value based purchasing series the first performance period has...

V a l u e B a s e d

P u r c h a s i n g S e r i e s

The first performance

period has ended…what

now?

Presented by:

Craig Deao, MHA

Objectives

At the conclusion of this video you will be able to:

Discuss where we stand within the Value-Based

Purchasing timeline

Describe the key changes taking effect for the 2014

performance period

W h e r e w e ’ v e b e e n . . .

Implementation Timeline

We Are Here

CY 2009 CY 2010 CY 2011 CY 2012 CY 2013

1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q

Baseline Period

(Jul 2009 – Mar 2010 ) Performance Period

(Jul 2011 – Mar 2012 ) Payments Affected

(Oct 2012 – Sept 2013 )

Incentive

Payments Announced

Value Based Purchasing FY 2013

12 Process of Care Measures

(* 70% Weight)

HCAHPS

(* 30% Weight)

1% Base operating DRG

payments

Performance attainment and improvement

will determine total

hospital reimbursement

Implementation FY 2013 (October 2012) Source: Value Based Purchasing Program final rule 4.29.11

W h e r e w e ’ r e g o i n g . . .

Value Based Purchasing FY 2014

Process of Care Measures (45% Weight)

HCAHPS Composites (30% Weight)

1.25% Base operating

DRG payments

Performance attainment and improvement

will determine total

hospital reimbursement

Outcomes (25% Weight)

New 2014

update

Note: Implementation FY 2014 Source: OPPS VBP Final rule 11.1.11

2014 VBP Reimbursement Periods New 2014

update

CY 2009 CY 2010 CY 2011 CY 2012 CY 2013


Process of Care & HCAHPS

Baseline Period

(Apr-Dec 2010)

Process of Care & HCAHPS

Performance Period

Outcomes

Baseline Period

(Jul 2009 – Jun 2010)

Outcomes

Performance Period

(Jul 2011 – Jun 2012)

CY 2009 CY 2010 CY 2011 CY 2012 CY 2013


(Apr-Dec 2012)

2014 Proposed vs. Final Rule

Eliminated the Efficiency Domain

Finalized the Outcomes Domain and associated measures

Eliminated the composite scores for Hospital Acquired

Conditions (HACs) and AHRQ Measures (initially part of

Outcomes Domain)

Addition of Core Process Measure: Postoperative Urinary

Catheter Removal on Postoperative Day 1 or 2

(SCIP-Inf-9)

Finalized domain weighting

Released new floor, threshold and benchmark numbers for

the 2014 performance periods


New 2014

update

2014 Patient Experience of Care Domain (HCAHPS)


Green = increased threshold from 2013

Red = decreased threshold from 2013

Floor

2013

National

Threshold

2014

National

Threshold

2013

National

Benchmark

2014

National

Benchmark

Communication with Nurses 42.84% 75.18% 75.79% 84.70% 84.99%

Communication with Doctors 55.49% 79.42% 79.57% 88.95% 88.45%

Responsiveness of Hospital Staff 32.15% 61.82% 62.21% 77.69% 78.08%

Pain Management 40.79% 68.75% 68.99% 77.90% 77.92%

Communication about Medicines 36.01% 59.28% 59.85% 70.42% 71.54%

Hospital Cleanliness & Quietness 38.52% 62.80% 63.54% 77.64% 78.10%

Discharge Information 54.73% 81.93% 82.72% 89.09% 89.24%

Overall Rating of Hospital 30.91% 66.02% 67.33% 82.52% 82.55%

New 2014

update

Improvement Achievement Consistency

The greater of the two

scores will be used for each

composite

Achievement – Improvement – Consistency HCAHPS Scoring

Based on achievement

performance in ALL

composites or lowest

index composite will be

used Note: Implementation FY 2014 Source: OPPS VBP Final rule 11.1.11

New 2014

update

2014 Final Rule Process of Care Measures

Measure ID Measure 2013 National

Threshold

2014 National

Threshold 2013 National

Benchmark

2014 National

Benchmark

AMI–7a

Fibrinolytic Therapy Received Within

30 Minutes of Hospital Arrival 0.6548 0.8066 0.9191 0.9630

AMI–8a

Primary PCI Received Within 90

Minutes of Hospital Arrival 0.9186 0.9344 1.0000 1.0000

HF–1 Discharge Instructions 0.9077 0.9266 1.0000 1.0000

PN–3b

Blood Cultures Performed in the

Emergency Department Prior to Initial Anti-biotic Received in Hospital

0.9643 0.9730 1.0000 1.0000

PN–6

Initial Antibiotic Selection for CAP in

Immunocompetent Patient 0.9277 0.9446 0.9958 1.0000

New 2014

update






Threshold

2014 National


Benchmark

2014 National

Benchmark

SCIP–Inf–1

Prophylactic Antibiotic Received Within

One Hour Prior to Surgical Incision 0.9735 0.9807 0.9998 1.0000

SCIP–Inf–2

Prophylactic Antibiotic Selection for

Surgical Patients 0.9766 0.9813 1.0000 1.0000

SCIP–Inf–3

Prophylactic Antibiotics Discontinued

Within 24 Hours After Surgery End Time 0.9507 0.9663 0.9968 0.9996

SCIP–Inf–4

Cardiac Surgery Patients with Controlled

6AM Postoperative Serum Glucose 0.9428 0.9634 0.9963 1.0000

SCIP–Inf–9

Postoperative Urinary Catheter Removal

on Post Operative Day 1 or 2 N/A 0.9286 N/A 0.9989

New 2014

update



NEW




Threshold

2014 National


Benchmark

2014 National

Benchmark

SCIP–Card–2

Surgery Patients on a Beta Blocker Prior

to Arrival That Received a Beta Blocker

During the Perioperative Period 0.9500 0.9565 1.0000 1.0000

SCIP–VTE–1

Surgery Patients with Recommended

Venous Thromboembolism Prophylaxis

Ordered 0.9307 0.9462 0.9985 1.0000

SCIP–VTE–2

Surgery Patients Who Received

Appropriate Venous Thromboembolism

Prophylaxis Within 24 Hours Prior to

Surgery to 24 Hours After Surgery

0.9399 0.9492 1.0000 0.9983

New 2014

update




2014 Outcome Measures

Measure ID Measure National

Threshold National

Benchmark

MORT–30–

AMI

Acute Myocardial Infarction (AMI) 30-

Day Mortality Rate (shown as survival

rate)

0.8477 0.8673

MORT–30–HF Heart Failure (HF) 30-Day Mortality

Rate (shown as survival rate) 0.8861 0.9042

MORT–30 PN Pneumonia (PN) 30-Day Mortality

Rate (shown as survival rate) 0.8818 0.9021


New 2014

update

HCAHPS & Mortality

“[W]hen we controlled for a hospital’s clinical

performance, higher hospital-level patient

satisfaction scores were independently associated

with lower hospital inpatient mortality rates.”

Source: Glickman SW et al, Patient Satisfaction and Its Relationship with Clinical Quality

and Inpatient Mortality in Acute Myocardial Infarction, Circ Cardiovasc Qual Outcomes

2010;3:188-195.

Improvement Achievement

The greater of the two

scores will be used for each

Core Measure

Achievement – Improvement Process of Care & Outcomes Scoring


New 2014

update

More in Store

1% 1.25% 1. 5% 1. 75% 2%

1% 2% 3% 3% 3%

HCAHPS & Readmissions

For all three clinical areas (AMI, HF, PN),HCAHPS

performance was more predictive of readmission

rates “than the objective clinical performance

measures often used to assess the quality of hospital

care.”

Source: Boulding W et al. Relationship between Patient Satisfaction with Inpatient Care

and Hospital Readmissions Within 30 Days, Am J Manag Care. 2011; 17(1): 41-48.

value based purchasing series the first performance period has...

Documents