Transcript Document

What’s New in 2008: The Leapfrog
Hospital Survey
April 16, 2008
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Town Hall Call Overview
• Introduction
– Survey Team
– Leapfrog and the Hospital Survey—why complete?
– Goals for 2008 survey
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Survey Submission Logistics/Timeline/Website Resources
What’s New for 2008
Approach to the Survey
Detailed review of survey questions
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Safe Practices Score
Computerized Physician Order Entry (CPOE)
Intensive Care Physician Staffing (IPS)
Evidence-based Hospital Referral (EBHR)
Never Events
Transparency Indicator
Hospital Acquired Conditions
Common Acute Conditions
• Q&A
• Schedule for Town Hall Special Calls
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Why Complete Leapfrog Survey?
Unique in the Milieu
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Represents employers/purchasers/consumers interests
Seeks public accountability/transparency
Rewards high performance
High impact performance measures “not the low hanging fruit”
(e.g., CPOE, IPS, EBHR, HACs)
Full range of measures—structural, process and outcome (but
focused on outcome)
Regional and national in scope—all payer information
Standardized measures to assure “same fruit” is sampled
Harmonized with other major national performance measurement
programs—but shows more complete picture of care delivery
Significant hospital input for 2008 survey
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Survey Review Process
Steps in the process to revise the survey have included:
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(August, 2007) – Roundtable calls - A representative group of
hospitals that completed the 2007 Leapfrog Hospital Survey
participated in three roundtable calls to share comments and
feedback on the 2007 survey.
(October, 2007) – First review – 14 hospitals reviewed an early
draft of the proposed changes to the 2008 Leapfrog Hospital
Survey and provided feedback to Leapfrog.
(November , 2007) - Public review and comment period –
hospitals were invited to share comments and feedback on the
proposed changes for the 2008 Leapfrog Hospital Survey.
(January, 2008) - Pilot test of revised survey – 19 hospitals
participated in a test of the draft 2008 Leapfrog Hospital Survey
and provided feedback to Leapfrog.
(February, 2008) - Pilot of CPOE test – Eight hospitals
participated in a test of the CPOE evaluation tool and provided
feedback to Leapfrog.
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Behind the Changes in 2008
Goals for the new survey—
1. Streamline survey—reduce burden
2. Reduce ambiguity in language in Safe Practices
3. Support CMS initiatives (HACs)
4. Align with other performance measurement groups
5. Provide two composites that are important to
consumers and purchasers
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Efficiency of care
Survival predictor
Incorporate Leapfrog’s Pay for Performance
program
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How did we do?
• Significantly reduced survey question
pages—now 66 pages vs 106 pages
• Language in Safe Practices tightened to
reduce ambiguity/increase action on safety
• Added LHRP conditions and efficiency
• Added 2 hospital acquired conditions
identified by CMS
• Reduced “LF-developed” measures down to
only a few—hospitals can report their results
from other data collections—lowering
burden—but providing full picture of care
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Survey Submission Logistics, Timeline,
Website Resources
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Submission Issues
• Security Codes and CEO Delegation
• Survey Affirmations and Maintaining
survey records of answers
• Helpdesk services
• Website resources
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Survey Security and Integrity
• Core principle: hospital self-certification
• Executive authority . . .and accountability
• Survey security and integrity are critical:
– 16-digit security code
• Authorization to access granted only to:
– CEO . . . can provide code directly to any
delegate(s)
– CEO-authorized delegate . . . Help Desk
can email security codes
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Regional Rollout Contacts
• RRO contacts:
– Identified on survey home page
– Help Desk refers RRO hospitals to contact
for 16-digit code
– Hospitals should consider getting CEO
Delegation authorizations for alternative
hospital contact person; fax authorizations
to the Help Desk
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Survey Helpdesk Available
• Survey Helpdesk—designed to respond within 48
hours of question (unless it requires an expert panel
member to respond)
• Don’t wait until June 30—if you have a problem you
likely will not make deadline..
• Survey must be completed before CPOE certification.
If completing MUST do before last week in June
otherwise will not be able to get Help Desk support
• Helpdesk link on survey homepage
leapfrog.medstat.com
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2008 Timeline
• April 1, 2008—Leapfrog Launches 2008
Survey
• June 30, 2008- RRO targeted hospitals report
or be listed on Leapfrog’s Web site as Did Not
Disclose
• July 7, 2008 Website lists new results
• Top Hospitals List--Recognition
programs/initiatives will be done in 2008
beginning as early as mid-September
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Website Resources
To assist hospitals in completing the Survey, Leapfrog
makes the following tools available:
– Frequently Asked Questions
– Overview of “What’s New in 2008?”
– Fact sheets on Each Leap (including bibliography
information)
– White Papers on Severity-adjustment for LOS, and Survival
Predictor
– Scoring Algorithms
– End Notes
– Specifications for measuring and reporting rates of HospitalAcquired Conditions
– Link to purchase NQF Safe Practices Revised Handbook
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Website Resources for EBHR
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Medical Coding for High-Risk Procedures and Conditions
Procedure code, diagnosis codes and other specifications for counting high-risk surgery
volumes
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Publicly Reported Outcomes for CABG and PCI
For hospitals in CA, MA, NJ, NY and PA – publicly reported risk-adjusted mortality rates for
responding to survey questions about PCI (MA, NY only) and CABG (all five states).
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Process Measures -- Specifications
Detailed specifications for Leapfrog’s procedure-specific process measures of quality -- for
CABG, PCI, AAA Repair and high-risk deliveries.
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Resource Utilization Measures – Specifications
Detailed specifications for Leapfrog’s CABG and PCI including:
– Coding for counting eligible cases
– Coding and other criteria for identifying cases with risk factors
– Specifications for reporting geometric mean length of stay
– Criteria for identifying cases followed by readmission
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Excel Tool for Computing Geometric Mean Length of Stay
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Website Resources for Common Acute
Conditions (CAC)
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Volume Standard Coding: Medical Coding for Chronic Acute Conditions
Procedure/diagnosis codes and other specifications for counting AMI and
Pneumonia volume
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Process Measures - Specifications
Specifications for Leapfrog’s nationally-endorsed procedure-specific process
measures of quality -- for AMI and Pneumonia.
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Resource Utilization Measures – Specifications
Detailed specifications for Leapfrog’s Common Acute Conditions (AMI and
Pneumonia) – including:
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Coding for counting eligible cases
Coding and other criteria for identifying cases with risk factors
Specifications for reporting geometric mean length of stay
Criteria for identifying cases followed by readmission
Excel Tool for Computing Geometric Mean Length of Stay
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What’s New for 2008
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Survey Changes: The Details
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Computerized Prescriber Order Entry Evaluation Tool
Streamlined Safe Practices
Hospital-Acquired Conditions
Common Acute Conditions – AMI & Pneumonia
Efficiency of Care Score
Additional Evidence Based Hospital Referral Changes
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Survival Predictor
Surgeon Volume Dropped
Public Reporting Additions- Mass & North. New Engl.
NICU Volume Change
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Bariatric Volume Standard Increases
Expansion of ICU Physician Staffing (IPS)
Leapfrog Hospital Rewards Program Changes
Other Hospital Recommendations
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Computerized Prescriber Order Entry
(CPOE) Evaluation Tool
• The CPOE Evaluation Tool provides hospitals an opportunity to
assess the hospital’s implementation of system alerts for potential
medication-related adverse events
• Test involves a hospital loading computer-generated patient profiles
and medication orders into their CPOE system and reporting back on
the alerts they received
• Hospitals must complete the test to achieve either Fully Meets or
Good Progress on the CPOE Leap in 2008
• In the 2008 survey, scored results will not be used, only the fact that
the hospital tested its system. In 2009, scores from the test will be
used.
• Hospitals access the tool from the survey website once they have
completed the CPOE section of the online survey (i.e. CPOE
Q1=YES).
• Same security code as survey.
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CPOE Evaluation – Impact on Overall CPOE Score
• 2008 survey cycle: successful completion of test is the only
requirement for credit in CPOE overall score
• 2008 survey scoring algorithm:
– Fully implemented:
CPOE implemented, 75%+ IP orders, and appropriate* test
completed
– Good progress (3/4):
CPOE implemented, <75% IP orders, and appropriate* test
completed
– Good early stage effort (1/2):
CPOE implemented OR
Selecting/implementing, written strategy, budgeted,
champion
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– Will to report publicly:
Completed CPOE section of survey
2009: Leapfrog will release results of test, scoring criteria TBD
* Adult inpatient test for adult/general hospital (pediatric test optional);19
pediatric test for children’s hospital
CPOE Evaluation – Scored Results, Sample
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CPOE Evaluation – Scored Results,
Sample (cont’d)
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Feedback on CPOE Evaluation Tool
“No question—this is a valuable
experience—it is very important work
and it should be applauded.”
David Stockwell, Patient Safety Officer
Children’s National Medical Center
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Streamlined Safe Practices
• Through numerous hospital roundtable calls, we heard
substantial feedback from hospitals on the length and the
ambiguity of the 2007 Safe Practices section
• The 2008 Safe Practices chosen for hospitals to report on
are those that have the strongest supporting evidence and
are not measured in other sections of the survey
• The 2008 Safe Practices section focuses on 13 of the 27
non-Leapfrog-created Safe Practices
• The Safe Practices have kept the 4A framework, but have
been re-worded to make the questions more tightly defined
and actionable
• Hospitals that wish to continue to report on all 27 Safe
Practices may do so through TMIT. Leapfrog will recognize
hospitals that do so as part of the survey’s Transparency
Indicator section.
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Safe Practices 2008
• Basic design of survey ( 4 A’s) remains the same
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Awareness
Accountability
Ability
Action
• Changes to the content
– Revisions to existing measures
– Individual practice weighting remains the same as
2007, but overall is now 707
– Fewer questions—more crisply defined actions
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13 Safe Practices
Weighting
(pts)
Safe Practice
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5
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Creating and Sustaining a Culture of Safety
Element 1: Leadership Structures and Systems
Element 2: Culture Measurement for Performance
Element 3: Teamwork Training and Skill Building
Element 4: Identification and Mitigation of Risks and Hazards
Informed Consent
Life Sustaining Treatment
Nursing Workforce
Communication of Critical Information
Labeling of Diagnostic Studies
Discharge Systems
Medication Reconciliation
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Prevention of Aspiration and Ventilator Associated Pneumonia
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Central Venous Catheter Related Bloodstream Infection Prevention
Hand Hygiene
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DVT/VTE Prevention
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Anticoagulation Therapy
GRAND TOTAL
120
20
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120
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100
84
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707
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Hospital-Acquired Conditions
• New section added on two hospital-acquired conditions for which
CMS has indicated they will no longer reimburse hospitals
• This survey cycle measures hospital-acquired pressure ulcers
and hospital-acquired injuries (burns, falls, etc.)
• Results will be reported as a rate per inpatient days
• Pressure ulcers aligned with IHI 5 million lives campaign
• These two conditions can be identified by hospitals using the
same codes that CMS is using for its payment reduction
• Hospitals will need to rely on CMS-required Present-OnAdmission coding to identify which conditions occurred during the
hospital stay.
• Hospitals have until October 31, 2008, to report on six months of
data to the survey; after that, results will indicate “Did not
measure or report this information”
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Common Acute Conditions
• New section focused on two common acute conditions -Acute Myocardial Infarction (AMI) and Pneumonia—both
were measured in LHRP
• Quality measures for these conditions are based on
CMS/Joint Commission Process Measures of Quality
• Scoring thresholds for the quality of care process measures
are set based on historical Joint Commission data
• Resource Utilization is measured using severity adjusted
LOS inflated by readmission
• Resource Utilization combined with safety and quality
measures produce an Efficiency of Care score for these
two conditions
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Resource Utilization Measures
• Measure: Severity-adjusted average length of stay inflated
by readmission rate
• Length of stay associated with resource utilization
• Readmission used as inflator to avoid “perverse incentive”
(inappropriately releasing patients too early)
• Measurement is specific to a condition--added to
compliment quality measures for four procedures
/conditions: CABG, PCI, AMI, and Pneumonia
• For each procedure/condition, hospitals are asked to
report:
- the average length of stay (logarithmically transformed—GEOMEAN),
- the number of cases followed by any readmission to that hospital within 14
days for any cause,
- a count of cases with certain risk factors present
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Resource Utilization Reporting
• The clinical information (risk factors) and
LOS/Readmission statistics needed to report
these data can be accessed from the hospital’s
administrative data system; no chart abstraction
is necessary]
• Hospital will use an automated worksheet to
calculate “GEOMEAN for LOS” (see next slide)
• LF will report the efficiency of care scores as a
composite of the two scores and a drilldown of
quality and resource utilization scores
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GEOMEAN Calculator
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Evidence Based Hospital Referral (EBHR)
Changes
• Additional statewide and regional public risk-adjusted
mortality outcomes recognized
– Massachusetts for CABG and PCI
– Northern New England Cardiovascular Disease Study Group
(NH, ME, and VT) for CABG, PCI, and AVR
• NICU census changed to annual count of very-low
birthweight babies; 50+ required to fully meet standard
– Based on research by Ciaran Phibbs, Ph.D., and others
– All hospitals in the 50+group were over 15 average daily
census—reverse not true—thus, raising the bar!
• Reporting time periods specified for those not
participating in a specific reporting program
• Resource utilization measures added to CABG and
PCI
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EBHR: Survival Predictor Added
• No additional questions from last year
• “Survival predictor”—based on volume and nonadjusted in-hospital deaths--a composite measure
that predicts future hospital performance on mortality
• Takes into account number of cases via weights—so
that reliability related to small numbers is assured
• No predictor for bariatric surgery in this survey cycle
• Developers—Drs. Justin Dimick and John Birkmeyer,
U.Mich Medical School, Doug Staiger from
Dartmouth
• Reported as independent score on consumer pages
• White paper available on LF website
http://www.leapfroggroup.org/news/leapfrog_news/4729468
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EBHR: Surgeon Volume
• Given addition of the “survival predictor”
surgeon volume was dropped—except
for bariatric surgeries (no survival
predictor available yet)
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Expansion of IPS
• IPS Leap expanded to include neuro ICUs (first specialty
ICU included in the standard)
• Patients in a neuro ICU must be managed or co-managed
by “neuro-intensivists” or critical care intensivists
• “Neuro-intensivists” are classified as neurologists and
neurological surgeons who are board-certified in their
primary specialty and who have completed a UCNScertified fellowship training program in neurocritical care, or
a physician who is board certified in neuro-critical care.
• Use of “neuro-intensivists” only applies to neuro ICUs
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Leapfrog’s Hospital Rewards Program
Changes
• A revised Leapfrog Hospital Rewards Program™ (LHRP)
will be based solely on Leapfrog survey data
• Key data elements of Leapfrog Hospital Insights (LHI) were
included in the 2008 survey (LHI database eliminated)
• Any hospital submitting a completed 2008 Leapfrog survey
now meets all the reporting requirements for participation in
licensed LHRP programs
• A current survey must be submitted by June 30, 2008 to be
included in July 2008 LHRP results. An updated 2008
survey must be re-submitted in November/December 2008
to be included in January 2009 LHRP results.
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Other Hospital Recommendations
• Hospitals requested a revamp of the
organization of ancillary documents for each
section of the survey—this will take place in
the 2009 survey
• Revamp of the website—hospitals often had
difficulty finding documents—have changed
document names to better reflect section of
the survey
• Page references to the specific Safe Practices
section which the survey question relates to
are included in the paper copy of the survey
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Questions?
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Dates of Town Hall Specialty Calls
• Severity adjustment for LOS (resource
utilization measure) -- April 25, 2 PM EDT
• CPOE Tool -- May 2, 11 AM EDT
• Survival Predictor -- May 7, 2 PM EDT
Check “News & Events” on Leapfrog’s
website for call details and materials
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