Transcript Pneumonia Core Measure Scores

The Impact of Pneumonia Core
Measure Scores on Value
Based Purchasing Financial
Outcomes
Presented by Brenda Lee, MSN,RN
Why are we focused on Pneumonia?
• In FY 2010, UTHSCT compliance with the allor-none bundle pneumonia core measure set
was 85% - 20th percentile ranking (July 9, 2009
– June 30, 2010).
• Value Based Purchasing Score decreasing from
83 to 23 for all core measures. Pneumonia
measures are being dropped in the areas we
are 100%.
Initial Antibiotic Received Within 6 Hours of Arrival (PN5-c)
1.000
UCL
1.000
CL
0.948
Observed
0.900
0.800
0.777
LCL
0.700
April 2009 - March 2011
Antibiotic Selection for Non-ICU Patients (PN6-b)
1.000
UCL
1.000
CL
0.923
0.900
0.800
0.700
Observed
0.657
0.600
0.500
LCL
0.400
0.300
0.200
April 2009 - March 2011
Antibiotic Selection for ICU Patients (PN6-a)
1.000
UCL
1.000
CL
0.688
Observed
0.750
0.500
0.250
0.000
Apr-09
Jul-09
Nov-09
Apr-10
May-10
Jun-10
Sep-10
April 2009 - March 2011
(Months with Qualifying Cases)
Oct-10
Dec-10
Jan-11
Feb-11
Jan-09
January 2009 - July 2011
Jul-11
Jun-11
May-11
Apr-11
Mar-11
Feb-11
Jan-11
Dec-10
Nov-10
Oct-10
Sep-10
Aug-10
Jul-10
Jun-10
May-10
Apr-10
Mar-10
Feb-10
Jan-10
Dec-09
Nov-09
Oct-09
Sep-09
Aug-09
Jul-09
Jun-09
May-09
Apr-09
Mar-09
Feb-09
Percent Compliant
Influenza Vaccine
(Midas Comparative Performance Measurement System)
100.0
95.0
90.0
85.0
80.0
75.0
70.0
Site Value
65.0
95th
80th
60.0
50th
55.0
20th
5th
50.0
45.0
40.0
35.0
Pneumonia: Setting a Goal
Performance Required for 95th Percentile National Ranking
Vaccinations
(P & I)
Antibiotic
within 6 hrs
Initial Antibiotic
Selection
Compliance Rate
92.25 20th
97.21 20th
Pneumonia 96.82 20th
Influenza 87.69 5th
Total 88.28 5th
ICU 66.69 5th
Non-ICU 91.73 20th
Goal Success Rate
100
100
100
Average Metric Failures/Month
1.0 (.33/.66)
.33
.66 (.50/.41)
Permitted Metric Failures
/Month
0
0
0
AIM Statement
Improve compliance to 100%
for all Pneumonia evidenced
based performance measures
by June 2011.
Pneumonia: Building the Team
•
•
•
•
•
Physicians/Inpatient Nurses
ED Medical Director/ED Physicians/ED Nurses
Internal Medicine Physicians
Pharmacists
Quality Staff
Pneumonia: Measuring the Problem
Pneumonia Core Measure Opportunities for Improvement (OFIs)
October 1, 2009 - September 30, 2010
100.0%
97.1%
91.2%
30
90.0%
82.4%
80.0%
25
70.0%
Number of OFIs
67.6%
60.0%
20
34 RFI’s Total
50.0%
47.1%
15
40.0%
10
30.0%
9
26.5%
7
7
20.0%
5
5
3
2
10.0%
1
0
0.0%
Pneumococcal
screening
Antibiotic selection
Influenza
vaccination
Antibiotic within 6 Blood Cultures for
hours
ICU Patients
Indicators
Initial Blood
Culture in ER
Smoking Cessation
Counseling
Pneumonia: Interventions
•
•
•
•
Revise Pulmonary Order Set (prior separate)
Revise Physician Discharge Instruction Set
Design Concurrent Review Checklist for nursing
Present core measure compliance data to staff
and physicians (committee/dept level)
• Printed off booklets for medical staff and made
download available
• Nursing/MD staff educational program/inservices
Pneumonia: Interventions
• Address physician concerns per CDC
Guidelines regarding administration of
immunizations
• Revise immunization protocol to align with
CDC; dropping physician order to not
administer as an option
• Administer immunizations prior to discharge
for all patients as appropriate – JUST GIVE IT!
Pneumonia: Barriers
• Current form approval process hindered
“pilot” of forms and created delay in changes
• Physicians outside of team wanted a separate
order set for Pneumonia patients
• Nursing did not want to perform concurrent
review documentation – additional work
Pneumonia: Interventions
• Create Pneumonia Order Set
• Adjust admission initial nursing assessment form to
incorporate core measure requirements
• Create a “pilot” plan utilizing next 5 patients with
hospitalist admissions only
• Post laminated Pneumonia Core Measure Antibiotic
selection sheet as reference
Results
2
0
10/01/10
10/08/10
10/15/10
10/22/10
10/29/10
11/05/10
11/12/10
11/19/10
11/26/10
12/03/10
12/10/10
12/17/10
12/24/10
12/31/10
01/07/11
01/14/11
01/21/11
01/28/11
02/04/11
02/11/11
02/18/11
02/25/11
03/04/11
03/11/11
03/18/11
03/25/11
04/01/11
04/08/11
04/15/11
04/22/11
04/29/11
05/06/11
05/13/11
05/20/11
05/27/11
06/03/11
06/10/11
06/17/11
06/24/11
07/01/11
07/08/11
07/15/11
07/22/11
07/29/11
08/05/11
Values
Pneumonia Core Measure - All or None Bundle
12
12
Number of OFIs
10
10
8
7
6
6
6
5
4
2
3
3 3
2
2
1 1 1
0 0
6
6
4 4
4 4
3
2
1 1 1
1
0 0
0
1
1
0 0 0
0
6
5 5
5
4 4 4 4 4
3
1
0
4
2 2
2
2
1
0
October 1, 2010 to August 11, 2011
Red = Pneumococcal Vaccine
Turquoise = Blood Culture in ED
Number of Patients
Number Compliant
1
1
0 0 0 0 0
10
9
8
7 7
6
7
7
6
6
5
4
4
1
1
0
4
3
2
1
1
0 0 0 0 0 0
10
9
8
8
7
6
5
5
5
4
4
3
3
2
2
2
1
1
0 0 0 0 0
0
0.0
0.0
30.0
20.0
50.0
10.0
October 1, 2010 - August 11, 2011
Approval of pneumonia order set
Pilot of pneumonia order set
Discharge order set approved
Posted laminated antibiotic
selection sheets
Revised immunization protocol 50.0
Tracer tool implementation
66.7
66.7
75.0
70.0
In-service for staff and physicians
Team formed
40.0
44.4
66.7
80.0
90.0
85.7
85.7
85.7
80.0
83.3
85.7
80.0
66.7
66.7
60.0
10/01/10
10/08/10
10/15/10
10/22/10
10/29/10
11/05/10
11/12/10
11/19/10
11/26/10
12/03/10
12/10/10
12/17/10
12/24/10
12/31/10
01/07/11
01/14/11
01/21/11
01/28/11
02/04/11
02/11/11
02/18/11
02/25/11
03/04/11
03/11/11
03/18/11
03/25/11
04/01/11
04/08/11
04/15/11
04/22/11
04/29/11
05/06/11
05/13/11
05/20/11
05/27/11
06/03/11
06/10/11
06/17/11
06/24/11
07/01/11
07/08/11
07/15/11
07/22/11
07/29/11
08/05/11
Percent Compliant
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
Pneumonia Core Measure Weekly All-or-None Bundle
100.0
90.0
50.0
Pneumonia All or None Bundle
(Midas Comparative Performance Measurement System )
100.0
95.0
90.0
85.0
75.0
Site Data
70.0
95th
80th
65.0
50th
20th
60.0
5th
55.0
Red = Site
Data with
projected
CPMS
Comparative
Data
50.0
45.0
January 2009 - July 2011
Jul-11
Jun-11
May-11
Apr-11
Mar-11
Feb-11
Jan-11
Dec-10
Nov-10
Oct-10
Sep-10
Aug-10
Jul-10
Jun-10
May-10
Apr-10
Mar-10
Feb-10
Jan-10
Dec-09
Nov-09
Oct-09
Sep-09
Aug-09
Jul-09
Jun-09
May-09
Apr-09
Mar-09
Feb-09
40.0
Jan-09
Percent Compliant
80.0
REVENUE
ENHANCEMENT
Analysis of the Final FFY 2013 VBP Rule
Process Measures Score Calculation
Performance Period: January 1, 2010 – December 31, 2010
Process Domain Score: 30%
Payment Conversion Line
340%
320%
300%
280%
260%
240%
220%
200%
180%
160%
140%
120%
100%
80%
60%
40%
20%
0%
Payment Percentage
Expected Payment from
VBP $83,143
0%
10%
20%
30%
40%
Payment Conversion Line - Current Estimate Using National Data
Payment Conversion Line - Conservative Estimate
50%
Score
60%
70%
80%
University of Texas Health Science Center at Tyler
90%
100%
Analysis of the Final FFY 2013 VBP Rule
Process Measures Score Calculation
Performance Period: October 1, 2010 - August 31, 2011 (Projected)
Process Domain Score Increasing Pneumonia Measures Only: 43%
Payment Conversion Line
340%
320%
300%
280%
260%
240%
220%
200%
180%
160%
140%
120%
100%
80%
60%
40%
20%
0%
Expected Payment from
VBP $105,864
Payment Percentage
ROI:
$22,721
0%
10%
20%
30%
40%
Payment Conversion Line - Current Estimate Using National Data
Payment Conversion Line - Conservative Estimate
50%
Score
60%
70%
80%
90%
University of Texas Health Science Center at Tyler
100%
Pneumonia:
Conclusions and Next Steps
• An order set and forms revisions “pilot”
process is instrumental for rapid cycle change
• Continue to provide feedback as cases “fall
out” as soon as identified (trending)
• Implement aggressive campaign with medical
and nursing staff for Influenza Vaccination
• Continue study to determine if order set
contributes to decrease LOS and cost of care
Questions?