Hospital Metrics TAG April 12, 2016 PLEASE DO NOT PUT YOUR PHONE ON - - PowerPoint PPT Presentation

Hospital Metrics TAG

April 12, 2016 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 2: CAUTI / CLABSI
• Year 4: Measure Development - Opioids
• Year 4: Measure Development - EDIE

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Year 3 Updates

• Verbal Approval from CMS

– Having a Year 3 – Measurement period

• Continuation of FFY, October 2015 – September 2016
• Will propose switch to CY for Year 4
• Still Pending with CMS

– Readmission measure – Benchmarks – Final, written approval for Year 3

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Hospital Committee Nominations

• OHA received applications from 11 individuals.
• Applications are being reviewed by OHA and a

recommendation will then be sent to the Speaker of the House and the President of the Senate for confirmation.

• OHA hopes to notify applicants by mid-June.

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Hospital Committee

• The Committee next meets on April 22nd from 1-4 pm in

Wilsonville.

• Agenda items include:

– Year 3 / CMS Updates – Presentation from Oregon Perinatal Collaborative on future measure options for the Maternal and Child Health Domain – Year 4 program structure and measure development (EDIE, Opioid Rx).

http://www.oregon.gov/oha/analytics/Pages/Hospital-Performance- Metrics.aspx

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CCO Metrics & Scoring Committee

• The Committee next meetings on April 22nd, from 9 –

noon in Wilsonville.

• The agenda will focus on disparities in current

performance data and ways to measure disparities.

http://www.oregon.gov/oha/analytics/Pages/Metrics-Scoring- Committee.aspx

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Evaluation

• HTPP Evaluation Survey launched April 4th – thanks to

those of you who have already started!

• Survey will remain in the field through May 15th.
• If questions about survey, please contact CORE at

Maggie.Weller@providence.org

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Opioid Prescribing Guidelines Taskforce

• OHA heard from a number of hospitals interested in

participating on the taskforce – thank you!

• First taskforce meeting will be Friday, April 29th.
• Meeting will be public (can sign up for notifications)

https://public.health.oregon.gov/PreventionWellness/Sub stanceUse/Opioids/Pages/index.aspx

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Year 2 Close Out

• OHA has received hospital Year 2 data submissions from

OAHHS and is beginning review.

• OHA intends to send summary reports to each hospital
• n May 12th for final hospital review prior to processing

payments and populating the year 2 public report.

• OHA / OAHHS may contact hospitals with questions

between now and May 12th.

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Other updates or questions?

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CAUTI / CLABSI

Potential Year 2 Resubmission

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Issues (1)

• Hospitals are not all tracking the same units, leading to

unequal comparison of performance.

• OHA is accepting the already-submitted Year 2 data as is

for Year 2 payment.

• However, for equal comparison and more accurate data

(and improvement targets) for Year 3, OHA is considering re-calculating Year 2.

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Issues (2)

• Hospital Committee is considering dropping CLABSI for

Year 4 – is it worth re-submitting Year 2 for Year 3 comparison if the measure is going away soon?

• Given CMS approval for FFY as the measurement

period, Year 2 recalculation of CAUTI will only cover 9 months.

• New template (all tracked units) available for reporting.

However, hospitals have already submitted 6 months of data for Year 3. Should we still re-base Year 2 / Year 3?

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Year 4 Measure Development

Safe Opioid Prescribing in the ED EDIE

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Opioid Recap

• February H-TAG meeting, we discussed alternative opioid measure:

Total number of opioid pills dispensed over x time, as a rate per 1,000 ED visits.

• Alternate measure presented to Committee in March as part of

bundled measure. Committee interested in: MED per 1,000 ED visits

• March H-TAG meeting, discussed technical ability to report on this

type of measure. H-TAG suggested third option: Total number of pills per 1,000 ED visits.

• March discussion also noted concerns re: prescribing policies, given

upcoming taskforce work. Current measure development will focus

• n the rate, not the policy component.

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Revised Draft Opioid Specifications: Denominator

• Total number of emergency department visits in the

measurement period.

• Exclude:

– ED visits resulting in admissions – Neoplasm-related pain, end-of-life care, palliative care, or hospice care

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Revised Draft Opioid Specifications: Numerator Options

1 Total number of opioid pills dispensed in the measurement period 2 Morphine equivalent doses dispensed in the measurement period MED = drug strength * (quantity / days’ supply) * conversion factor 3 Total number of Rx for opioids written in the measurement period

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All options would use all drugs in the “narcotic analgesics” therapeutic class (standard code 40).

Opioid Questions

• 1. Ages to include in the denominator (12+ or 18+)?
• 2. Any suggested changes to the exclusions?
• 3. Option 3: prescriptions written or prescriptions filled?
• 4. Measurement period full 12 months?
• 5. Which of the numerator options would be the best to

focus on, striking the right balance between feasibility of reporting and improving patient care?

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EDIE Recap

• Initial EDIE measure focuses on process: care

guidelines created and outreach notifications sent to primary care providers for ED “frequent flyers”

• Original proposal for Year 3 EDIE measure would create

bundled measure with three components:

– Notifications – Care guidelines – ED revisit rates among those with care guidelines.

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Transition to Outcome Measure

Given widespread use of EDIE and PreManage tools and unintended consequences of original process measure… …Oregon Health Leadership Council will be proposing an

• utcome measure to the Committee on April 22:

Percentage of individuals who have 5 qualifying ED visits at the same facility, who subsequently re-visit the same ED within 30 days of the 5th visit.

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Draft EDIE Specifications

Denominator

• Count of patients with at least 5 emergency department

visits in 12 months (5/12) at the same facility.

• Exclude patients who die, visits resulting in admissions,

and patients who left AMA or without being seen. Numerator

• Of those patients, count of those who return to the same

ED within 30 days after their 5th ED visit.

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Test Data

# of visits Hospital Range (denominator n) Hospital Range (30 day rate) Hospital Range (60 day rate) 4 in 12 63 – 4,390 22.21 – 29.03% 32.65 – 44.44% 5 in 12 208 – 2,663 25.48 – 40.00% 37.57 – 73.33% 7 in 12 85 – 1,227 0.00 – 48.42% 0.00 – 65.45% 10 in 12 26 – 535 38.46 – 61.31% 53.85 – 75.91%

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Test Data: 5/12/30 days

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Hospitals 5 in 12 30 day 30 day rate

1 208 53 25.48% 2 525 162 30.86% 3 559 150 26.83% 4 577 151 26.17% 5 630 199 31.59% 6 665 230 34.59% 7 685 222 32.41% 8 771 226 29.31% 9 843 281 33.33% 10 875 248 28.34% 11 886 250 28.22% 12 933 254 27.22% 13 941 275 29.22% 14 984 271 27.54%

Test Data: 5/12/30 days

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Hospitals 5 in 12 30 day 30 day rate

15 1038 334 32.18% 16 1073 312 29.08% 17 1097 316 28.81% 18 1133 335 29.57% 19 1136 313 27.55% 20 1146 321 28.01% 21 1162 312 26.85% 22 1280 376 29.38% 23 1457 427 29.31% 24 1475 377 25.56% 25 1896 565 29.80% 26 2442 788 32.27% 27 2663 854 32.07%

EDIE Questions

• 1. 30 days versus 60 days?
• 2. Individuals who qualify for the denominator multiple

times during the measurement year?

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Wrap-up

• Next meeting: Tuesday, May 10th, 10 am – noon
• H-TAG webpage

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

• OHA contact for all HTPP related questions:

metrics.questions@state.or.us

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