Overall Hospital Quality Star Rating on Hospital Compare Launching April February 8, 2016/ 3:00-4:00 PM EST

Transcription

1 Overall Hospital Quality Star Rating on Hospital Compare Launching April 2016 February 8, 2016/ 3:00-4:00 PM EST 1

2 Today s Presenter Melinda Hancock Partner, DHG Healthcare Leads a team in developing DHG Healthcare s next generation financial modeling products and services related to a variety of revenue transformation business issues, including the transition from fee-for-service to non-ffs payment models More than 22 years of healthcare experience in the public and private industry sectors A member of HFMA since 1994, Melinda s involvement has been at the National and Chapter levels in a variety of leadership positions and she is currently the National Chair

3 Agenda Overall Star Rating Guiding Principles 5 Step Methodology Goals of Process Measures Mortality, Safety of Care and etc. Measure s Loading Examples National Performance All information in this presentation is from two sources: Inpatient/Outpatient Hospital Compare Preview Report Help Guide; January 2016/April 2016 Hospital Compare Release Overall Hospital Star Quality Star Ratings on Hospital Compare April 2016 Methodology and Specifications Report 3

4 How Do I Get My Report? There are 2 quick guides and two preview guides on the QualityNet website: outpatient and inpatient: NO LOG IN NEEDED FOR THIS PART Preview Period is January 16-February

5 Overall Star Rating Star Rating is based on available inpatient and outpatient quality reporting (IQR and OQR) that is posted to Hospital Compare. The stars for each overall hospital rating will be uploaded with the April 2016 upload. Source: Overall Hospital Quality Star Ratings on Hospital Compare April 2016 Methodology and Specifications Report by CMS posted 1/29/16 5

6 Guiding Principles Alignment with Hospital Compare and other CMS programs; Transparency of methodological decisions; and Responsiveness to stakeholder input. 6

7 5 Step Methodology 1. Selection and standardization of measures for inclusion in Star Ratings 2. Assignment of measures to groups 3. Calculation of latent variable model group scores 4. Calculation of hospital summary scores as a weighted average of group scores 5. Application of clustering algorithm to categorize summary scores into Star Ratings 7

8 Step Process 8

9 Goals of Process Generate single aggregate representation of available hospital quality information; Account for the heterogeneity of the existing measures available; Account for the different hospitals reporting different numbers and types of measures; Accommodate changes in the included measures over time; and Utilize an evidence-based approach reflecting both modern statistical methods, and expert insights that previously has been applied to healthcare quality measurement. 9

10 Step 1: Selection 10

11 Step 1: Standardization Standardized by subtracting the national mean of the measure scores from a hospital s mean score and dividing it by the standard deviation across hospitals. The direction is reversed for all scores that are lower is better, converting them to higher is better Scores are Winsorized at extreme outliers.125 th percentile (Z=-3) and th percentile (Z=3). 11

12 Step 2: Assignment Using consumer tested language, slightly modified from the dry run Total of 7 groups: Group # of Measures Mortality 7 Safety of Care 8 Readmission 8 Patient Experience 11 Effectiveness of Care 16 Timeliness of Care 7 Efficient Use of Medical Imaging 5 12

13 Mortality Measures 13

14 Safety of Care Measures 14

15 Readmission Measures 15

16 Patient Experience Measures 16

17 Effectiveness of Care Measures 17

18 Timeliness of Care Measures 18

19 Effective Use of Imaging Measures 19

20 Step 3: Latent Variable Model (LVM) Used LVM to estimate a group score for each group LVM accounts for the correlation between measures for a single hospital. For example, measures that are more consistent with each other or measures with larger denominators have larger influences on the latent variable. This influence is represented by a measure s loading. The loading reflects the degree of the measure s influence on the group score relative to the other measures in the group. 20

21 Measure s Loadings Examples 21

22 Safety of Care and Readmission CAUTI SSI: Colon SSI: AH CLABSI MRSA C DIff 22

23 Readmission Example 23

24 Weightings Different hospitals have different ns for each measure This results in differing precisions on the scores known as sampling variation Therefore CMS gave more weight to the more precise scores by using weighted scores: used the denominators to weight the observed value 24

25 Step 4: Summary Score CMS used 3 criteria when evaluating the weighting options 1. Group importance 2. Consistency with existing CMS policies and priorities 3. Stakeholder input Final methodology uses a modified version from the HVBP program after vetted through a variety of channels Will reapportion 25

26 Step 4 Continued The final summary score is a weighted average of the group scores Another Winsorization is performed to the.5 th and 99.5 th percentiles. This was in response to comments received from the dry run and for a preference for broader distribution of Star Ratings. Resulted in modification of 46 hospital scores. Scores US 5 Stars 17 4 Stars Stars 2,615 2 Stars 544 Recall the Dry Run Distribution from July Star 5 Not Reported 1,037 26

27 Step 5: Star Ratings Clustering Algorithm application: k-means clustering Standard method for creating clusters so that each observation are closer to their category mean than any other category mean. 1-5 Stars Minimum thresholds as of April 2016: Measures Per Group: 3 measures per group Groups in Summary Score: 3 groups but at least one has to be an outcome group. This one trumps the measures threshold. Categorical Group Performance Above, Same or Below the national average Uses the LVM to produce a point estimate and standard error for each group score and a 95% confidence interval 27

28 National Performance 3,000 2,500 2,615 2,000 1,881 1,500 1, Star 2 Stars 3 Stars 4 Stars 5 Stars Dry Run Preview 28

29 By Group Performance 3,000 2,500 2,000 1,500 1, Mortality Safety Readmission Pt Experience Effectiveness Timeliness Med Imaging Above No Different Below 29

30 Sample Performance 30

31 Structural Measure 4 structural measures includes but not calculated Data is entered through the QualityNet portal April 1 through May 15 and posted with the December update on Hospital Compare Participation in a Systematic Database for Cardiac Database Participation in a Systematic Clinical Database Registry for Nursing Sensitive Care Participation in a Systematic Clinical Database Registry for General Surgery Safe Surgery Checklist Use 31

32 Audience Questions

33 Upcoming Webinars February 29, 2016 Care For the Community: Who Owns It Who Pays for It? March 28, 2016 Transparency: Quality and Pricing April 25, 2016 The New Reform Based Financial Model May 23, 2016 IPPS Proposed Rule 33

34 Contact Us Melinda Hancock Partner DHG Healthcare Richmond, VA P: E: Laurajeanne Fligor Manager DHG Healthcare Cleveland, OH P: E: