Everything you ever wanted to know about Value-Based Purchasing* *But were afraid to ask

Transcription

1 Everything you ever wanted to know about Value-Based Purchasing* *But were afraid to ask TAHFM - April 10, 2013 John Murray, MBA Director, Patient Experience Deric Hebert Director, Engineering Services

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3 Discussion What is Value-Based Purchasing? How are Texas and Houston area hospitals performing? What can we do to improve? 3

4 Hospital Quality Reporting 4

5 Public Reporting 5

6 Data retrieved from Hospital Compare on January 8, 2012 and represents period 4/1/2011 to 3/31/

7 Medicare Payment Reform 7

8 Medicare From passive payer to active purchaser of quality health care Goal = Higher quality & more efficient care Quality Reporting Systems Pay for Performance Hospital Inpatient Quality Reporting Program (IQR) Value-Based Purchasing Hospital Outpatient Quality Reporting Program (HOQR) Physician Quality Reporting Program (PQRI) The Hospital IQR Program is intertwined with the Hospital VBP Program: VBP measures are selected from the IQR measure set. Reporting infrastructures overlap. CMS views the Hospital VBP Program as the next step in promoting higher quality care for Medicare beneficiaries by transforming Medicare from a passive payer of claims into an active purchaser of quality health care for its beneficiaries. 8

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11 Mark E. Damon - All Rights Reserved What is Value-Based Purchasing all about? 50: $1 Million $500,000 $250,000 $125,000 $64,000 $32,000 $16,000 $8,000 $4,000 $2,000 $1,000 $500 $300 $200 $100 A: Saving Money B: Improving Quality C: Improving Patient Outcomes D: Improving Patient Experiences

12 What is Value-Based Purchasing? True or False Value-based Purchasing is all about MONEY?? 12

13 Value-Based Purchasing Definition VBP is a payment methodology that rewards quality of care through payment incentives and transparency. In health care, value can be broadly considered to be a function of quality, efficiency, safety, and cost. In VBP, providers are held accountable for the quality and cost of the health care services they provide by a system of rewards and consequences, conditional upon achieving pre-specified performance measures. Incentives are structured to discourage inappropriate, unnecessary, and costly care. Source: Deloitte Issue Brief: Value Based Purchasing: A strategic overview for health care industry stakeholders, March

14 Value-Based Purchasing Goals CMS set out the goals for the Medicare Hospital VBP program as: Improve clinical quality, Reduce adverse events and improve patient safety, Encourage more patient-centered care, Avoid unnecessary costs in the delivery of care, Stimulate investments in structural components or systems such as IT capability and care management tools and processes that have been proven effective in improving quality and/or efficiency, and Make performance results transparent and comprehensible so that consumers can be empowered to make value-based decisions about their health care and to encourage hospitals and clinicians to improve the quality of care. Source: Medicare Hospital Value-based Purchasing Plan Development, Issue Paper, U.S. Department of Health & Human Services, 1st Public Listening Session, January 17,

15 Value-Based Purchasing Methodology Payments impacted beginning in Federal Fiscal Year (FFY) 2013 which began on October 1st, Program is funded by % withheld from all patient DRG Base Operating payments during the impact year (approx $917m in FY2013). VBP program is budget neutral at Federal level - funds withheld from low performing hospitals must be paid out to others. Withhold increases from 1.0% in 2013 to 2.0% in Break-even point to earn back all withheld funds is ~50 th %ile. Highest performers have the potential to earn more than the original amount withheld. Scoring methodology is based on two performance measurement periods, (1) a baseline period and (2) a performance period. Initially each is a 9 month period, but over time these are expected to move to 12 month periods. 15

16 Medicare Payment Reform Existing hospital revenue at risk % 1.25% 1.5% 1.75% 2% 1% 2% 3% 3% 3% 1% 1% 1% 0.7% 1.4% Value-Based Purchasing Readmissions Hosp Acq Conditions 2.8% Meaningful Use of EHR 16

17 Value-Based Purchasing There is an Upside Maximum Redistributed Funds Available Existing Funds Withheld Potential Impact Range 17

18 Value Based Purchasing Measures Used to Calculate Score TBD TBD 18

19 Patient Experience (HCAHPS) Measures HCAHPS Measures Communication with Nurses Communication with Physicians Staff Responsiveness Pain Control Domains Communication on Medications Room Quiet and Clean Discharge Information Overall Rating 0-10 Consistency Minimum Percentile Rank 19

20 HCAHPS Goals H ospital C onsumer A ssessment of H ealthcare P roviders and S ystems Goals: Standardize patient satisfaction data Aid consumer choice by making patient satisfaction indicators available to the public Create increased public accountability by reimbursing hospitals based on performance and quality of care 20

21 HCAHPS survey categories (Domains) Communication with Nurses Communication with Doctors Room kept clean Room quiet at night Responsiveness of Staff Communication about New Meds Pain Management Discharge Information Overall Hospital Rating Hospital Environment Likelihood to Recommend Hospital 21

22 Question and scoring format Hospital Environment Domain Frequency based response scale Scoring based on Top Box percentage - the percentage of possible best scores (top box) earned. Top Box Response Vendor also assigns a percentile rank for each question, based on relative position in database Top Box Response 22

23 Room Cleanliness 23

24 Room Quiet at Night 24

25 FFY 2013 VBP Calculation Baseline Period 7/1/09 to 3/31/10 Performance Period 7/1/11 to 3/31/12 Calculation Period Impact 10/1/2012 to 9/30/13 25

26 VBP Calculation Performance Standards All U.S. Hospitals National VBP Standards Benchmark: Top 10% US Score 9 months Threshold: Median US Score 7/1/09 to 3/31/10 FFY 2013 Baseline Period Floor: Worst Hospital 26

27 FFY2013 Thresholds and Benchmarks Patient Experience (HCAHPS) Measures 27

28 VBP Calculation Scoring Each individual measure Achievement 0-10 points Higher of Improvement 0-9 points Performance period score Compared to threshold and benchmark Score in Performance Period compared to Baseline Period HCAHPS only: Consistency measure 0-20 points Lowest Scoring Domain 28

29 Value Based Purchasing FFY2013 Total Performance Score Clinical Process Patient Experience 12 Process Measures 8 HCAHPS Domains AMI (2 measures) CHF (1 measure) Pneu (2 measures) HAI (4 measures) SCIP (3 measures) Up to 10 Points each Up to 10 Points each 1 Consistency measure Up to 20 Points ( Clinical Patient Process Weight Experience Weight x ) + ( Score (70%) x ) Score (30%) = Total Performance Score 29

30 Value-Based Purchasing Determining Financial Impact CMS compares all hospitals Total Performance scores to determine how a hospital s base operating DRG payment (per patient) will be adjusted. Maximum Redistributed Funds Available Existing Funds Withheld FFY 2013 High Performing Hospitals + up to 0.8% Median Hospitals Break Even Lowest Performing Hospitals - up to 1% 30

31 How are we doing? 31

32 Medicare Payment Reform Estimated FFY2013 Impact for Houston Hospitals Sources: (1) CMS and Kaiser Health News. (2) Internal calculation. (3) Based on MedPar data (2010 volumes/cmi). 32

33 Let s look ahead to FFY2014 Final Thoughts nn 33

34 FFY2014 VBP Measurement Periods Domain Baseline Period Performance Period Clinical Process (Quality) Patient Experience (HCAHPS) Apr 1, 2010 Dec 31, 2010 (9 months) Apr 1, 2012 Dec 31, 2012 (9 months) Outcomes (Mortality) Jul 1, 2009 Jun 30, 2010 (12 months) Jul 1, 2011 Jun 30, 2012 (12 months) 34

35 Okay, okay.. How about FFY2015? Final Thoughts nn 35

36 FFY2015 Measurement Periods Domain Weight Baseline Period Performance Period Clinical Process of Care Patient Experience of Care Outcomes 20% Jan 1, 2011 Dec 31, 2011 Jan 1, 2013 Dec 31, % Jan 1, 2011 Dec 31, 2011 Jan 1, 2013 Dec 31, 2013 Mortality Oct 1, 2010 Jun 30, 2011 Oct 1, 2012 Jun 30, % AHRQ Oct 15, 2010 Jun 30, 2011 Oct 15, 2012 Jun 30, 2013 CLABSI Jan 1, 2011 Dec 31, 2011 Feb 1, 2013 Dec 31, 2013 Efficiency: MSPB-1 20% May 1, 2011 Dec 31, 2011 May 1, 2013 Dec 31,

37 FFY2015 Thresholds and Benchmarks Was 77.64% in FFY

38 What can we do to Improve? 38

39 What can we do to Improve? 1. Awareness and Education Frontline Staff Departmental Leaders Understand the Methodology. Assemble teams to research performance on current and future VBP measures to identify improvement opportunities and drivers of performance. Ensure compliance with standards to promote high reliability. Hospital Executives System Executives Foster and promote high reliability culture. Set strategic direction and establish improvement goals. Provide resources required to support improvement initiatives. Hospital Board Oversight Track overall performance and progress. Hold leadership accountable. 39

40 What can we do to Improve? 2. Evaluate the impact of deficiencies Establish the performance gap Use VBP reports to pinpoint measures which are not achieving the maximum 10 points Identify the performance needed and how many additional points are to be gained. Quantify the potential gain Using a VBP analytical tool, estimate the potential improvement in Total Performance Score, based on achieving benchmark level performance. 40

41 What can we do to Improve? 3. Identify Improvement Opportunities Examine performance on each VBP indicator to identify improvement opportunities. Conduct research to understand where and why deficiencies are occurring. Identify improvement opportunities to enhance high reliability and make recommendations to senior leaders. Track progress on actions established by monitoring frequency and effectiveness of action plan items, which should provide a predictive indicator of how HCAHPS scores will be impacted. 41

42 VBP & Engineering How Engineering Operations Impact VBP Memorial Hermann Memorial City Medical Center

43 Ownership Team connection - owners of the patient experience. Begin with the end in mind. What outcomes do you want? What behaviors/actions will create those outcomes?

44 Ownership Develop team engagement. Give team POWER to make decisions concerning patient satisfaction. Recognize and reward those go above call of duty to provide exceptional service. Start every service event with patient satisfaction in mind.

45 Ownership If you see it you own it!

46 Through the Customer s Eyes Impressions begin long before arrival. External influences (marketing, word of mouth) affect perceptions. Evaluate the customer journey from the patient/family perspective.

47 Through the Customer s Eyes Customer Main Entrance Signage Clear? Condition? Current?

48 Through the Customer s Eyes Customer Main Entrance Landscaping?

49 Through the Customer s Eyes Parking Adequate and properly defined? Striping and directional's fresh and accurate?

50 Through the Customer s Eyes Potholes & Curbs

51 Through the Customer s Eyes Customer Main Entrance Trash pickup?

52 Through the Customer s Eyes Outside Entrance

53 Quiet at Night Noise Matters Noise = sleep deprivation Sound environment top stressor Affects perception of care