Centennial Care Hospital Quality Improvement Incentive Pool - - PowerPoint PPT Presentation

Centennial Care Hospital Quality Improvement Incentive Pool

Presented by Ellen Interlandi and Beth Landon, NMHA

 HQII – Hospital Quality

Improvement Incentive Pool

 SNCP – Safety Net Care Pool

Hospitals (formerly SCP – Sole

Community Provider Hospitals)

NM-specific, 29 hospitals

 MAD – Medical Assistance

Division, a division of …..

 HSD – NM Human Services

Dept

 HCAHPs – Hospital

Consumer Assessment of Healthcare Providers & Systems

 HIDD – Hospital

Inpatient Discharge Data (or Administrative Data)

patient record level information for all inpatients in non-federal hospitals, reported quarterly

 HEN – Hospital

Engagement Network a

CMS nationally funded initiative for quality outcomes, 30 NM hospitals participating; similar quality measures but NOT the same program as HQII

AAAA AAAA – American

Association Against Acronym Abuse

What is is the HQII? I?

∙The Hospital Quality Improvement Incentive (HQII) Pool is a component of the Safety Net Care Pool. ∙It was approved by the Centers for Medicare and Medicaid Services (CMS) as part of the §1115 Waiver – Centennial Care. ∙Calendar year 2014 was “Year 1” for the Waiver, data submission began in Year 2 (2015) ∙The purpose of the HQII is “to incentivize hospitals’ efforts to meaningfully improve the health and quality of care of the Medicaid and uninsured individuals that they serve”.

How wil ill i l it work rk?

∙The HQII Pool will be distributed to participating “qualified hospitals” that meet certain benchmarks on the designated performance measures ∙For 2015, there was $2.8 million in the Pool; for 2016 there is about $5.7 million

DY 1 (CY 2014) DY 2 (CY 2015) DY 3 (CY 2016) DY 4 (CY 2017) DY 5 (CY 2018) Total UC Pool $68,889,323 $68,889,323 $68,889,323 $68,889,323 $68,889,323 $344,446,615 HQII Pool

• $2,824,462

$5,764,727 $8,825,544 $12,011,853 $29,426,586 % UC Pool 100% 96% 92% 89% 85% 92% % HQII n/a 4% 8% 11% 15% 8% Total $68,889,323 $71,713,785 $74,654,050 $77,714,867 $80,901,176 $373,873,201

How Much is is in in the Po Pool? l?

• The HQII is a component of the Safety Net Care Pool.
• The other component, the Uncompensated Care Pool is a fixed

amount ($68.9 million each year).

• The amount available for HQII is designed to be the “growth

rate” over time and will increase each year,

From the Centennial Care Waiver – Special Terms and Conditions

What is is the HQII I Tim imeli line? ne?

• HQII implementation began January 1, 2014 with hospital

agreement to participate

• Hospitals submitted baseline data for DY2 (Calendar Year

2014) November 2015

• Hospitals will submit new measures for DY3 by October

2016.

• Allocation Payment Methodology will be used to

determine pool of funds for which each hospital is eligible. Pause se for Questions ions

What t are the Perfor rformance mance Measu sures res

The outcome measures are divided into two domains: ∙Doma main in 1 - Urgent nt Impro provements ements in Care. Critical patient safety and quality measures for areas of widespread need. ∙Doma main in 2 - Popula ulatio tion-fo focuse cused d Improve provemen ments ts. . Measures of prevention and improved care delivery for the highest burden conditions in the Medicaid and uninsured population

Do Doma main in 1 M Measures sures

• Adverse Drug Events
• Catheter-Associated Urinary Tract Infections
• Central Line Associated Blood Stream Infections
• Injuries from Falls and Immobility
• Obstetrical Adverse Events
• Pressure Ulcers
• Surgical Site Infections
• Venous Thromboembolism
• Ventilator-Associated Pneumonia
• All Cause Readmissions

• 1. Adverse Drug Events

DATA COLLECTION METHOD: Self-report

• A. Hypogly

poglyce cemia mia in Inpatien patients Receiv eceivin ing g Insuli sulin Numerator – Hypoglycemia in inpatients receiving insulin or other hypoglycemic agents Denominator - Inpatients receiving insulin or other hypoglycemic agents Rate = Numerator Denominator x 100

• 1. Adverse Drug Events

DATA COLLECTION METHOD: Self-report

• B. Adverse Drug Events

nts due to O Opioids

Numerator – number of patients treated with opioids who received naloxone Denominator - number of inpatients who received an opioid agent Rate = Numerator Denominator x 100 patients

c.

• c. Exce

cessive ve anticoag

• agul

ulati ation n with Warfar arin in – Inpatients ients

Numerator – Inpatients experiencing excessive anticoagulation with warfarin Denominator - Inpatients receiving warfarin anticoagulation therapy Rate = Numerator Denominator x 100

Resources online at the following link: http://partnershipforpatients.cms.gov/p4p_resources/tspadversedrugeven ts/tooladversedrugeventsade.htm

http://www.hcahpsonline.org/Files/HCAHPS_Fact_Sheet_June_2015.pdf https://www.cms.gov/medicare/quality-initiatives-patient-assessment- instruments/hospitalqualityinits/downloads/hospitalhcahpsfactsheet201007.pdf

• Asks recently discharged patients about aspects of hospital experience
• Random sample of adult inpatients(medical, surgical, maternity)

between 48 hours and six weeks after discharge; not restricted to Medicare patients

• Can be done by mail, telephone, mail with telephone follow-up or active

interactive voice recognition. Publicly available, hospitals may get soon after end of each quarter

• Must have at least 300 completed surveys over 4 calendar quarters to

reach statistical reliability

• Percentage of patients who gave their hospital a rating of 9 o
• r 1

10

• 2. Cath

atheter ter-Assoc Associated iated Urinary nary Tract act In Infe fections(CAUTI) tions(CAUTI) (NHSN)

Numerator – total number of observed healthcare associated CAUTI among patients in bedded inpatient locations Denominator - total number of indwelling urinary catheter days for each location under surveillance for CAUTI Rate = Numerator Denominator x 1,000 Specifications available from http://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf

• 3. Centr

ntral al Line Associa

• ciated

ted Blood

• d

Str tream eam In Infe fections tions (CLABSI) ABSI) (NHSN)

Numerator – total number of observed healthcare associated CLABSI among patients in bedded inpatient locations Denominator - total number of central line days for each location under surveillance for CLABSI Rate = Numerator Denominator x 1,000 Specifications available from http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf

• 4. In

Inju juries ries fr from Falls lls and d Im Immo mobility/Trauma bility/Trauma HAC 05 CMS (HIDD)

Numerator – total number of hospital acquired

• ccurrences of fracture, dislocation, intracranial injury,

crushing injury, burn and other injury (codes within the CC/MCC list) Denominator - inpatient discharges Rate = Numerator Denominator x 1,000

https://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/wPOAFactSheet.pdf https://www.cms.gov/Medicare/Medicare-Fee-for- Service-Payment/HospitalAcqCond/Hospital- Acquired_Conditions.html

• 5. Ob

Obstet stetrical rical Ad Adve verse rse Eve vent nts (HIDD)

OB Traum auma a – Vagina inal l Deliv iver ery y with th Instr trum umen enta tatio ion PSI 18

Numerator – discharges, among cases meeting the inclusion and exclusion rules for the Denominator, with any listed diagnostic codes for third and fourth degree obstetric trauma Denominator - all vaginal delivery discharges with any procedure code for instrument-assisted delivery Rate = Numerator Denominator x 1,000

Specifications available from http://qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50- ICD10/TechSpecs/PSI%2018%20Obstetric%20Trauma%20Rate%20%E2%80%93 %20Vaginal%20Delivery%20With%20Instrument.pdf

5. . Ob

Obstet tetrical rical Adve verse rse Eve vent nts s (HIDD)

OB Traum uma a – Vaginal nal Delivery very witho hout ut Instr trumen umentati ation

• n PSI 19

Numerator – discharges, among cases meeting the inclusion and exclusion rules for the denominator, with any listed diagnostic codes for third and fourth degree obstetric trauma Denominator - vaginal deliveries identified by DRG or MS-DRG code Rate = Numerator Denominator x 1,000

Specifications available from http://qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50- ICD10/TechSpecs/PSI%2019%20Obstetric%20Trauma%20Rate- Vaginal%20Delivery%20Without%20Instrument.pdf

6. . Pressure

sure Ul Ulcers St Stage ge III & IV & IV rate PSI

I 3 (HIDD)

Numerator - discharges, among cases meeting the inclusion and exclusion rules for the denominator, with any secondary ICD-9-CM or ICD-10-CM diagnosis codes for pressure ulcer and any secondary ICD-9-CM or ICD-10-CM diagnosis codes for pressure ulcer stage III or IV (or unstageable). Denominator – inpatient adult discharges Rate = Numerator Denominator x

Specifications available from http://qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50- ICD10/TechSpecs/PSI%2003%20Pressure%20Ulcer%20Rate.pdf Note: update terminology, NPUAP has revised language to describe “pressure injury”

• 7. Sur

urgica gical l Site te In Infe fections tions (NHSN)

Colon, abdominal hysterectomy, total knee replacement, or total hip replacements Numerator – total number surgical site infections based on CDC NHSN definition Denominator - all patients having any of the procedures included in the selected NHSN operative procedures category(s) Rate = Numerator Denominator X 100

Specifications available from http://www.cdc.gov/nhsn/PDFs/ pscManual/9pscSSIcurrent.pdf

8.

• 8. Ve

Veno nous us Thr hromboembolism

• mboembolism (VT

VTE) E)

post

• st-op
• per

erative ative PSI

I 12 (HIDD)

Numerator – Discharges, among cases meeting the inclusion and exclusion rules for the denominator, with a secondary ICD-9-CM diagnosis code for deep vein thrombosis or a secondary ICD-9-CM diagnosis code for pulmonary embolism. Denominator - all patients having any of the procedures included in the selected NHSN operative procedures category(s) Rate = Numerator Denominator X 1,000

Specifications available from http://www.qualityindicators.ahrq.gov/Downloads/Modules/ PSI/V50/TechSpecs/PSI_12_Perioperative_Pulmonary_Embolis m_or_Deep_Vein_Thrombosis_Rate.pdf

9. . Ventil

ilat ator

• r –Asso

socia ciated ed Pneumo umoni nia a (VAP) (NHSN)

Vent ntil ilator

• r Associ

ssociated ed Condit ition

• n (VAC)

AC)

Numerator – number of events that meet the criteria of VAC; including those that meet the criteria for infection- related ventilator associated complication (IVAC) and possible/probable ventilator-associated pneumonia (VAP) Denominator - number of ventilator days Rate = Numerator Denominator X 1,000 vent days

Infec fecti tion

• n-Rel

Relate ted Vent ntila lato tor r Ass ssoc

• cia

iated ted Compli lica cati tion

• n (IVAC)

IVAC)

Numerator – number of events that meet the criteria of infection-related ventilator-associated condition (IVAC); including those that meet the criteria for possible/probable ventilator-associated pneumonia (VAP) Denominator - number of ventilator days Rate = Numerator Denominator X 1,000 Resources available from http://www.cdc.gov/nhsn/PDFs/pscManual/10-VAE_FINAL.pdf NOTE: VAE is currently not included in CMS Hospital Inpatient Quality Reporting. Current NHSN recommendations for “appropriate public reporting” include  Overall VAE rate = rate of all events meeting at least the VAC definition  “IVAC –plus” rate = rate of ALL events meeting at least the IVAC definition According to NHSN, only 44% of the experts can correctly identify a VAE/IVAC/VAC, PVAP

10.

• 10. Al

All Cau ause se Pre reventa ventable ble Readmis admissions sions

(NQF QF 1789) (HIDD)

Numerator - inpatient admission to any acute care facility which occurs within 30 days of the discharge date of an eligible index admission. All readmissions are counted as outcomes except those that are considered planned. Denominator – adult admissions to acute care facility (minus Denominator exclusions) Rate = Numerator Denominator X 100

Resource available from: http://www.qualityforum.org/Projects/NQF_All- Cause_Readmissions_Project.aspx

1.

Diabetes Short-term Complications Admissions Rate (PQI 01)

2.

Diabetes Long-term Complications Admission Rate (PQI 03)

3.

COPD or Asthma in Older Adults Admission Rate (PQI 05)

4.

Heart Failure Admission Rate (PQI08)

5.

Bacterial Pneumonia Admission Rate (PQI 11)

6.

Angina without Procedure Admission Rate

(PQI13)

7.

Uncontrolled Diabetes Admission Rate (PQI14)

8.

Asthma in Younger Adults Admission Rate (PQI

15)

1.

Diabetes Short-term Complications Admissions Rate (PQI 01)

Numerator - Discharges, for patients ages 18 years and older, with a principal ICD-9-CM diagnosis code for diabetes short-term complications (ketoacidosis, hyperosmolarity, or coma). Denominator – Patient discharges

2.

Diabetes Long-term Complications Admission Rate (PQI 03)

3.

COPD or Asthma in Older Adults Admission Rate (PQI 05)

4.

Heart Failure Admission Rate (PQI08)

5.

Bacterial Pneumonia (PQI 11)

6.

Angina without Procedure Admission Rate

(PQI13) 7.

Uncontrolled Diabetes Admission Rate (PQI14)

8.

Asthma in Younger Adults Admission Rate

(PQI 15) References for Domain 2 measures at: http://www.qualityindicators.ahrq.gov/modules /pqi_resources.aspx Pause e for Questions estions

 http://nmhanet.org/quality.html  http://www.qualityindicators.ahrq.gov/Modul

es/PQI_TechSpec.aspx

Wha hat t Do

• Ho

Hospital pitals Ha Have ve to to Do Do?

Pause for Questi tions

• ns

Outs tstanding tanding Quest stion ions s and d Is Issu sues es

What if hospitals submitted different data numerator/denominators in DY2? To be determined Do all hospitals need to meet benchmarks on all measures?

• No. Hospitals with fewer than 100

beds will only be evaluated on 6 of the 10 domain 1 measures. Will hospitals be penalized for not submitting data for services they do not provide? This is not the State’s intent and is why we limited the number of measures for hospitals with <100 beds. Is there a minimum denominator to be statistically significant? Denominator less than 10 for most measures; HCAHPs measure is 300 min surveys in a calendar year How should collected data be submitted to HSD? How will the dollars be allocated? To be determined

Ellen Interlandi einterlandi@nmhsc.com Beth Landon blandon@nmhsc.com 505-343-0010