HCAHPS and Hospital Value-Based Purchasing (Hospital VBP)

Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov HCAHPS and Hospital Value-Based Purchasing (Hospital VBP) Agency for Healthcare Research and Quality Centers for Medicare and Medicaid Services June 28, 2012

Advancing Excellence in Health Care Acknowledgements This Web conference program is supported by the U.S. Agency for Healthcare Research and Quality (AHRQ) through a contract with the Health Research and Educational Trust (HRET). AHRQ is a federal agency whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. AHRQ is a sister agency of CMS within the U.S. Department of Health and Human Services. HRET is a charitable and educational organization affiliated with the American Hospital Association, whose mission is to transform health care through research and education. 2

Advancing Excellence in Health Care AHRQ/HRET Patient Safety Learning Network (PSLN) Project AHRQ hired HRET to partner with state hospital associations and others to create 25 Patient Safety Learning Networks (PSLNs). This year the project will provide over 30 workshops and 100 Web conferences and teleconferences to support hospitals in implementing HCAHPS, Project RED (to reduce preventable readmissions), Medication Reconciliation, AHRQ s Quality Indicators, and the Door to Doc ED flow method. We want hospitals in the 25 PSLNs to learn together and share strategies across State lines. In May we hosted a Web conference on the patient-centered discharge process, and today s Web conference is intended to answer hospital staff s questions about how HCAHPS fits into the VBP program. 3

Advancing Excellence in Health Care Hospitals are Focusing on the Relationship between HCAHPS, Valuebased Purchasing, and Care Transitions Top four HCAHPS Priorities of over 430 hospitals participating in 18 PSLNs: 1. RN Communication 2. Responsiveness 3. Medication Communication* 4. Discharge Information* * HCAHPS domains that can be improved by a patient-centered discharge process such as Project RED or by implementing a medication reconciliation process via the MATCH Toolkit. 4

Advancing Excellence in Health Care Staff Always Explained About Medicines: U.S. Benchmarks by Type of Hospital 2010-11

Advancing Excellence in Health Care Patients Given Information About Recovery At Home: U.S. Benchmarks by Type of Hospital 2010-11

Advancing Excellence in Health Care Today s Speakers Christine Crofton, Ph.D., Center for Quality Measurement and Improvement, Agency for Healthcare Research and Quality (AHRQ) Elizabeth Goldstein, Ph.D., Centers for Medicare and Medicaid Services (CMS) 7

HCAHPS and Hospital Value-Based Purchasing (Hospital VBP) Liz Goldstein, Ph.D. 8

HCAHPS and Hospital VBP Hospital VBP links a portion of CMS payment to hospitals based on performance on a set of quality measures Inpatient Prospective Payment System (IPPS) hospitals only Established by the Patient Protection and Affordable Care Act of 2010 (Public Law 111-148) Affects payment for patients discharged October 1, 2012 (FY 2013) and forward 9

Total Performance Score 10

Patient Experience Domain Score Sum of HCAHPS Base Score (0 80 points) PLUS HCAHPS Consistency Points (0 20 points) Patient Experience Domain Score: 0 to 100 points Comprises 30% of Hospital VBP Total Performance Score 11

HCAHPS and Hospital VBP Scoring Eight HCAHPS Dimensions in Hospital VBP Communication with Nurses Communication with Doctors Staff Responsiveness Pain Management Communication about Medicines Discharge Information Cleanliness & Quietness of Hospital Environment (combined) Overall Rating of Hospital Percent of patients who chose Top-box response 12

Hospital VBP Time Periods, FY 2013 Two time periods in Hospital VBP: FY 2013 Baseline Period: July 2009 - March 2010 FY 2013 Performance Period: July 2011 - March 2012 IPPS hospitals must have at least 100 completed HCAHPS surveys in the Performance Period to be included in Hospital VBP 13

HCAHPS and Hospital VBP Scoring For each HCAHPS Dimension, both Improvement points and Achievement points are calculated Improvement Points (0-9 for each Dimension): Amount of change from Baseline to Performance Periods Achievement Points (0-10 for each Dimension): Difference between a Hospital s Dimension score and the national median score in the Performance Period 14

HCAHPS Base Score The first component of the Patient Experience Domain in Hospital VBP is the HCAHPS Base Score For each of the Eight HCAHPS Dimensions: 1. Improvement Points (0-9) and/or Achievement Points (0-10) are calculated 2. The larger of the Improvement Points or Achievement Points for each Dimension 3. Are summed to create the HCAHPS Base Score 0 to 80 points 15

HCAHPS Consistency Points The second component of the Patient Experience Domain in Hospital VBP is HCAHPS Consistency Points Consistency Points 0 to 20 points Target hospital s lowest performing HCAHPS Dimension During the Performance Period 16

HCAHPS Consistency Points (cont d) If the lowest scoring Dimension is below the national median, Then the hospital earns between 0 and 19 Consistency Points Calculation of Consistency Points is explained thoroughly on the CMS Hospital VBP Web site 17

Patient Experience Domain Score Sum of HCAHPS Base Score (0 80 points) PLUS HCAHPS Consistency Points (0 20 points) Patient Experience Domain Score: 0 to 100 points Comprises 30% of Hospital VBP Total Performance Score 18

Hospital IQR vs. Hospital VBP Hospital IQR Hospital VBP FY 2013 Four quarter roll-up Ten HCAHPS Measures Non-IPPS hospitals can participate Three quarter roll-up Eight HCAHPS Dimensions Cleanliness and Quietness combined No Recommend IPPS hospitals only Minimum of 100 completed surveys in Performance Period 19

Detailed Calculations 20

Baseline Performance Data, FY 2013 7/1/2009-3/31/2010 21

Base Points Patient Experience of Care Domain Score equals (Greater of Improvement or Achievement Points for each HCAHPS dimension) plus Consistency Points Up to 80 Base Points are possible based on each of the eight HCAHPS dimensions: For each of the eight dimensions, determine the greater of the Achievement Points or the Improvement Points. Add these 8 values to arrive at the total HCAHPS Base Points. 24

Calculating Achievement Points 25

Achievement Ranges 26

Achievement Range for the 8 HCAHPS Dimensions 27

Example: Nurse Communication Dimension 28

Calculating Improvement Points 32

Comparing Achievement and Improvement Points 36

Example: Greater of Achievement or Improvement 38

HCAHPS Consistency Points Patient Experience of Care Domain Score equals (Greater of Improvement or Achievement Points for each dimension) plus Consistency Points Consistency Points encourage hospitals to meet or exceed the Achievement Threshold in all HCAHPS dimensions 40

HCAHPS Consistency Points Up to 20 Consistency Points may be earned based on the LOWEST dimension: 20 points are awarded if all dimension rates are greater than or equal to the Achievement Threshold If any dimension rate is less than the Achievement Threshold, then Consistency Points are awarded based on the lowest dimension s location relative to the Floor 41

8 HCAHPS Dimensions and Consistency Points 42

Consistency Points Pain Management & Discharge Information 43

Consistency Points Calculation 44

Consistency Points Calculation: Pain Management 45

Consistency Points Calculation: Discharge Information 46

Patient Experience Domain Score 50

Information on HCAHPS and Hospital VBP Information about Hospital VBP available at new CMS Web site http://www.cms.gov/hospital-value-based- Purchasing/ Hospital VBP slide set can be found at: http://www.cms.gov/hospital-value-based- Purchasing/Downloads/HospVBP_ODF_072711.pdf Summary of the Patient Experience of Care domain (HCAHPS) and how this score will be calculated is on slides 35-61 56