value-based purchasing program overview - scripps.org · an annual market basket update with a 2.0...

Value-Based Purchasing Program Overview

Maida Soghikian, MDGrand Rounds

Scripps Green Hospital November 28, 2012

IQR and VBP Evolution and History

• Background and Introduction– Inpatient Quality Reporting Program– Value-Based Purchasing Program

• CMS FY13 VBP Final Scores• Process Measures Analysis

– Core Measure All or None Bundles– Value-Based Purchasing Program Measures

• Status of FY14 VBP Performance– Current data collection– Addition of Outcome Measures

• CMS VBP in FY16 and Beyond

Presentation Overview

2

Background and Introduction

3

IQR and VBP Evolution and History

• 2001 – Department of Health and Human Services developed Hospital Inpatient Quality Reporting (IQR) Program which requires hospitals to submit quality measures.– Conditions include: acute myocardial infarction (AMI), heart

failure (HF), pneumonia (PNE), surgical care improvement project (SCIP)

– Indicators include: process measures and patient experience 30-day mortality and readmission rates, patient safety indicators

• Eligible hospitals that do not participate will receive an annual market basket update with a 2.0 percentage point reduction.

IQR Program

4

VBP Program:Background

5

• Congress authorized the hospital inpatientValue-Based Purchasing (VBP) Programthrough the Affordable Care Act.– Built on the Hospital IQR measure reporting

infrastructure. – Uses Hospital IQR measures that have had results

published on Hospital Compare* for at least one year– Funded by a 1% reduction from participating hospitals’

base operating diagnosis-related group (DRG) payments for FY 2013, increasing to 2% by FY 2017

* http://www.hospitalcompare.hhs.gov/

VBP Program:Purpose

6

• VBP Program seeks to encourage hospitals to improve the quality and safety of care for Medicare beneficiaries and all patients receive during acute-care inpatient stays by:

1) Eliminating or reducing occurrence of adverse events2) Adopting evidence-based care standards and

protocols that result in the best outcomes for the most patients

3) Improve patients’ experience of care

7

*Six Domains:

1) Clinical Care

2) Person- and Caregiver-Centered Experience and Outcomes

3) Safety

4) Efficiency and Cost Reduction

5) Care Coordination

6) Community/ Population Health

CMS Shift for Quality Measurement:

Clinical Process Measures Outcomes and Efficiency Measures(not risk-adjusted) (risk-adjusted)

2013 2014 2015 2016

1.00% 1.25% 1.50% 1.75%

1 Process of Care 70% 45% 20%

2 Patient Experience 30% 30% 30%

3 Outcome - 25% 30%

4 Efficiency:Medicare Spending per Beneficiary - - 20%

VBP Fiscal Year

Reclassification of Domains:

National Quality Strategy*

% Program Contribution

VBP Program:Domain Overview

• BASELINE Performance Period:– July 2009 – March 2010

• FY13 Performance Period:– July 2011 – March 2012

• Payment Impact Period:– October 2012 – September 2013

FY13 VBP: Performance Periods

8

National Targets

9

*Data collection period for national baseline targets: July 2009 – March 2010

Achievement Points

10

Achievement Points

11

Improvement Points

12

Improvement Points

13

Final Points

14

• Each measure is worth 10 points– CMS takes the higher of either the achievement or

improvement points – FY13 VBP: 12 process measures (120 total points)

FY14 VBP: 13 process measures (130 total points) Add urinary catheter on post operative day 1 or 2

• Measures with fewer than 10 reported cases are considered to have insufficient data and will not be scored for that hospital.

CMS FY13 VBP Final Scores

15

16

CMS FY13 VBP:Process of Care

Bench-mark

Achieve-ment

Threshold

Baseline %

Current%

Achieve-ment Points

Improve-ment Points

Final Points

1 Fibrinolytic therapy within 30 minutes 91.91% 65.48% - - - - Insufficient Data

2 PCI within 90 minutes 100.00% 91.86% - - - - Insufficient Data

Heart Failure 3 Discharge instructions 100.00% 90.77% 92.67% 100.00% 10 9 10

4 Blood cultures in ED before antibiotic 100.00% 96.43% 97.56% - - - Insufficient Data

5 Appropriate antibiotic selection 99.58% 92.77% 93.22% 97.73% 7 7 7

6 Prophylactic antibiotic received within one hour prior to surgical incision 99.98% 97.35% 99.00% 100.00% 10 9 10

7 Prophylactic antibiotic selection for surgical patients 100.00% 97.66% 99.67% 100.00% 10 9 10

8 Prophylactic antibiotics discontinued within 24 hours after surgery end time 99.68% 95.07% 94.79% 99.67% 9 9 9

9 Cardiac surgery patients with controlled 6AM postoperative serum glucose 99.63% 94.28% 100.00% 98.85% 8 0 8

10 Recommended VTE prophylaxis ordered 100.00% 95.00% 98.18% 100.00% 10 9 10

11 Received appropriate VTE prophylaxis within 24 hours prior - 24 hours after surgery 99.85% 93.07% 96.36% 100.00% 10 9 10

12 Patients on beta blocker therapy prior to admit who received a beta blocker during perioperative period 100.00% 93.99% 96.90% 98.97% 8 6 8

91.11%

Clinical Process of Care MeasuresNational Baseline

Performance Period: July 2011 - March 2012

Green

Heart Attack

Pneumonia

Surgical Care Improvement

Project

Score:

17

* Patient experience data is adjusted by CMS for certain patient-mix variables. These include: service line, age, response percentile, and self-reported level of education, health, and primary language.

CMS FY13 VBP:Patient Experience of Care

Benchmark

Achieve-ment

ThresholdFloor Baseline

%Current

%

Achieve-ment Points

Improve-ment Points

Final Points

1 Nurses always communicated well 84.70% 75.18% 38.98% 79% 81% 6 4 6

2 Doctors always communicated well 88.95% 79.42% 51.51% 83% 86% 7 5 7

3 Patients always received help quickly from hospital staff 77.69% 61.82% 30.25% 63% 67% 3 2 3

4 Patients' pain was always well controlled 77.90% 68.75% 34.76% 70% 75% 6 6 6

5 Staff always explained about medicines before giving them to patients 70.42% 59.28% 29.27% 63% 66% 6 4 6

6 Patients' rooms and bathrooms were always kept clean and quiet 77.64% 62.80% 36.88% 63% 65% 2 1 2

7 Patients were definitely given information about what to do during their recovery at home 89.09% 81.93% 50.47% 81% 85% 4 4 4

8 Patients who gave their hospital a rating of 9 or higher on a scale of 0 to 10 82.52% 66.02% 29.32% 79% 81% 9 7 9

20

63.00%

Patient Experience of Care*National Baseline

Performance Period: July 2011 - March 2012

Green

Score: Consistency Points:

CMS FY13 VBP:FINAL Scores*

Total VBP Score:State Average = 52.83%

National Average = 55.46%

18

Encinitas Green La Jolla Mercy

Process 87% 91% 74% 62%

Patient Experience** 42% 63% 50% 25%

Total VBP Score 74% 83% 67% 51%

FINAL VBP ScoresFY13 VBP

* Source: CMS Hospital Value Based Purchasing - Actual Percentage Summary Report, released 10/31/12. ** Patient experience data is adjusted by CMS for certain patient-mix variables. These include: service line, age, response percentile, and self-reported level of education, health, and primary language.

• FY13 VBP Data Collection Periods:– Baseline Performance: July 2009 – March 2010– Current Performance: July 2011 – March 2012

• October 31, 2012: – CMS sent hospitals the Actual Payment Percentage

Summary Report

• January 1, 2013: – Incorporate 1% reduction and value-based incentive

payment simultaneously

CMS FY13 VBP: Performance Periods and Timeline

19

ACTUAL POTENTIAL*

1 FINAL VBP Scores 74% 83% 67% 51% - -

2 ESTIMATED FY13 IPPS Operating Payments $24,110,800 $47,430,600 $47,576,100 $70,942,000 $190,059,500 $190,059,500

3 1% Reduction (Pay-In Amount into VBP Pool) ($241,108) ($474,306) ($475,761) ($709,420) ($1,900,595) ($1,900,595)

4 1% Reduction + Value-based Incentive(Total Payment from VBP Pool) $325,606 $720,512 $581,702 $661,801 $2,289,621 $3,491,393

5 Net Loss/Gain $84,498 $246,206 $105,941 ($47,619) $389,026 $1,590,798

6 Total Reimbursement for FY13 IPPS Operating Payments $24,195,298 $47,676,806 $47,682,041 $70,894,381 $190,448,526 $191,650,298

Scripps HospitalsMeasure Encinitas Green La Jolla Mercy

CMS FY13 VBP:Estimated Financial Impact

*POTENTIAL reimbursement: if all sites had VBP score of 100%

20

Example for an FY13 Claim:

1 FINAL VBP Score Based on performance period: July 2011 - March 2012 83%

2 Operating Payment Claim Billed to Medicare For inpatient stay in FY13 $100.00

3 1% Reduction Pay-in amount into VBP pool ($1.00)

4 1% Reduction + Value-based Incentive Total payment from VBP pool $1.52

5 Net Loss/Gain - $0.52

6 Total Reimbursement for Claim - $100.52

GreenMeasure Measure Description

21

CMS FY13 VBP:Example for Green

Process Measures Analysis

22

Core Measures System-wide:All or None Bundle Scores

0%

20%

40%

60%

80%

100%

FY 03 FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12

Bund

le Com

pliance (%

) Heart Attack

Heart Failure

Pneumonia

SCIP

23

Core Measures System-wide:Heart Attack Bundle Scores

50%

60%

70%

80%

90%

100%

2005 2006 2007 2008 2009 2010 2011 2012

Bund

le Com

pliance (%

) Scripps

Top Decile

Top Quartile

Median

Bottom Quartile

Bottom Decile

24

# Hospitals for percentile ranks

= 540

Core Measures System-wide: Heart Failure Bundle Scores

0%

20%

40%

60%

80%

100%

2005 2006 2007 2008 2009 2010 2011 2012

Bund

le Com

pliance (%

)

Scripps

Top Decile

Top Quartile

Median

Bottom Quartile

Bottom Decile

25


= 582

Core Measures System-wide: Pneumonia Bundle Scores

0%

20%

40%

60%

80%

100%

2005 2006 2007 2008 2009 2010 2011 2012

Bund

le Com

pliance (%

)

Scripps

Top Decile

Top Quartile

Median

Bottom Quartile

Bottom Decile

26


= 586

Core Measures System-wide: SCIP Bundle Scores

20%

40%

60%

80%

100%

2006 2007 2008 2009 2010 2011 2012

Bund

le Com

pliance (%

)

Scripps

Top Decile

Top Quartile

Median

Bottom Quartile

Bottom Decile

27


= 588

VBP Process Scores:System-wide Performance

28

Scripps Health Yearly Goals

Baseline performance*

(FY14 VBP Benchmarks)

FY13 Goal


72.5% 75.3% 76.6% 78%

3-year Goal = 78% Systemwide (National Predicted Top Decile)

FY14 Goal


FY15 Goal


29 *Based on system aggregate scores for the performance period of April to July 2012.

VBP Process Scores:System-wide Performance Objectives

30

Process Scores:Site Performance

National top decile for process bundle FY13 VBP

Legend:= M aximum of either achievement or improvement points= Current performance meeting FY12 Value-Based Purchasing Goal= Current performance below FY12 Value-Based Purchasing Goal

FY12 VBP Board Objective(using CMS FY13 Targets)

Bench-mark

Achieve-ment

Threshold

Current%

Current n

Final Points

Current%

Current n

Final Points

Current%

Current n

Final Points

Current%

Current n

Final Points

Current%

Current n

Final Points

1 Fibrinolytic therapy within 30 minutes 91.9% 65.5% - 0 Insuff icient Data

- 0 Insuff icient Data




2 PCI within 90 minutes 100.0% 91.9% 95.4% 151 6 97.1% 34 6 100.0% 7 Insuff icient Data 97.0% 33 6 94.0% 84 6

Heart Failure 3 Discharge instructions 100.0% 90.8% 99.3% 1018 9 98.8% 171 8 100.0% 221 10 99.5% 187 9 99.1% 439 9

4 Blood cultures in ED before antibiotic 100.0% 96.4% 99.2% 770 8 99.5% 216 8 100.0% 8 Insuff icient Data 100.0% 148 10 98.8% 406 6

5 Appropriate antibiotic selection 99.6% 92.8% 99.0% 480 9 99.0% 99 9 98.2% 55 8 98.8% 85 9 99.2% 241 9

6Prophylactic antibiotic received within one hour prior to surgical incision 100.0% 97.4% 99.6% 1984 8 100.0% 313 10 99.8% 406 9 99.8% 538 9 99.2% 727 7

7Prophylactic antibiotic selection for surgical patients 100.0% 97.7% 99.5% 1991 8 99.4% 314 7 100.0% 407 10 99.1% 540 6 99.7% 730 8

8Prophylactic antibiotics discontinued within 24 hours after surgery end time 99.7% 95.1% 99.1% 1895 8 99.7% 297 9 99.0% 399 8 99.2% 503 9 98.9% 696 8

9Cardiac surgery patients with controlled 6AM postoperative serum glucose 99.6% 94.3% 96.0% 446 3 - 0 Insuff icient

Data99.2% 123 9 96.5% 173 4 92.7% 150 1

10 Recommended VTE prophylaxis ordered 100.0% 95.0% 99.1% 1948 8 100.0% 387 10 100.0% 368 10 98.3% 470 6 98.6% 723 7

11Received appropriate VTE prophylaxis within 24 hours prior - 24 hours after surgery 99.9% 93.1% 98.5% 1948 8 100.0% 387 10 100.0% 368 10 97.2% 470 7 97.8% 723 7

12Patients on beta blocker therapy prior to admit who received a beta blocker during perioperative period 100.0% 94.0% 98.7% 797 8 100.0% 91 10 99.3% 139 8 99.6% 266 9 97.3% 301 6


Project

FY12 Score Goal

FY12-to-date Score 91.1% 76.4% 67.3%

National Baseline

Heart Attack

Performance Period: FY12 (August 2011 - July 2012)

Scripps Hospitals Encinitas Green La Jolla Mercy

75.5%

65.9% 65.9%67.7%90.6%67.0%

87.0%

Value-Based Purchasing Measures:Clinical Process of Care

Pneumonia

31

Bench-mark

Achieve-ment

Threshold

Current%

Current n

Final PointsBench-mark

Achieve-ment

Threshold

Current%

Current n

Final Points

1 Fibrinolytic therapy within 30 minutes 91.91% 65.48% - 0 Insuff icient Data 96.30% 80.66% - 0 Insuff icient

Data

2 PCI within 90 minutes 100.00% 91.86% 100.00% 7 Insuff icient Data 100.00% 93.44% - 0 Insuff icient

Data

Heart Failure 3 Discharge instructions 100.00% 90.77% 100.00% 221 10 100.00% 92.66% 100.00% 22 10

4 Blood cultures in ED before antibiotic 100.00% 96.43% 100.00% 8 Insuff icient Data 100.00% 97.30% - 0 Insuff icient

Data

5 Appropriate antibiotic selection 99.58% 92.77% 98.18% 55 8 100.00% 94.46% 100.00% 7 10

6Prophylactic antibiotic received within one hour prior to surgical incision 99.98% 97.35% 99.75% 406 9 100.00% 98.07% 96.88% 32 0

7 Prophylactic antibiotic selection for surgical patients 100.00% 97.66% 100.00% 407 10 100.00% 98.13% 100.00% 32 10

8Prophylactic antibiotics discontinued within 24 hours after surgery end time 99.68% 95.07% 99.00% 399 8 99.96% 96.63% 96.88% 32 1

9Cardiac surgery patients with controlled 6AM postoperative serum glucose 99.63% 94.28% 99.19% 123 9 100.00% 96.34% 100.00% 8 10

10Postoperative urinary catheter removal on post operative day 1 or day 2

n/a n/a n/a n/a n/a 99.89% 92.86% 100.00% 34 10

11 Recommended VTE prophylaxis ordered 100.00% 95.00% 100.00% 368 10 100.00% 95.65% 100.00% 8 10

12Received appropriate VTE prophylaxis within 24 hours prior - 24 hours after surgery 99.85% 93.07% 100.00% 368 10 100.00% 94.62% 100.00% 33 10

13Patients on beta blocker therapy prior to admit who received a beta blocker during perioperative period 100.00% 93.99% 99.28% 139 8 99.83% 94.92% 100.00% 33 10

Heart Attack

Pneumonia


Project

90.6%

National Baseline

Green

91.1%


National Baseline

Green

FY13 Score ACTUAL


Performance Period: FY13 (August 2012)

FY12 Score ACTUAL

FY12 Score GOAL 91.00%

81.00%

FY13 Score GOAL

Green’s Performance:CMS FY13 vs. FY14 Targets

CMS FY13 VBP CMS FY14 VBP

32

Green’s Performance:Indicator Drilldown

Site performance

National performance

Gap between top decile and median scores

decreases and the VBP achievement range narrows

FY13: 97.4% - 100%FY14: 98.1% - 100%

SCIP Antibiotic within 1 hourGreen’s score: 9 (99.8%) 0 (96.9% = 1 OFI*)

33 *OFI = Opportunity for improvement

FY 2014 Baseline and Performance Periods

ACTUAL Performance Period: Apr 2012 – Dec 2012 CURRENT Performance Period: Apr 2012 – Sep 2012

35

CMS FY14 VBP Performance:Update for Green

Bench-mark

Achieve-ment

Threshold

Current%

Current n Final Points

1 Fibrinolytic therapy within 30 minutes 96.30% 80.66% - 0 Insufficient Data

2 PCI within 90 minutes 100.00% 93.44% 100.00% 5 Insufficient Data

Heart Failure 3 Discharge instructions 100.00% 92.66% 100.00% 114 10

4 Blood cultures in ED before antibiotic 100.00% 97.30% 100.00% 1 Insufficient Data

5 Appropriate antibiotic selection 100.00% 94.46% 100.00% 26 10

6 Prophylactic antibiotic received within one hour prior to surgical incision 100.00% 98.07% 99.04% 208 5

7 Prophylactic antibiotic selection for surgical patients 100.00% 98.13% 100.00% 208 10

8 Prophylactic antibiotics discontinued within 24 hours after surgery end time 99.96% 96.63% 98.04% 204 4

9 Cardiac surgery patients with controlled 6AM postoperative serum glucose 100.00% 96.34% 100.00% 60 10

10 Postoperative urinary catheter removal on post operative day 1 or day 2 99.89% 92.86% 100.00% 210 10

11 Recommended VTE prophylaxis ordered 100.00% 95.65% 100.00% 71 10

12 Received appropriate VTE prophylaxis within 24 hours prior - 24 hours after surgery 100.00% 94.62% 100.00% 198 10

13 Patients on beta blocker therapy prior to admit who received a beta blocker during perioperative period 99.83% 94.92% 100.00% 198 10

Score: 89.00%

Heart Attack

Pneumonia


Project


National Baseline

Performance Period: FY13 (Apr 2012 - Sep 2012)

Green

How Will Hospitals Be Evaluated?Total Performance Score

CMS FY14 VBP

Patient Experience

About the same as our last VBP report so far

Outcome:Current Performance

38

B = Better than U.S. National RateN = No different than U.S. National RateW = Worse than U.S. National Rate

Performance Data Collection Period

Heart Attack 86.4% (N)

Heart Failure 91.2% (N)

Pneumonia 89.9% (N)

0.89 (W)

PSI 6: Iatrogenic pneumothorax 0.42 (N)

PSI 12: Postoperative VTE 5.88 (N)

PSI 14: Postoperative wound dehiscence 0.41 (N)

PSI 15: Accidental Puncture or Laceration 2.84 (W)

PSI 3: Pressure Ulcer 0.01PSI 7: Central Venous Catheter-Related Bloodstream Infections 0.28

PSI 8: Postoperative Hip Fracture 0.06

PSI 13: Postoperative Sepsis 17.95

1.35 (W) Jul 2011 - Mar 2012

AHRQ PSI-90 Composite for selected indicators(n = # outcomes)

30-day Mortality Rate (displayed as survival rate)

Central line-associated blood stream infection (shown as a Standardized Infection Ratio)

Green

Part of PSI-90 Composite



PSI-90 Measures:

NOT Publicly Reported

PSI-90 Measures:

Publicly Reported

not included 0.00 0.44 not included

Jul 2009 - Jun 2011

0.62not included 0.45 0.62 0.45

90.21% 88.18% 90.42% 88.27% 90.42% 88.27%

Jul 2008 - Jun 201190.42% 88.61% 90.03% 88.15% 90.03% 88.15%

BenchmarkAchieve-

mentThreshold

86.73% 84.77% 86.24% 84.75% 86.24% 84.75%

Achieve-ment

ThresholdBenchmark Benchmark

OUTCOME MEASURES2014 National

Baseline2015 National

Baseline2016 National

BaselineAchieve-

mentThreshold

VBP in FY16 and Beyond

39

40

*Six Domains:

1) Clinical Care

2) Person- and Caregiver-Centered Experience and Outcomes

3) Safety

4) Efficiency and Cost Reduction

5) Care Coordination

6) Community/ Population Health

CMS Shift for Quality Measurement:

Clinical Process Measures Outcomes and Efficiency Measures(not risk-adjusted) (risk-adjusted)

2013 2014 2015 2016

1.00% 1.25% 1.50% 1.75%

1 Process of Care 70% 45% 20%

2 Patient Experience 30% 30% 30%

3 Outcome - 25% 30%

4 Efficiency:Medicare Spending per Beneficiary - - 20%

VBP Fiscal Year

Reclassification of Domains:

National Quality Strategy*


VBP Program:Domain Overview

VBP FY16:Example of Reclassification

PROPOSED FY 2015 Domain

PROPOSED FY 2016 Domain

Clinical Care

Care Coordination

Clinical Care

Clinical Care

Patient Experience of Care

Person- and Caregiver-Centered Experience

and Outcomes

Clinical Care

Safety

Safety

Efficiency Efficiency and Cost Reduction

Pneumonia

Heart Failure - Discharge instructions

Heart Attack

30-day Mortality - Heart Attack, Heart Failure, Pneumonia

Clinical Process of Care

OutcomePSI-90 Composite - Patient safety for selected indicators

Central line-associated blood stream infection

Medicare spending per beneficiary

PROPOSED FY 2015 Measures

HCAHPS Questions

Surgical Care Improvement Project

41

SUMMARY

• The CMS VBP is how Medicare is paying us from here on out

• The top performers make money the poor performers have money taken away

• SGH is performing well but did not receive full opportunity payment

• Even 1 OFI impacts our final score• The bar keeps increasing as the nation

improves and as the measures evolve

Appendix

43

Bench-mark

Achieve-ment

Threshold

Current%

Current n Final Points Bench-

mark

Achieve-ment

Threshold

Current%

Current n Final Points

1 Fibrinolytic therapy within 30 minutes 91.91% 65.48% - 0 Insufficient Data 96.30% 80.66% - 0 Insufficient

Data

2 PCI within 90 minutes 100.00% 91.86% 100.00% 7 Insufficient Data 100.00% 93.44% 100.00% 2 Insufficient

Data

Heart Failure 3 Discharge instructions 100.00% 90.77% 100.00% 221 10 100.00% 92.66% 100.00% 40 10

4 Blood cultures in ED before antibiotic 100.00% 96.43% 100.00% 8 Insufficient Data 100.00% 97.30% - 0 Insufficient

Data

5 Appropriate antibiotic selection 99.58% 92.77% 98.18% 55 8 100.00% 94.46% 100.00% 9 10

6 Prophylactic antibiotic received within one hour prior to surgical incision 99.98% 97.35% 99.75% 406 9 100.00% 98.07% 98.65% 74 3

7 Prophylactic antibiotic selection for surgical patients 100.00% 97.66% 100.00% 407 10 100.00% 98.13% 100.00% 74 10

8 Prophylactic antibiotics discontinued within 24 hours after surgery end time 99.68% 95.07% 99.00% 399 8 99.96% 96.63% 98.65% 74 6

9 Cardiac surgery patients with controlled 6AM postoperative serum glucose 99.63% 94.28% 99.19% 123 9 100.00% 96.34% 100.00% 18 10

10 Postoperative urinary catheter removal on post operative day 1 or day 2 n/a n/a n/a n/a n/a 99.89% 92.86% 100.00% 75 10

11 Recommended VTE prophylaxis ordered 100.00% 95.00% 100.00% 368 10 100.00% 95.65% 100.00% 21 10

12 Received appropriate VTE prophylaxis within 24 hours prior - 24 hours after surgery 99.85% 93.07% 100.00% 368 10 100.00% 94.62% 100.00% 70 10

13 Patients on beta blocker therapy prior to admit who received a beta blocker during perioperative period 100.00% 93.99% 99.28% 139 8 99.83% 94.92% 100.00% 70 10

National Baseline

Green

Heart Attack

Pneumonia


Project


National Baseline

Green

FY13 Score ACTUAL


Performance Period: FY13 (August - September 2012)

FY12 Score ACTUAL

FY12 Score GOAL 91.0%89.0%

FY13 Score GOAL

91.1%90.6%

CMS FY13 VBP Targets CMS FY14 VBP Targets

44

FY12 vs FY13 VBP Board Objective for Green

VBP Board Objective:Indicator Drilldown for Green

Site performance

National performance

Gap between top decile and median scores

decreases and the VBP achievement range narrows

FY13: 97.35% - 100%FY14: 98.07% - 100%

SCIP Antibiotic within 1 hourGreen’s score: 9 (99.75%) 3 (98.65% = 1 OFI*)

45 *OFI = Opportunity for improvement

46

VBP Program:Performance Periods Overview

2013 VBP 2014 VBP 2015 VBP

1.00% 1.25% 1.50%weight 70% 45% 20%

All except AMI-10 Jul 1, 2011 - Mar 31, 2012 Apr 1, 2012 - Dec 31, 2012 Jan 1, 2013 - Dec 31, 2013

Only AMI-10 - - Apr 1, 2013 - Dec 31, 2013

weight 30% 30% 30%HCAHPS Jul 1, 2011 - Mar 31, 2012 Apr 1, 2012 - Dec 31, 2012 Jan 1, 2013 - Dec 31, 2013

weight 0% 25% 30%Mortality - Jul 1, 2011 - Jun 30, 2012 Oct 1, 2012 - Jun 30, 2013

AHRQ - - Oct 15, 2012 - Jun 30, 2013

CLABSI - - Jan 26, 2013 - Dec 31, 2013

weight 0% 0% 20%MSPB - - May 1, 2013 - Dec 31, 2013

Efficiency

VBP Fiscal Year

Outcome

Patient Experience of Care

Process of Care


Medicare Spending per Beneficiary (MSPB):• CMS claims based efficiency measure• Evaluates cost to Medicare of services performed by

hospitals and other healthcare providers during an MSPB episode– Start Date = 3 days prior to an inpatient index admission– End Date = 30 days post-hospital discharge

MSPB Measure =Hospital’s Average MSPB Amount

National Median MSPB Amount

Risk-adjusted Spending for All Episodes# Episodes MSPB Amount =

Efficiency:Medicare Spending per Beneficiary

47

• Price-standardization– Removes sources of variation that are due to

geographic payment differences– Variables: wage index, geographic practice

cost differences, disproportionate share hospital (DSH) payments for the poor and uninsured population

• Risk-adjustment– Accounts for variation due to patient health

status– Variables: age and severity of illness

Efficiency:Measure Methodology

48

Performance Period: May 2011 – December 2011

* Source: CMS Hospital-Specific Report, released September 2012

AchievementThreshold Benchmark Encinitas Green La Jolla Mercy

# Eligible Admissions - - 1,062 1,413 1,686 3,034

Cost per case(Risk-adjusted) ≈ $18,307 ≈ $14,495 $18,666 $17,112 $17,931 $19,312

MSPB Score Median ≈ 0.99

Mean of Top Decile ≈ 0.81

1.02 0.93 0.98 1.05

Scripps PerformanceVBP Performance Standards

Efficiency:Site Performance

49

Top 5%

Top 10%

Top 25% Median Bottom

25% Bottom

10%Bottom

5%

0.75 0.8 0.85 0.9 0.95 1 1.05 1.1 1.15

MSPB Scores

Mercy1.05

Encinitas1.02

La Jolla0.98

Green0.93

Efficiency:National Percentile Categories

50

value-based purchasing program overview - scripps.org · an annual market basket update with a 2.0...

Documents