Indun Whetsell March 6, 2015

VBP RRP HAC BCBS TOTAL Contributed $408,893 $817,786 $272,595 $1,499,274 Potential Gain/At Risk $1,054,593* $817,786** $272,595** $1.2 million* $3,344,974 *potential gain **at risk Recoupment VBP RRP HAC BCBS TOTAL $285,678 $681,489 0 $716,457 $1,683,624 NOTE: BCBS % increase on compounded dollars

35% loss of CMS monies contributed BCBS models CMS programs; however, no penalties associated – only gain

• Value Based Purchasing – VBP Core Measures, Patient experience, Mortality, Efficiency Made $408,803 but could have made $1,054,593 Reducing Core Measures & heavier focus on outcome & safety • Readmissions - RRP HF, AMI, PN, COPD, THA, TKA Loss $136298 – reduction program; cannot make $ Risk of $817,787 loss • Hospital acquired conditions - HAC PSI 90, CLABSI, CAUTI All or nothing Loss $ 272,608 • BCBS Currently models CMS – however talks to change to BCBS Compiles every year Made $716,457– loss $515,833 Composite of VBP, pt experience, HCAPS, HAC, mortality readmission, OP measures Based on numerical score either better than national average or 10% better than your last score BCBS 31% HAC 16% RRP 8% VBP 45%

250 000 200 000 150 000 100 000 50 000 0

250000 200000 150000 100000 50000 0

Hospital Staff Response Overall Hospital Rating Doctor Communication Medicine Communication Nurse Communication Pain management D/C information Cleanliness & Quietness TOTAL LOSS $ Loss $53,873 $53,873 $22,146 $25,310 $25,310 $22,146 $57,037 $44,382 $304,077

PSI 90 (aggregate) WEIGHT PSI 3 Pressure Ulcer PSI 6 Iatrogenic pneumothorax PSI 7 CLABSI PSI 8 Post op hip fracture PSI 12 Periop PE or DVT PSI 13 Postop sepsis PSI 14 Postop wound dehiscence PSI 15 Accidental laceration FFY15 (ended 12/13) $95.408

35% $11,926 $11,926 $11,926 $11,926 $11,926 $11,926 $11,926 $11,926 FFY16 (1/13 – 12/14) $95.408

35% $11,926 $11,926 $11,926 $11,926 $11,926 $11,926 $11,926 $11,926 FFY17 (1/14 – 12/15) $68144 25% $8518 $8518 $8518 Comments Based on coded data (not aligned with NHSN) $8518 $8518 $8518 $8518 $8518

CDC NHSN CLABSI CAUTI SSI Colon WEIGHT SSI Ab Hysterectomy

TOTAL DOLLARS AT RISK

FFY15 (ended 12/13) $177,186 65% $88,593 $88,593

$272,595

FFY16 (1/13 – 12/14) $177,186 65% $44,296 $44,296 $44,296 $44,296

$272,595

FFY17 (1/14 – 12/15) $204,446 75% $51,111 $51,111 $51,111 $51,111

$272,595

Comments

            ◦ ◦ ◦ ◦ Numbers here only account for rewards – not savings in cost (antibiotics, LOS, lives, etc) Lot of people “in the chart” – silo approach Data not concurrent Worst with infection (10 of 10) Need focus on Prevention infection ◦ CLABSI (improvement in 2014) CAUTI SSI c. Diff and MRSA Pneumonia Prevent Readmissions Decrease mortality Need focus on nursing homes Superior results with PSI related to surgery Heavier weights to outcomes going forward BCBS – did well FFY15 n FFY17 measures not available FFY 16 already “done”

                   Physician driven Concurrent coding Mortality reviews Daily tracking board “Unexpected deaths” – RCA Need to increase RCAs Infection Control monitoring lines daily HAC rate by doc & unit Integrate nursing care with plan 24/7 operation MD mandatory madness Antibiotic stewardship TeamsTEPPS Restructure: HRO & Infection Control CQO leadership Pressure ulcer prevention Nursing home alignment Palliative Care Continued focus on surgical prevention of complications Focus on ZERO harm

Core Measures (Lighthouse) Infection Issues (CL, foley, c. diff, Asp risk, MRSA, SSI)

Warroom w monitors

Care Transitions Safety concerns (Huddles) Concurrent coding

FUNCTIONAL (not org) CHART

CEO Care Planning D/C Clinic HLC Pt. Exp CQO Director of Quality Data Analysts inclusive of CDI & Core Measures (War Room) Medical School Affiliation Medical Staff Services • VBP • Core Measures • HAC • RRP • BCBS Peer Review, FPPE, OPPE, credentialing Safety IC RM SERVICE LINES • Medicine (LOS, Readmit, Cost, Antibiotic Stewardship, Palliative Care, NH Liason) • Surgery (Trauma), NSQIP, CC, SCIP, Bariatric) • Specialty Medicine (Stroke) • Radiology • Maternal Child (Early delivery, Infant M&M, CS) • ED LEAN DACS • Sepsis • Readmit • Asp PN • PC