Transcript Slide 1

Health Care Effectiveness
Summer Quarterly Meeting
July 19, 2011
ASTHMA
ASTHMA
CANCER
CANCER
KIDNEY
KIDNEY
DISEASE
DISEASE
HIV
HIV
CHF
CHF
DIABETES
DIABETES
LSU Medical Home
THROMBOGENIC STATE CONTROL
GLYCEMIC CONTROL
LIPID CONTROL
DIET
EXERCISE
WEIGHT CONTROL
SMOKING CESSATION
SCREENING
BLOOD PRESSURE CONTROL
Domain #1: Development of medical home patient rosters and
orientation of patients to medical homes.
Domain #2: Access to primary care, with subareas:
Domain #3: Access to specialty care
Domain #4: Primary care efficiency
Domain #5: Wellness, with subareas:
Domain #6: Chronic disease management and high-risk patient
management, with subareas:
Domain #7: Patient perceptions of medical home experiences
Domain #8: Provider perceptions of medical home experiences.
Domain #9: Reduction of inpatient stays
Funded in part by HRSA Grant #H97HA08476
LaPHIE identified persons (N=345*)
•
•
•
•
40% <35 years of age
72% black/African American
38% female
MOT (most common)
– Of males
• 22% MSM
– Of females and non-MSM
• 27% heterosexual
• 66% NIR/unknown
• 24% had no prior labs in OPH system
• 32% had not been in LSU system for any HIV-related test or
care
– Would have been missed in the absence of LaPHIE
Source: LaPHIE linked file; OPH
N=378 through March 2011
Follow up
• Of those previously in care
– Months return to care
• Median 20 (IQR 15 to 36)
– CD4 at return to care
• Median 233 (IQR 120-333)
• Of those not previously in care
– CD4 at first engagement in care
• Median 247 (IQR 58-394)
• Of those followed at least 6 months
– 82% had at least one LSU visit
– 82% had at least one viral load and/or CD4 count
– 62% had at least one HIV specialty visit in LSU
system
Source: OPH
Quality
“ the degree to which health care
services for individuals and
populations increase the likelihood
of desired health outcomes and are
consistent with current professional
knowledge”
- AAP Policy Statement
htn: Sustained BP > 140/90
denom: in PC pop at least 3mos
.35
The BP improvement levels seen for
diabetes reflects a general improvement
in BP levels in our PC population.
.3
11376
.25
6709
7279
68368
12369
12236
.2
7140
SITES over QUARTERS
Graph uses data from quarters 200703 through 201004
T
_T
O
O
M
W
C
U
M
L
C
M
LJ
C
LA
K
L
EK
BM
C
11258
coloncancer: Colonscopy in past 10 years
denom: PC Sustained, 6/12
.5
.45
4004
7910
.4
Our colonoscopy levels have
been rising across all sites
4428
.35
.3
42189
6358
7054
.25
7866
.2
4569
.15
SITES over QUARTERS
Graph uses data from quarters 200701 through 201004
T
_T
O
O
M
W
C
U
M
L
C
M
LJ
C
LA
K
L
EK
BM
C
.1
Value Based Purchasing
With Thanks to Simone Olivier!
Requirements
• Legislation requires that the VBP program apply to payments for
discharges starting October 1, 2012.
• To fund the VBP incentive pool our base DRG payments will be
reduced by 1% starting FFY 2013. It will increase by .25% per year
to 2% by 2017.
• The incentive pool will be budget neutral.
Timeframes
• For FFY 2013 VBP Program
Baseline period = July 1, 2009 through March 31,
2010
Performance period = July 1, 2011 through
March 31, 2012
FFY 2013 Domains and
Measures/Dimensions
Two Domains
30%
70%
HCAHPS
Process of
Care Measures
Clinical Process of Care Domain Measures
• Total of 12 measures
• Each measure is worth up to 10 points (improvement or
achievement points – whichever is higher)
• A hospital can earn a total of 120 points
• Hospitals need to have at least 10 cases for each measure to
qualify
• 58% of the 12 measures are SCIP measures
• CMS will only use the measures that hospitals qualify for or are
able to collect data on to calculate an overall score. Ex:
EWE only qualifies for 9 of the 12
measures therefore total points possible = 90
Clinical Process of Care Domain Measures
Acute Myocardial Infarction
AMI 2 Aspirin Prescribed at Discharge – removed 4/29/11
AMI 7a Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival
AMI 8 Primary Percutaneous Coronary Intervention (PCI) Received Within 90 Minutes of Hospital Arrival
Heart Failure
HF 1 Discharge Instructions
HF 2 Evaluation of Left Ventricular Systolic (LVS) Function – removed 4/29/11
HF 3 ACE Inhibitor or ARB for LVS Dysfunction – removed 4/29/11
Pneumonia
PN-2 Pneumococcal Vaccination – removed 4/29/11
PN 3b Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in
Hospital
PN 6 Initial Antibiotic Selection for CAP in Immunocompetent Patient
PN 7 Influenza Vaccination – removed 4/29/11
Surgeries (as measured by Surgical Care Improvement (SCIP) measures)
SCIP Card 2 Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the
Perioperative Period
SCIP VTE 1 Surgery Patients with Recommended VTE Prophylaxis Ordered
SCIP VTE 2 Surgery Patients Who Received Appropriate VTE Prophylaxis Within 24 Hours Prior to Surgery
to 24 Hours After Surgery
Healthcare Associated Infections (as measured by SCIP measures)
SCIP Inf 1 Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision
SCIP Inf 2 Prophylactic Antibiotic Selection for Surgical Patients
SCIP Inf 3 Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time
SCIP Inf 4 Cardiac Surgery Patients with Controlled 6 AM Postoperative Serum Glucose
Patient Experience of Care Domain
Dimensions (HCAHPS)
• Total of 8 dimensions
• Each dimension is worth 10 points (improvement or
achievement points – whichever is higher)
• Hospitals can also earn up to 20 “consistency points”
• This equals to a total of 100 points possible
• Hospitals need to have at least 100 HCAHPS surveys
during the performance period to qualify for the VBP
program
Patient Experience of Care Domain
Dimensions
1 - Communication with Nurses
2 - Communication with Doctors
3 - Responsiveness of Hospital Staff
4 - Pain Management
5 - Communication About Medicines
6 - Cleanliness and Quietness of Hospital Environment
7 - Discharge Information
8 - Overall Rating of Hospital
National Performance Standards used in
Calculating the VBP Incentive
National
Benchmark
Process of Care
Measures
HCAHPS
The average performance
score for the top 10% of
all hospitals during the
baseline period
Achievement
Threshold
The median performance
score (50th percentile) for
all hospitals during the
baseline period
Achievement Points vs. Improvement Points
for Clinical Process of Care Measures
• How are achievement points awarded?
If our performance score for the measure is:
► at or above the national benchmark = 10 points
► below the achievement threshold = 0 points
► between the national benchmark and the achievement
threshold = a formula is used to determine # of
points
National Baseline Period
Indicator
Initial Antibiotic
Selection for PN
patients
Hospital Baseline Period
Hospital Performance
Period
Benchmark
Achievement
Threshold
Case
Count
Rate
Case
Count
Rate
Achievement
Points
98.0%
91.0%
45
99%
49
98%
10
Achievement Points vs. Improvement Points
for Clinical Process of Care Measures
• How are improvement points awarded?
If our performance score for the measure is:
► at or below our baseline period performance score = 0 points
► above our baseline period performance score = a formula is used to
determine # of points awarded ( range of 0 – 9 points)
National Baseline Period
Indicator
Initial Antibiotic
Selection for PN
Patients
Hospital Baseline Period
Hospital Performance
Period
Benchmark
Achievement
Threshold
Case
Count
Performance
Case
Count
Performance
Improvement
Points
98%
91%
45
99%
49
98%
0
Achievement Points vs. Improvement Points
for Clinical Process of Care Measures
• Final points awarded are the higher of the
Achievement Points vs. the Improvement Points.
National Baseline Period
Indicator
Initial
Antibiotic
Selection for
PN patients
Hospital Baseline
Period
Hospital
Performance Period
Benchmark
Achievement
Threshold
Case
Count
Performance
Case
Count
Performance
98%
91%
45
99%
49
98%
Achievement
Points
Improvement
Points
Final
Points
10
0
10
Achievement Points vs. Improvement Points for
HCAHPS Dimensions
• Achievement/Improvement points for HCAHPS
are calculated using the same method as for
the Process of Care Measures .
Achievement Points vs. Improvement Points for
HCAHPS Dimensions
National Baseline Period
Benchmark
Indicator
Nurses always
communicated
well
Hospital Baseline
Period
Achievement
Threshold
Hospital Performance
Period
Score
Achievement
Points
Improvement
Points
Final
Points
9
0
9
Score
85%
75%
85%
81%
Consistency Points for HCAHPS
• CMS will use consistency points to recognize consistent
achievement across the HCAHPS dimensions.
• If our lowest performance score for each HCAHPS
dimension during the performance period is at or above
the achievement threshold for that dimension = 20
consistency points
• If the lowest score is at or below the floor (minimum
score) = 0 consistency points
• If the lowest score is between the achievement threshold
and the floor = a formula is used to determine the # of
consistency points (vary between 0-19)
Consistency Points for HCAHPS
Indicator
Nurses always communicated well
Doctors always communicated well
Patients always received help quickly from hospital staff
Patients’ pain was always well controlled
Staff always explained about medicines before giving them to
patients
Patients’ rooms and bathrooms were always kept clean and
quiet
Patients were given information about what to do during their
recovery at home
Patients who gave their hospital a rating of 9 or higher on a
scale of 0 to 10
Lowest performance score from above dimensions
Achievement
Threshold
Floor
75%
79%
62%
39%
52%
30%
Hospital
Performance
Period Score
81%
84%
74%
69%
35%
77%
59%
29%
71%
63%
37%
76%
82%
50%
83%
66%
29%
78%
59%
71%
Receive all
20
consistency
points
Calculating an Overall VBP Score
• Process of Care Domain Overall Score =
Total points (achievement vs. improvement)
90 (only qualified for 9 measures)
 has a weight of 70%
Example:
41 (total of final points) / 90 = 46%
46 X 70% (domain weight) =
32%
Calculating an Overall VBP Score
• Patient Experience of Care Domain Overall Score
=
Total points (achievement vs. improvement) + Consistency points
100
 has a weight of 30%
Example:
89 (total of final points + 20 consistency points) /100 = 89%
89 X 30% (domain weight) =
27%
Overall VBP Score
• Equals to the Process of Care Domain Score + Patient
Experience of Care Domain Score
32% + 27% = 59%
Overall VBP Score
Public Reporting of the VBP Scores and
Payments
• In addition to what is presently posted on the
Hospital Compare website, CMS will add each
hospital’s domain-specific score and its overall
VBP score.
Quality
“ the degree to which health care
services for individuals and
populations increase the likelihood
of desired health outcomes and are
consistent with current professional
knowledge”
- AAP Policy Statement