports available on the WHA Quality Center site are populated with the most current data available from CMS/Hospital Compare. Reports will be made available through WHA on a quarterly basis (or as soon as Hospital Compare measures are updated). (And you don t need to supply any data for a change!)

31 Other Reports for your Hospital Four HANYS Reports: ABC Hospital VBP Report based on current Hospital Compare data Quality Indicators Report Medicare Readmission HCAHPS Benchmark Report Text in blue is a description of each report.

32 HANYS Reports VBP Estimate Sample Hospital FFY 2013 FFY 2014 FFY 2015 FFY 2016 FFY 2017 Process Domain Score: 31% 1% Carve-Out 1.25% Carve-Out 1.5% Carve-Out 1.75% Carve-Out 2% Carve-Out HCAHPS Domain Score: 6% Dollars Contributed to VBP $147,000 $184,000 $221,000 $258,000 $294,000 Overall VBP Score (70% Process, 30% HCAHPS): 24% Estimated Payment from VBP Pool $82,075 $102,733 $123,391 $144,050 $164,150 Payment Percentage: 56% Dollars Left in the VBP Pool for Redistribution ($64,925) ($81,267) ($97,609) ($113,950) ($129,850) Linear Payment Scenario 260% 240% 220% 200% Payment Percentage 180% 160% 140% 120% 100% 80% 60% 40% 20% 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Payment Conversion Linear Function Score Sample Hospital

33 HANYS Reports - HCAHPS Your Hospital Also has HCAHPS benchmarks for CAH and rural hospitals

34 HANYS Quality Reports - Process

35 HANYS Reports -Readmissions ABC Hospital

36 Updating Hospital Reports The South Carolina Hospital association updates the VBP Template with each release of CMS proposed rule changes. HANYS Reports are updated as the data is made available in Hospital Compare. WHA will post any updates to the Quality Center, and notify QI Managers via . From: Stephanie Sobczak Subject: WHA Hospital Reports QC Update

37 Suggested Next Steps 1. Access the Hospital Quality Reports on the WHA Quality Center website. 2. Download the Value Based Purchasing Template 3. Following the instructions, enter 13 months of your quality indicators data on the spreadsheet. 4. Then examine the template and the HANYS reports and collaborate with Finance to make an assessment of strengths and areas for improvement. 5. You will be notified by with a link to the Quality Center website, whenever the HANYS reports or the VBP template is updated.

38 Thank you! Any Questions? Stephanie Sobczak, QI Manager Brian Potter, VP Finance and Operations