Hospital Metrics TAG February 14, 2017 PLEASE DO NOT PUT YOUR PHONE - - PowerPoint PPT Presentation

Hospital Metrics TAG

February 14, 2017 PLEASE DO NOT PUT YOUR PHONE ON HOLD: IT IS BETTER TO HANG UP AND CALL BACK IN IF NEEDED

Welcome and Introductions

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Agenda Overview

• Updates
• Year 3 data submission process and schedule
• CLABSI / CAUTI (Year 3 and 4)
• Details of CMS approved Year 4 program structure
• H-TAG in 2017
• Unity Center for Behavioral Health

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Updates

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Updates

• CMS approved Oregon’s Medicaid waiver and

HTPP Year 4 (more on that separately)

• OAHHS opioid / readmissions education day

planned for February 24, 2017

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CCO Metrics & Scoring Committee Updates (1/2)

• The Committee has removed the claims-based SBIRT

measure from the 2017 incentive measure set, given additional coding complications.

• The Committee encourages CCOs and practices to

continue implementing SBIRT while an EHR-based measure is developed in 2017.

• The Committee intends to reinstate the EHR-based

measure to the incentive set for CY 2018.

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CCO Metrics & Scoring Committee Updates (2/2)

• The Committee also met on January 20th to review their

work plan for selecting 2018 measures, begin a discussion on patient experience measures, and to come to a decision about a health equity measure.

• The Committee has agreed to adopt the Emergency

Department Utilization measure for people experiencing severe and persistent mental illness (SPMI) as the equity measure for 2018.

– Additional details about the proposal are available in the January meeting materials online. http://www.oregon.gov/oha/analytics/Pages/Metrics- Scoring-Committee.aspx

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Health Plan Quality Metrics Committee

• Purpose: to identify health outcome and quality

measures that may be applied to services provided by CCOs or paid for by health benefit plans sold though the HIE or offered by the OEBB or the PEBB.

• Will not oversee hospital metrics, but there will

be a hospital representative on the Committee

• OHA working to finalize Committee

membership

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Year 3 Close Out Process

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Year 3 Close-out

• See materials, Year 3 performance calculations

document

• OHA is posting an Excel document that gives an

explanation of the calculations used in assessing payment, including rounding conventions, etc: http://www.oregon.gov/oha/analytics/Pages/Hos pital-Baseline-Data.aspx

• It includes a copy of the template OHA uses to

assess payment. Hospital can see the formulas used, etc.

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Year 3 Close-out

• See materials: Year 3 timeline
• Timeline and data submission document

updated to include a table with the data source for each metric (progress reporting versus final data used for payment).

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Year 3 Close-out

• Key dates

– February 15th: CMT publishes final Year 3 EDIE measure report. – February 23rd: OHA distributes final Follow-up after hospitalization for mental illness measure progress report to all hospitals. Hospitals must respond with any additional requested changes to these reports by 3/31/2017 – March 31st: Apprise makes official data submission to OHA an all measures but EDIE, CLABSI, CAUTI, and FU after mental illness hospitalization

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Year 3 Close-out

• Key dates (cont.)

– May 12th: OHA will distribute draft Year 3 performance reports to all hospitals – June 10th: Hospitals will be notified of final performance and payment amounts – June 30th: Payments issues

• As for Year 2, hospitals are reminded to send their Year

3 HCAHPS documentation to htpp@apprisehealthinsights.com.

• Any additional Year 3 process questions?

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CLABSI and CAUTI reporting for HTPP

Roza Tammer, MPH, CIC HAI Reporting Epidemiologist, HAI Program Hospital Metrics Technical Advisory Group (TAG) Meeting February 15, 2017, 10am-12pm

Acronyms, in order of appearance

• HTPP: Hospital Transformation Performance Program
• CLABSI: Central line-associated bloodstream infection
• CAUTI: Catheter-associated urinary tract infection
• NHSN: National Healthcare Safety Network
• OHA: Oregon Health Authority
• HAI: Healthcare-associated infection
• OAHHS: Oregon Association of Hospitals and Health

Systems

CLABSI & CAUTI reporting for HTPP

• HTPP metrics include CLABSI and CAUTI data
• Facilities historically report these data to

– NHSN for the OHA HAI Program legislatively mandated reporting requirements – Apprise and Excel spreadsheet for HTPP participation reporting requirements (managed by OAHHS) – The OHA Office of Health Analytics uses these data to manage HTPP reimbursements

• OAHHS, OHA of Health Analytics, and OHA HAI Program are

collaborating to

– Coordinate efforts and use resources more efficiently – Reduce burden on facility staff time – Implement a consistent process – Continue to provide progress data to facilities

All hospitals (incl. HTPP participants) OHA HAI Program OHA Office

• f Health

Analytics OAHHS

Enter data into NHSN Send OHA Office of Health Analytics quarterly progress data, incl. CLABSI & CAUTI Manage Apprise platform Manage NHSN groups & data Edit data in NHSN Export final data from NHSN Provide technical assistance to facilities to resolve identified discrepancies Report quarterly progress reporting data on all measures (incl. CLABSI & CAUTI) to CMS Publish data in annual HTPP report Export and format data (incl. CLABSI & CAUTI) from NHSN Coordinate biweekly status calls with OAHHS Staff monthly Technical Advisory Group (TAG) meetings Coordinate issuance of HTPP payments Edit final data in Apprise platform Analyze data & send to OHA Office

• f Health Analytics

(CC OAHHS) Request technical assistance if needed during internal validation review period Review NHSN data sent by HAI Program Provide data to facilities for internal validation (CC OHA Office of Health Analytics & OAHHS) Analyze & publish data in annual HAI Program report Pull quarterly CLABSI & CAUTI data from NHSN and enter into Apprise platform

SIR: Standardized infection ratio

Reporting timelines: 2017 & 2018

2017 Activities 2018 4/3

• OHA HAI Program generates data in NHSN
• OHA HAI Program prepares reports to send to hospitals

for internal validation 4/2 4/10

• OHA HAI Program sends CAUTI and CLABSI data to

hospitals for internal validation

• Hospitals review and make any necessary changes in

NHSN 4/9 4/24

• Hospitals have until the COB on this date to make any

necessary changes in NHSN

• OHA HAI Program will generate data in NHSN at 5pm to

ensure any changes made during the validation period are included in the final data used in HTPP and HAI Program reports; changes made after this date will not be represented in HTPP or HAI Program report data 4/20 4/28 • OHA HAI Program will provide final CLABSI and CAUTI data to the OHA Office of Health Analytics 4/30

Rates for HTPP Year 3 SIRs for HTPP Year 4 baseline SIRs for HTPP Year 4

Priority: Save facilities time & effort

• Internal validation process managed by HAI Program

covers both HAI Program and HTPP needs

• Facilities can contact HAI Program directly for technical

assistance with NHSN

– Not just during the review period!

• Mismatches inherent in using different data

systems/export dates resolved

– Data will be easier to interpret and explain – Only one data source (NHSN) makes internal validation more straightforward

Contact us!

Questions and discussion

OAHHS Elyssa Tran, MPA Associate Vice President, Government Services Direct phone: 503-479-6004 elyssa.tran@apprisehealthinsights.com OHA HAI Program Roza Tammer, MPH, CIC Healthcare-Associated Infections (HAI) Reporting Epidemiologist Direct phone: 971-673-1074 roza.p.tammer@state.or.us OHA Office of Health Analytics Sara Kleinschmit, MSc Policy Advisor Direct phone: 971-673-3364 sara.kleinschmit@state.or.us

HTPP Year 4

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Final Year 4 Program Structure

CMS approved an additional year of HTPP (HTPP Year 4) in January 2017. To summarize:

• Limited changes to overall structure and measures

(domain and payment structure, and 11 incentive measures from Year 3 continue into Year 4)

• Approval of specification changes to CLABSI (shift to

SIR); CAUTI (shift to SIR); and, EDIE (shift to outcome measure).

• Payment amounts remain based on Medicaid

discharges and days (but shift base from FFY 2012 to CY 2015)

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Final Year 4 Program Structure

• Amount in pool is consistent with Year 3

(federal match of state dollars generated by 0.5% of the Hospital Assessment Program)

• Shift to calendar year:

– The Year 4 measurement period is January 1, 2017 – December 31, 2017. – Any hospitals not conducting SBIRT screenings at every visit an individual patient has (instead using a ‘look back’), need to update the look back date so that staff are reminded to screen any patient who has not had an SBIRT screening from January 1, 2017, on.

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Final Year 4 Benchmarks

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Measure Year 4 Benchmark Improvement Target Floor

Adverse drug events due to Opioids 2.0% N/A (no improvement target) Excessive anticoagulation due to Warfarin 2.0% N/A (no improvement target) Hypoglycemia in inpatients receiving insulin 3.0% MN method with 1 percentage point floor HCAHPS – discharge National 90th percentile, April / May 2016 (91.0%) Shriners, 90th percentile (TBD%) MN method with 2 percentage point floor HCAHPS – medication National 90th percentile, April / May 2016 (73.0%) MN method with 2 percentage point floor

Final Year 4 Benchmarks

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Measure Year 4 Benchmark Improvement Target Floor

All-cause readmissions 90th percentile HTPP Year 1 (8.0%) MN method with 3 percent floor EDIE 90th percentile HTPP Year 2 (30.1%) MN method with 2 percentage point floor Follow-up after hospitalization 90th percentile HTPP Year 2, hosp only rate (80.2%) MN method with 3 percentage point floor CLABSI SIR of 0.50 or lower MN method with 3 percent floor CAUTI SIR of 0.75 or lower MN method with 3 percent floor SBIRT Brief Screen: 90th percentile from HTPP year 2 rate for brief screens (83.5%) Full Screen: 90th percentile from HTPP year 2 rate (71.3%) MN method with 3 percentage point floor

Year 4 Voluntary Measures – Not Eligible for Payment (1/2)

• The original proposal to CMS included three

new measures beginning in Year 4:

– C-difficile; – C-sections / unexpected newborn complications; and – Safe opioid prescribing in the ED.

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Year 4 Voluntary Measures – Not Eligible for Payment (2/2)

• These measures are not eligible for incentive

payments in 2017.

• However, hospitals are encouraged to track and

voluntarily report data to OHA.

• Voluntarily reported data may be used as

baseline or in benchmarking for potential future quality incentive payments.

• OHA will issue guidance on data submission for

those hospitals choosing to report data on these measures.

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Year 4 Draft Specifications

• Final specifications for all Year 4 measures will

be available by the end of the day (14 February)

• n the HTPP webpage, here:

http://www.oregon.gov/oha/analytics/Pages/Hospital- Baseline-Data.aspx

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Location Change - Year 4 EDIE Measure Reports

• Per requests from hospitals, these reports have been

augmented to include DOB and Dx code description.

• These reports are currently found under the ‘Manage

Facility Files’ tab.

• As of Tuesday, February 21, they will move to

‘Scheduled Tasks’, as below:

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Year 4 Supporting Documentation

• Year 4 program documentation will be up on the HTPP

webpage by the end of the day

(http://www.oregon.gov/oha/analytics/Pages/Hospital-Baseline- Data.aspx)

• This includes:

– Final Year 4 measure specifications – Year 4 payment reference instructions – Year 4 measures and benchmarks table (also in your meeting materials) – Year 4 EDIE measure validation process timeline and instructions (also in your meeting materials) – Year 4 data submission process and schedule (also in your meeting materials)

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Any remaining Year 4 questions?

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Future H-TAG meetings

• Full H-TAG webinar every other month
• Office hour during interim months (beginning with a

focus on a particular measure, coordinated by Apprise)

• Next meetings:
• March 14, 2017: office hour, starting with a focus on XX

measure

• Hospital question re: SBIRT
• April 11, 2017: Full meeting

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Unity Center for Behavioral Health and HTPP Year 4

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Year 4 Unity Partner Hospitals – Metric Implications

• Follow-up after hospitalization for mental illness measure

decision:

– The Unity partner hospitals will receive an aggregated Unity rate. – The baseline (to be used in calculating an improvement target for Year 4) will be January 1, 2017 (or the date of Unity’s first discharge, as this will be later in the month) – June 30, 2017. – The performance period (used to assess whether the benchmark or improvement target is achieved) will be July 1, 2017 – December 31, 2017.

• Additional decisions needed:

– Process for quarterly progress reports, including data validation and review (who receives individual-level data, etc.)? – Other processes?

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Year 4 Unity Partner Hospitals – Metric Implications

• EDIE measure decision

– Unity psychiatric emergency department (PES) discharges are associated with Legacy Emanuel in EDIE. – However, PES discharges will be identified by CMT, the EDIE contractor, and excluded from the metric.

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Year 4 Unity Partner Hospitals – Metric Implications

• All-cause readmissions (for discussion)

– Unity inpatient discharges are associated with Legacy

• Emanuel. However, these patients can be identified and

excluded from Legacy Emanuel’s Year 4 readmissions calculation. – However, closing the psychiatric units at partner hospitals means that readmissions rates from HTPP Year 3 will not be comparable to HTPP Year 4 for these hospitals. – OHA is considering an interim step for HTPP Year 4:

• Monitor readmissions in Unity’s first year (2017)
• Rebasing the Unity partner hospitals’ Year 4 readmissions

improvement targets using data from HTPP Year 3 which excludes mental health discharges.

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Year 4 Unity Partner Hospitals – Readmissions discussion, cont.

• Hospitals would submit data for HTPP Year 3 that include their mental

health discharges. These would be used to determine whether they achieve their Year 3 HTPP improvement target and receive a payment. (no change)

• For 2017 HTPP Year 4, Apprise’s contractor would submit a

supplementary file covering HTPP Year 3 that excludes mental health discharges for Unity partner hospitals. This ‘Year 3 rebase’ would be used to set HTPP Year 4/2017 improvement targets for Unity partners.

– For Year 4, these hospitals would submit their readmissions data as normal (and they wouldn’t include any mental health discharges, since these would be at Unity), and receive Year 4 payment by achieving their ‘rebased’ improvement target. – Apprise would report Unity’s 2017 readmissions rate to OHA for monitoring purposes, and use in determining how these discharges would be treated in the future.

Wrap-up

• H-TAG webpage

– www.oregon.gov/oha/analytics/Pages/Hospital-Metrics-Technical- Advisory-Group.aspx

• HTPP webpage (Year 4 specifications and supporting

documentation) – http://www.oregon.gov/oha/analytics/Pages/Hospital- Baseline-Data.aspx

• OHA contact for all HTPP related questions:

– metrics.questions@state.or.us

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