FHA Quality Initiatives: Understanding the Star Ratings Background - - PowerPoint PPT Presentation

FHA Quality Initiatives: Understanding the Star Ratings

Background

• FHA Board Goal to Improve Care in

Florida

• FHA Quality and Patient Safety

Committee

• More Florida Hospitals as 4 or 5 Stars

Star Ratings

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% One Star Two Stars Three Stars Four Stars Five Stars Florida National

34 260 65 753 33 1,187 32 1,155 5 337

Steps to Increasing 4 and 5 Star Hospitals

• Increase understanding of the Star

Ratings

• Offer improvement resources, tools and

support

• Identify high performing hospitals and

their strategies

7/13/2018 5

Hospital STAR Ratings

Presented by: Kimberly Rask, MD PhD Chief Data Officer

Kimberly.Rask@Allianthealth.org

July 2018

Key Objectives

► Purpose of star ratings ► Measures that are included in star ratings ► How those measures are translated into a rating ► Impact of recent changes in methodology ► Potential future changes ► Strategies for high performance

Purpose of Star ratings

► Over 100 measures on Hospital Compare ► Complaints by consumer groups that it is

intimidating and difficult to compare hospitals

► User-friendly format that lets consumers gauge

a summary rating across multiple dimensions of quality

What is included in Star rating

► Current measures on Hospital Compare ► Will evolve as measures are added or removed ► Different measures reported by different

hospitals

► For the same measure, each hospital may

report a different number of cases

► Some metrics are updated quarterly, some

annually

Translating Hospital Compare Measures into a Star Rating

Step 1: Picking the measures

► Start with all measures on Hospital Compare ► Delete any measures that are suspended,

retired or delayed

► Exclude any measures not being currently

publicly reported

► Exclude measures reported by <100 hospitals ► Exclude most structural measures ► Exclude non-directional measures

Step 2: Grouping the Measures

Measure Group Individual Measures es Mortality AMI, CABG, COPD, HF, PN, Stroke; PSI- surgical complications Readmission EDAC for AMI, HF, PN; READM for CABG, COPD, Hip-Knee, Stroke, hospital-wide; visit after outpatient colonoscopy Safety of Care CLABSI, CAUTI, SSI-colon, SSI-Hysterectomy, MRSA, c diff, complication following Hip-Knee, PSI composite Patient Experience Cleanliness, nurse and MD communication, responsiveness, medications, discharge, overall rating, quietness, transition measure, willingness to recommend Efficient Use of Medical Imaging MRI low back pain, Thorax and Abd CT with contrast, pre-

• p cardiac imaging, simultaneous sinus and brain CT

Timeliness of Care ED times, fibrinolysis times, ECG time, time to transfer for cardiac intervention, time to evaluation, fracture med time Effectiveness of Care Influenza, ASA, stroke scan results, polyp surveillance, elective delivery, sepsis, VTE, XRT for bone mets

Steps 3: Calculating a Group Score

1.

Standardize individual measures so on same scale

• Z-score: higher value always better

2.

Group into categories similar to HVBP program

3.

Calculate group scores from latent variable models (LVM)

• Measures that are more consistent with each other and

measures that have larger denominators have more influence

• The influence of individual measures will change with every

cycle 4.

Modification added adaptive quadrature enhancement to the model

Step 4: Generate Summary Scores

► Policy-based weighting for measure groups

– Measure importance – Consistency – Policy priorities – Stakeholder input

► Re-distribute group weights if hospital does not

report any in that group

► Generate summary scores as a weighted

average of group scores

Weighting the Measures

Step 5: Apply reporting threshold

► Previously this happened AFTER the Star ratings

were calculated

► Now only calculate Star ratings for hospitals for

whom they will be reported

– Must have 3 measure groups, one of which is an

• utcomes group, with 3 measures each

– 80% of hospitals meet threshold

Translating Hospital Compare Measures into a Star Rating

Step 6: Assign Star Ratings

St Star ar Description Cluster of hospitals with highest summary scores Cluster with higher than average summary scores Cluster of hospitals with average summary scores Cluster with below average summary scores Cluster of hospitals with lowest summary scores

• Apply k- clustering with multiple iterations to assign hospitals to
• ne of five Star Ratings categories
• Hospitals are more similar to others in their group than to

hospitals in other groups

July Update to Hospital Compare Delayed

► Concerns about the weighting process

1. Number of measures reported can affect the rating

• ? Bias toward specialty hospitals and against major teaching

hospitals

2. Differential weighting intended to “separate” hospitals in the ranking process means that an individual measure may be much more heavily weighted than other measures in the same group

• Changes from quarter to quarter
• Example of PSI-90 and complications from Hip-Knee following

transition to ICD-10

Hospital Specific Reports

► CMS shares Overall Hospital Quality Star

Ratings Hospital Specific Reports (HSRs) approximately 2 month prior to public reporting

► Hospitals receive a QualityNet notification and

have a 30 day review period

► Reports include summary scores, performance

category and standardized individual measure scores

Overall Hospital Quality Star Rating Hospital-Specific Report (HSR)

Table 1: Overall Hospital Quality Star Rating Results for Your Hospital and the Nation HOSPITAL NAME Results corresponding with data for July 2018 public reporting on Hospital Compare Overall Hospital Rating Results Your Hospital's Results National Average Star Rating [a] ** (2 out of 5 stars) *** (3 out of 5 stars) Hospital Summary Score [b]

• 0.29
• 0.02

Hospital Summary Score Confidence Interval - Lower Limit [c]

• 0.64
• Hospital Summary Score

Confidence Interval - Upper Limit [c] 0.06

• [a] A star rating is categorized as one to five whole stars or "N/A". A greater number of stars indicates better
• performance. The National Average column shows the average star rating across the nation.

[b] A summary score is used to determine the star rating category and is calculated from each hospital's measure group scores shown in Table 2. A higher summary score indicates better performance. [c] The 95% confidence interval for your hospital's summary score. The lower confidence limit and upper confidence limit are provided, with a 95% confidence that your performance falls within this range for summary scores.

Table 2: Measure Group Score Results and Weights

Table 2: Measure Group Score Results and Weights for the Overall Hospital Quality Star Rating HOSPITAL NAME Results corresponding with data for July 2018 public reporting on Hospital Compare Measure Group Number of Potential Measures within Each Group [a] Number of Measures for Your Hospital [b] Your Hospital's Measure Group Weight [c] Standard Measure Group Weight Measure Group Score [d] Group Confidence Intervals - Lower Limit, Upper Limit [e] National Group Score [f] Performance Category [g] Mortality 7 4 22.0% 22.0%

• 0.16
• 1.51, 1.20

0.0004 Same as the national average Readmission 9 5 22.0% 22.0%

• 0.29
• 0.57, -0.02
• 0.06

Same as the national average Safety of Care 8 5 22.0% 22.0% 0.16

• 0.28, 0.60
• 0.04

Same as the national average Patient Experience 10 10 22.0% 22.0%

• 0.98
• 1.61, -0.36
• 0.0004

Below the national average Efficient Use of Medical Imaging 5 3 4.0% 4.0% 0.64

• 0.36, 1.63

0.003 Same as the national average Timeliness of Care 7 6 4.0% 4.0%

• 0.75
• 1.14, -0.35
• 0.02

Below the national average Effectiveness of Care 11 9 4.0% 4.0%

• 0.14
• 1.02, 0.73

0.03 Same as the national average

Table 3: Individual Measure Scores

Table 3: Individual Measure Score Results for the Overall Hospital Quality Star Rating HOSPIITAL NAME Results corresponding with data for July 2018 public reporting on Hospital Compare Measure Group [a] Measure ID [b] Measure Name [c] Your Hospital's Measure Result on Hospital Compare [d] Measure’s National Mean of Scores [e] Measure's Standard Deviation Across Hospitals [f] Your Hospital's Standardized Measure Score [g] Mortality MORT-30-AMI Acute Myocardial Infarction (AMI) 30-Day Mortality Rate 13.0% 13.2% 0.01 0.17 Mortality MORT-30-CABG Coronary Artery Bypass Graft (CABG) 30-Day Mortality Rate N/A 3.2% 0.01

• Mortality

MORT-30-COPD Chronic Obstructive Pulmonary Disease (COPD) 30-Day Mortality Rate 8.0% 8.4% 0.01 0.36 Mortality MORT-30-HF Heart Failure (HF) 30-Day Mortality Rate 10.1% 11.8% 0.02 1.02 Mortality MORT-30-PN Pneumonia (PN) 30-Day Mortality Rate 19.1% 15.9% 0.02

• 1.64

Mortality MORT-30-STK Acute Ischemic Stroke (STK) 30-Day Mortality Rate N/A 14.3% 0.02

• Mortality

PSI-4-SURG- COMP Death Rate Among Surgical Inpatients with Serious Treatable Complications N/A 161.78 17.01

Table 4: Appendix A. National Measure Loadings - July 2018 Release

Table 4: Appendix A. National Measure Loadings for the Overall Hospital Quality Star Rating - July 2018 Release The loading coefficients in this tab are the same for all hospitals across the nation in this release of the Star Rating. Results corresponding with data for July 2018 public reporting on Hospital Compare. Measure Group [a] Measure ID [b] Measure Name [c] Loading Coefficient [d] Mortality MORT-30-AMI Acute Myocardial Infarction (AMI) 30-Day Mortality Rate 0.51 Mortality MORT-30-CABG Coronary Artery Bypass Graft (CABG) 30-Day Mortality Rate 0.33 Mortality MORT-30-COPD Chronic Obstructive Pulmonary Disease (COPD) 30-Day Mortality Rate 0.68 Mortality MORT-30-HF Heart Failure (HF) 30-Day Mortality Rate 0.71 Mortality MORT-30-PN Pneumonia (PN) 30-Day Mortality Rate 0.66 Mortality MORT-30-STK Acute Ischemic Stroke (STK) 30-Day Mortality Rate 0.48 Mortality PSI-4-SURG-COMP Death Rate Among Surgical Inpatients with Serious Treatable Complications 0.28

Overall Hospital Quality Star Rating

► Are updated quarterly, but not all measures will

change

► Performance is always compared to other

hospitals nationally

► All measures come from Hospital Compare and

many are included in HVBP, HRRP, HAC programs

► Use HSRs to drill down and guide improvement

efforts

This material was prepared by GMCF, for Alliant Quality, the Medicare Quality Innovation Network – Quality Improvement Organization for Georgia and North Carolina, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 11SOW-GMCFQIN-NC-C3-18-05

FHA Resources

• Mission to Care HIIN
• http://www.fha.org/health-care-issues/quality-and-

safety/mtc-hiin.aspx

• Upcoming Events
• July 19 – Readmissions: the Role of the Pharmacist in

Care Transitions (Webinar)

• July 24 – Readmissions: Discharge Lounge (Webinar)
• July 26 –Emergency Department Information Exchange

Tool (Lunch & Learn, Hollywood, FL)

• August 7 – Wound Care Training [HIIN hospitals only]

(Orlando, FL)

• August 14 – Chasing Zero Infections Series: Sustaining

Zero Infections: Stop the "Whack a Mole Syndrome" (Webinar)

• August 16 – NHSN Workshop II (Orlando , FL)

Visit the FHA Mission to Care HIIN Website to register for upcoming events and to access quality improvement resources.

FHA Quality Support

Contact Us: HIIN@fha.org | Phone: 407-841-6230

• Kim Streit, FACHE, MBA, MHS

VP of Health Care Research & Information Services

• Phyllis Byles, RN, BSN, MHSM, BC-NEA

Clinical Performance Improvement Advisor

• Dianne Cosgrove, MS, RN, CPHQ, LHRM

Director of Clinical Quality Improvement

• Cheryl D. Love, RN, BSN, BS-HCA, MBA, LHRM, CPHRM

Director of Quality & Patient Safety

• Debbie Hegarty

Manager of Surveys & Special Projects / Data Support

• Luanne MacNeill

Quality Initiatives Coordinator

• Allison Sandera

Project Manager