Hospital Metrics TAG July 1, 2015 Welcome and Introductions 2 - - PowerPoint PPT Presentation

Hospital Metrics TAG

July 1, 2015

Welcome and Introductions

2

Group Charter and Membership

3

Introduction to Hospital Transformation Performance Program and Year 2 Measures and Benchmarks

4

Background

• Incentive measure program for DRG hospitals in

Oregon

• Mandated by Oregon’s 2013 HB 2216 and 2015

HB 2395 – Established Hospital Metrics Advisory Committee (analogous committee for CCO measures is the CCO Metrics & Scoring Committee)

• Approved through OHA’s 1115 Medicaid waiver

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Timing

• Initially approved by CMS for two years

– Recently approved for four more years by Oregon legislature

• CMS must approve additional years
• Baseline (Year 1): October 2013 – September 2014

– Report published and payments distributed April 2015

• Performance Year (Year 2): October 2014 –

September 2015 – Payments distributed June 2016 (report to follow)

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Funding

• Funding is provided by the Hospital

Provider Assessment

• In first two years, equal to 1% of federal

financial participation (capped at $150 million per year)

• In subsequent years, equal to 0.5% of

federal financial participation

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Incentive Payments

• Payment in the baseline year was for

reporting

• Payment in the second year is contingent

upon meeting benchmarks or improvement targets

• In years 1 and 2 hospitals achieving 75% of

the measures for which they are eligible receive a floor payment of $500,000

• The remaining funds are distributed based

upon performance on individual measures

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Hospital Performance Metrics Advisory Committee

• Charged with identifying measure and targets

– Initial list of measures had to be approved by CMS – Should align with goals of Health System Transformation and CCOs

• Charter dictates that the committee meet at least

four times each year

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Hospital Performance Metrics Advisory Committee

• Hospital representatives (four representatives):

– Manny Berman, CEO, Tuality – Doug Koekkoek, MD: Chief Medical Officer, Providence Health & Services – Janet O’Hallaran, Kaiser – Pam Steinke, Chief Nurse Executive, St. Charles Healthcare

• CCO representatives (two representatives):

– Maggie Bennington Davis, MD, Health Share, Chair of CCO Metrics & Scoring Committee. – Ken House, Pacific Source, Director of Health Analytics at Mosaic Health.

• Quality experts (three representatives):

– Steve Gordon, MD: Physician Executive, Salem Hospital – Jeff Luck, PhD, Oregon State University – Vacant

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Year 2 Measures and Benchmarks - 1

• Per CMS agreement, the HTPP measures are divided into two focus

areas: hospital-focused and hospital-CCO coordination focused

• ns

Domains Measures Benchmark Improvement Target

• 1. Healthcare

Associated Infections

• 1. CLABSI in all tracked units (modified NQF

0139) 0.18 per 1,000 device days (2010 NHSN Data Summary Report 50th percentile) 3 percent

• 2. CAUTI in all tracked units (modified NQF

0754) 1.13 per 1,000 catheter days (50th percentile from HTPP baseline) 3 percent

• 2. Medication

Safety

• 3. Hypoglycemia in inpatients receiving insulin

7% or below 1 percentage point

• 4. Excessive anticoagulation with Warfarin

5% or below 1 percentage point

• 5. Adverse drug events due to opioids

5% or below 1 percentage point

• 3. Patient

Experience

• 6. HCAHPS, Staff always explained medicines

(NQF 0166) 72% (national 90th percentile) 2 percentage points

• 7. HCAHPS, Staff gave patient discharge

information (NQF 0166) Shriners benchmark: 92.7% (90th percentile, all PG database peer group) All others: 90% (national 90th percentile) 2 percentage points (for all hospitals, including Shriners) 4. Readmissions

• 8. Hospital-wide all-cause readmission

8.0% (state 90th percentile for DRG hospitals) 3 percent 11

Year 2 Measures and Benchmarks - 2

• The hospital-CCO coordination focused measures are below:On

Domains Measures Benchmark Improvement Target

• 5. Behavioral

Health

• 9. Follow-up after

hospitalization for mental illness (modified NQF 0576) 70.0% (national Medicaid 90th percentile, aligned with 2015 CCO measure) 3 percentage points

• 10. SBIRT

Brief Screen: 67.8% (75th percentile from HTPP baseline) Full Screen: 12.0% (alignment with CCO full screen benchmark) *No benchmark for brief intervention rate, which is reporting only Brief Screen: 3 percentage points Full Screen: 3 percentage points

• 6. Sharing ED

Visit Info

• 11. Hospitals share ED visit

information with primary care providers and other hospitals to reduce unnecessary ED visits 78.7% (75th percentile from HTPP baseline) *Benchmark for notification to primary care only; care guideline rate is reporting only 3 percentage points

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Year 2 – Current Progress

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Year 2 Progress Report Summary (data aggregated across first 6 months of Year 2) – 1

*Note data are preliminary and subject to change

Domains Measures Statewide Progress – Baseline to Year 2 (first 6 months) 1. Healthcare Associated Infections

• 1. CLABSI in all tracked units

(modified NQF 0139) 0.80 to 0.63; 13 better than benchmark

• 2. CAUTI in all tracked units

(modified NQF 0754) 1.56 to 1.15; 24 better than benchmark 2. Medication Safety

• 3. Hypoglycemia in inpatients

receiving insulin 3.9% to 3.7%; 25 better than benchmark

• 4. Excessive anticoagulation with

Warfarin 1.5% to 1.4%; 27 better than benchmark

• 5. Adverse drug events due to
• pioids

steady at 0.5%; 28 better than benchmark

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Year 2 Progress Report Summary (data aggregated across first 6 months of Year 2) – 2

*Note data are preliminary and subject to change

Domains Measures Statewide Progress – Baseline to Year 2 (first 6 months)

• 3. Patient

Experience

• 6. HCAHPS, Staff always

explained medicines (NQF 0166) 63.6% to 63.2%; 0 hospitals performing better than benchmark

• 7. HCAHPS, Staff gave

patient discharge information (NQF 0166) 88.8% to 89.2%; 8 performing better than benchmark 4. Readmissions

• 8. Hospital-wide all-cause

readmission steady at 10.9%; 3 performing better than benchmark

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Year 2 Progress Report Summary (data aggregated across first 6 months of Year 2) – 3 *Note data are preliminary and subject to change

Domains Measures Statewide Progress – Baseline to Year 2 (first 6 months)

• 5. Behavioral

Health

• 9. Follow-up after hospitalization

for mental illness (modified NQF 0576) steady at 72.2%; 10 of 14 performing better than benchmark

• 10. SBIRT

5 of 17 reporting hospitals performing better than relevant benchmark

• 6. Sharing ED

Visit Info

• 11. Hospitals share ED visit

information with primary care providers and other hospitals to reduce unnecessary ED visits TBD

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Year 2 Q & A

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CMS Negotiations – National Context (1)

• Oregon’s negotiations with CMS must be seen in light of

the broader context of hospital incentive programs nationally.

• CMS has currently approved six Delivery System Reform

Incentive Payment (DSRIP) programs (CA, KS, MA, NJ, NY, and TX).

• These programs are elements of Section 1115

Medicaid/CHIP demonstrations.

• A recent NASHP report includes profiles of these

programs, as well as two ‘DSRIP-like’ programs: HTPP and a program in New Mexico. The full report is available at https://www.macpac.gov/wp- content/uploads/2015/06/State-Experiences-Designing- DSRIP-Pools.pdf.

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CMS Negotiations – National Context (2)

• DSRIP programs are designed to support the triple aim.
• They have the following types of metrics (though Oregon and

New Mexico don’t have the first):

• 1. Implementation milestones and metrics (aimed at measuring

progress on specific delivery system reform projects)

• 2. Pay-for-reporting metrics (this can be extensive; NJ has 45

such measures)

• 3. Pay-for-performance metrics
• New York State is the most recently approved DSRIP. To receive

payment, NYS hospitals must reduce the gap between the baseline and the benchmark (all at 90th percentile) by 10%.

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CMS Waiver Negotiations – Local Context

• CMS will be looking toward DSRIP program

requirements

• OHA will propose a program structure that bridges the

current program with CMS expectations

• CMS will be expecting closer coordination with CCOs

and the Coordinated Care Model

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Potential Program Structure Changes (1)

• Instituting a challenge pool
• Changing Year 3 benchmarks where appropriate and

continuing to monitor benchmarks annually

• Retiring measures that do not foster continuous

improvement

• Including additional hospital-CCO coordination

measures

• Coordinating more closely with CCO Metrics &

Scoring Committee in future years

• CMS will likely push for 75th and 90th percentile

benchmarks

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Potential Program Structure Changes (2)

• Look to DSRIP programs
• Provide menu of measures – must meet performance

benchmark or improvement target on x measures?

• Institute of Medicine Core Measures
• OHA tasked with bringing a proposal along these lines to

next committee meeting

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Committee Discussions on Current Measures - 1

Domains Committee Discussion

• 1. Healthcare

Associated Infections

• Would like to keep domain
• Discussion of getting away from device days to something

acuity focused and risk adjusted (as QI efforts focus on reducing denominators to limit exposure)

• More discussion at next meeting
• 2. Medication

Safety

• Want to keep domain
• If keep any of current measures, will need to revisit

benchmark

• Looking for additional measures, including HEDIS list, and

NQF medication reconciliation measure (NQF 2456)

• 3. Patient

Experience

• Keep domain, no changes

4. Readmissions

• Potential shift to Potentially Preventable Readmissions or

another risk-adjusted measure (more discussion at next meeting)

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Committee Discussions on Current Measures - 2

Domains Committee Discussion

• 5. Behavioral

Health

• Want to keep follow-up after hospitalization on

‘menu’ (if that is the agreed program structure)

• SBIRT may also continue on ‘menu’
• 6. Sharing

ED Visit Info

• Requested more data
• Feedback on any of these domains or measures?

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Additional Domains / Measures Under Consideration

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Maternal and Child Health Domain - 1

• Measures could include The Joint Commission Perinatal

Care Core Measure Set

• PC-01 Early Elective Delivery (CMS would not

approve in current waiver), NQF 0469

• PC-02 Cesarean sections (NQF 0471)
• PC-03 Antenatal steroids for preterm labor (NQF

0476)

• PC-04 Health care-associated bloodstream infections

in newborns (NQF 1731)

• PC-05 Exclusive breast milk feeding (NQF 0480)

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Maternal and Child Health Domain - 2

• Considerations
• Builds on a domain the Committee previously endorsed
• Hospitals are only required to report if they have 1100

births; therefore, tracking may be an issue.

• OAHHS contacted hospitals and 11 would not be

required to report

• They would need to track internally to qualify for

payment

• Three DRG hospitals do not have OB services, so would

either be ineligible for this domain or a CCO-based allocation method would be needed (‘menu’ may mitigate)

• Oregon Maternal Data Center as source?
• Other considerations?

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Medication Safety Domain

• Significant adjustment to benchmarks of current measure
• Potential additional measures:
• NQF 2456 Medication Reconciliation: Number of

Unintentional Medication Discrepancies per Patient

• Others?
• Considerations:
• Medication reconciliation is conceptually aligned with

CCO metrics and aims

• Hospitals may not be working in this area (medication

reconciliations) and require additional time to implement process changes

• Other considerations?

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PQI 92

• PQI 92: Prevention Quality Chronic Composite (rate of

admission per 100,000 population for the following admissions – diabetes [short & long-term complications, uncontrolled, w/lower-extremity amputation), COPD, asthma, hypertension, heart failure, or angina w/o cardiac procedure

• Considerations:
• Aligns with CCOs (individual PQIs reported as part of state

performance measure)

• No national benchmark
• Denominator definition difficulties
• OHA will present data on CCOs at next committee meeting,

but need further discussion on denominator for hospitals (Medicaid population in county? What of metro hospitals?)

• Other considerations?

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Additional ‘On-Deck’ Areas to Prioritize

• Opioid abuse
• Further explore availability of measures related to

painkiller prescription practice

• VA measure, proportion of opioid therapy patients with

evidence of medication management or pharmacy reconciliation

• Sepsis
• Hospitals accredited by The Joint Commission must begin

reporting this in October 2015

• Oral health
• OHA providing data
• Other areas?

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Next Steps

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Questions?

Sara Kleinschmit, OHA sara.kleinschmit@state.or.us Diane Waldo, OAHHS diane.waldo@oahhs.org Elyssa Tran, Apprise Health Insights elyssa.tran@apprisehealthinsights.com Barbara Wade, OAHHS/Apprise Barbara.wade@apprisehealthinsights.com

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