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

Hospital Metrics TAG

July 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

2

Agenda Overview

• Updates
• CLABSI / CAUTI
• Presentation: HTPP Years 1 and 2 Evaluation
• Presentation: EDIE Test Data, Year 4

specifications

• Proposed opioid measure continued discussion /

Washington specifications update

3

Updates

4

Committee Meeting Debrief

• There was no meeting held in June
• No meeting is scheduled for July
• The next meeting will be scheduled for August with new

committee membership

• Orientation for new members will occur before the

August meeting

5

6

Hospital Performance Metrics Advisory Committee: Effective July 1, 2016

Role Name Organization Term

Quality expert Laura Duffey Kaiser July 2016 – June 2018 Quality expert Mark Tomlinson Physician (OB) / Oregon Perinatal Collaborative July 2016 – June 2018 Quality expert Jeff Luck Oregon State University Feb 2014 – June 2017 Hospital rep. Manny Berman Tuality Healthcare Feb 2014 – June 2017 Hospital rep. Doug Koekkoek Providence Feb 2014 – June 2017 Hospital rep. Aisha Furbach Legacy July 2016 – June 2018 Hospital rep. Sheri Johnson Good Samaritan July 2016 – June 2018 CCO rep. Maggie Bennington-Davis Health Share of Oregon July 2015 – June 2017 CCO rep. Ken House PacificSource July 2015 – June 2017

CCO Metrics Update

• The CCO Metrics 2015 Final Report
• Published June 23
• Available online

 http://www.oregon.gov/oha/Metrics/Documents/2015_performance_report.pdf

7

CCO Metrics 2015 Final Report

• Summary

– Hospital readmissions have decreased – Decreased hospital admissions for short-term complications from diabetes – Increased access to primary care for children and adolescents – Increased rates of dental sealants – Increased use of effective contraceptives

8

HTPP Years 3 and 4: CMS Discussions

• Year 3 (Oct. 2015 – Sep. 2016)
• OHA now received formal, written approval from CMS for the Year 3

measures and benchmarks, hooray!

• Years 4+ (2017 on) are part of OHA’s new waiver

proposal; OHA continues working with CMS

9

Year 2 Data Resubmission Reminder (for use in Year 3 Improvement Targets)

• Some Year 2 data may need to be revised

(e.g. clarifying SBIRT brief / full screen, etc.)

– If Year 2 data needs to be revised, hospitals have through Friday, July 15th to notify OHA via metrics.questions@state.or.us

• Note hospitals have until July 22 to let OHA know of any

concerns about the revised CLABSI and CAUTI data

– OHA shared this with hospitals on July 8 – Any requests for revisions to these data should also be sent to metrics.questions@state.or.us

10

HTPP Year 3 Improvement Targets

• Year 3 improvement targets cannot be calculated until

Year 2 data are finalized

– OHA will release Year 3 improvement targets based on Year 2 final / revised data – OHA will email individual improvement targets to quality leaders / representatives at each hospital by July 31st

11

HTPP Year 3 Preliminary Benchmarks – correction from last meeting

12

Measure Year 2 Benchmarks Year 3 Benchmarks Year 3 Improvement Target Floor

SBIRT in the ED – brief screen 75th percentile from HTPP baseline (57.0%) 90th percentile of HTPP Year 2 performance: 86.4% 3 percentage point improvement from Year 2 performance. SBIRT in the ED – full screen Alignment with CCO benchmark (12%) 90th percentile of HTPP Year 2 performance: 71.3% 3 percentage point improvement from Year 2 performance. Follow-up after hospitalization for mental illness National 2014 Medicaid 90th percentile (70.0%) 90th percentile of HTPP Year 2 performance: 80.1% 3 percentage point improvement from Year 2 performance. Hospital-wide all- cause readmissions 90th percentile for all hospital types (8.0%) 90th percentile of HTPP Year 2 performance: 8.4% 3 percent improvement from Year 2 performance.

13

Measure Year 2 Benchmarks Year 3 Benchmarks Year 3 Improvement Target Floor

Hypoglycemia in inpatients receiving insulin 7% or below 5% or below 1 percentage point improvement from Year 2 performance Excessive anticoagulation with Warfarin 5% or below 3% or below 1 percentage point improvement from Year 2 performance Adverse Drug Events due to opioids 5% or below 3% or below 1 percentage point improvement from Year 2 performance HCAHPS – staff always explained medicines National 2014 90th percentile (72%) National 2015 90th percentile (73.0%) 2 percentage point improvement from Year 2 performance HCAHPS – staff gave patient discharge information National 2014 90th percentile (90%) National 2015 90th percentile (91.0%) 2 percentage point improvement from Year 2 performance

14

Measure Year 2 Benchmarks Year 3 Benchmarks Year 3 Improvement Target Floor

CLABSI 2010 NHSN 50th percentile (0.18 per 1,000 device days) N/A – improvement target only 3 percent improvement from Year 2 performance CAUTI 50th percentile from HTPP baseline (1.02 per 1,000 catheter days) N/A – improvement target only 3 percent improvement from Year 2 performance Hospitals sharing ED visit information with PCPs 75th percentile from HTPP baseline (77.4%) 90th percentile from HTPP baseline (84.4%) 3 percentage point improvement from Year 2 performance.

H-TAG Feedback – Date Specifications Posted

• Since we have written CMS approval we can now post

Year 3 specifications. But, due to resubmissions, absolute benchmarks may change.

– Post today without absolute benchmarks for potentially impacted measures? – Wait until next week?

15

Year 3 Follow-up After Hospitalization for Mental Illness

• Update: There were significant changes to the 2016

HEDIS specifications for FUH measure

– Given this, OHA holding off on sending hospitals their quarterly updates for this measure – OHA working through the new HEDIS specifications–to ensure our calculations are correct before sending anything out – Also holding off on the CCO side

16

SBIRT – Clarifications in Year 3 Specifications

• Emergency Severity Index (ESI) or similar triage

scales

• Can be used to exclude those in urgent or emergent

situations where time of essence and inappropriate to screen

• ESI acuity level 2 is at discretion of clinician (i.e.,

screen and include in denominator if allowed to wait in ED to be bedded; don’t screen and exclude from denominator if in need of immediate bedding)

17

SBIRT – Clarifications in Year 3 Specifications

• Look back period to determine if screening is required
• Best practice is to screen patients at each ED visit
• However, measure only requires patients to be screened once per

measurement year

• If a hospital has a process where they check to see who has

been screened in the measurement period, there may be confusion because of the protracted negotiations with CMS regarding the measurement period

• Therefore, for Year 3, hospitals can use either look back period

(October 2015 or January 2016)

• To better understand the implications of this, OAHHS sent a

survey last week asking what look back period (if any) hospitals are using

18

CLABSI / CAUTI

19

CLABSI / CAUTI

• Year 2 rebase

– Revised Jan-Sept 2015 data sent to hospitals on 8 July

• Year 3 template
• Crosswalk

20

CLABSI / CAUTI Year 2 Rebase (for Year 3 Improvement Targets) - 1

• Revised CLABSI and CAUTI data for period January 1,

2015 – September 30, 2015 sent to hospitals on 8 July

– Note 9 month baseline period used for both measures

• Data pulled directly from NHSN, using the definition of

“all tracked units” used for Healthcare Acquired Infections Advisory Committee (HAIAC) reporting

• Ensures consistency across hospitals
• Note that Public Health Division excluded mucosal

barrier injuries (MBIs) from the recalculated Year 2 data

21

CLABSI / CAUTI Year 2 Rebase (for Year 3 Improvement Targets) - 2

• Revised data were sent on 8 July
• Hospitals have until 22 July to respond about any

discrepancies, concerns about data

• Send issues / concerns to metrics.questions@state.or.us
• If hear nothing from hospitals, these data will be used to

calculate Year 3 improvement targets

22

Year 3 Template Clarification

• For Year 3 hospitals should use new template

– Hospitals should view the template at

http://www.oregon.gov/oha/analytics/HospitalMetricsDocs1/CAUTI- CLABSI%20Year%203%20Template.xlsx

– Hospitals should keep completed reporting templates internally for reference / OHA reserves right to review completed template – Hospitals should manually exclude MBIs in the template for Year 3

23

Year 3 Template, continued

• Hospitals will enter the total into the reporting platform
• When entering data on the Apprise Reporting Platform

use the totals for each month found in the green shaded boxes at the bottom of the reporting template

24

Crosswalk (see packet)

• OAHHS developed and shared a NHSN to Oregon

‘locations’ crosswalk

• This crosswalk maps the codes (CLABSI NHSN

locations) to the corresponding location / unit of a given hospital

25

Presentation: EDIE Test Data, Year 4 specifications

26

Proposed HTPP EDIE Metric

Emergency Department Information Exchange July 12, 2016 Adam Green, Founder Justin Keller, Director of Network Operations

HTPP Measure

• Initial metric was focused on process:

– Number of notifications sent to primary care when a patient visits the ED 5 times in 12 months (through EDIE or an EMR system) – The metric also counted the number of care guidelines created in EDIE (this was report only and not tied to incentive dollars)

• Proposed metric shifts focus to outcome:

– Number of patients who are readmitted to the ED within 30 days of a visit when that patient has been seen in that same facility 5 times in 12 months – This shift allows hospitals more flexibility in how it addresses high utilizers of the ED and focuses on patients that they see with some consistency – Removes incentive to create care guidelines in EDIE

28

Initial Data

• Initial data was pulled from EDIE for reporting

year 2 to look at potential scope of this new measure, and to begin thinking about a baseline and benchmarks

– Denominator: number of patients with 5 or more visits at the same facility – Numerator: number of patients with a 6th visit within 30 days of the fifth visit at the same facility

• Data was pulled for all HTPP participating

hospitals

Data Highlights

• Denominator range:
• Numerator range:
• Proportion range:
• Proportion did not necessarily correlate with

raw numbers

184 2511 54 772 26.46% 49.83%

Next Steps

• Awaiting CMS approval for proposed metric
• CMT will work with OHA and OAHHS to

finalize the methodology for data collection for the proposed metric, to begin in year 04

• CMT will provide monthly reports to each

hospital for validation and issue spotting during the reporting year

Presentation: HTPP Year 2 Evaluation

32

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Hospital Transformation Performance Program (HTPP) Evaluation

O H S U C E N T E R F O R H E A LT H S Y S T E M S E F F E C T I V E N E S S

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Oregon’s Hospital Transformation Performance Program (HTPP) pays DRG hospitals for reporting and performance on 11 quality measures.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Hospitals earned payment for...

2013 2014 2015

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

Baseline Year Performance Year

Reporting data from the Baseline Year.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Hospitals earned payment for...

2013 2014 2015

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

Baseline Year Performance Year

Reporting data from the Baseline Year. Achieving benchmarks or improvement targets in the Performance Year.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

HTPP includes 11 quality measures in two focus areas and six domains.

Focus us Area Domain ain Measur ure

Hospi spital-CCO Collabo bora ration

• n

Sharing ED Visits Information 1. Hospitals Share Emergency Department (ED) Visit Information with Primary Hospitals to Reduce Unnecessary ED Visits Behavioral 2. Follow-Up after Hospitalization for Mental Illness 3. Screening for Alcohol and Drug Misuse, Brief Intervention, and Referral to Hospi spital Focus Readmissions 4. Hospital-Wide All-Cause Readmissions (lower is better) Medication 5. Hypoglycemia in Inpatients Receiving Insulin (lower is better) 6. Excessive Anticoagulation with Warfarin (lower is better) 7. Adverse Drug Events Due to Opioids (lower is better) Patient 8. Staff Always Explained Medicines 9. Staff Gave Patient Discharge Information Health Care Infections 10. Central Line Associated Bloodstream Infection (CLABSI) in All Tracked Units 11. Catheter Associated Urinary Tract Infection (CAUTI) in All Tracked Units

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

HTPP Goals:

• Improve patient safety by rewarding hospitals

for improving their delivery systems.

• Improve coordination between hospitals and

coordinated care organizations (CCOs).

• Include hospitals in Oregon’s health system

transformation.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

The federal Centers for Medicare & Medicaid Services (CMS) required Oregon to conduct an evaluation of HTPP.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

OHA contracted with Oregon Health & Science University’s Center for Health Systems Effectiveness (CHSE) to conduct the evaluation.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

CHSE partnered with the Providence Center for Outcomes Research and Education (CORE) to develop and administer hospital surveys and stakeholder interviews.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

CHSE and CORE were required to answer seven questions through the evaluation.

Q6 Q2 Q7 Q4 Q3 Q5 Q1

How have DRG hospitals performed on all HTPP measures compared to the baseline? How have DRG hospitals performed on HTPP measures that are also CCO measures compared to non-DRG hospitals? What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals? What kinds of barriers prevented any hospitals from meeting HTPP measurement goals? What kinds of changes in practice have hospitals made as a result of HTPP? What kinds of quality improvements or investments have hospitals made as a result of receiving HTPP payments?

What kinds of changes to quality incentive programs are CCOs and the State of Oregon considering as a result of lessons learned from HTPP?

?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

CHSE and CORE were required to answer seven questions through the evaluation.

Q6 Q2 Q7 Q4 Q3 Q5 Q1

How have DRG hospitals performed on all HTPP measures compared to the baseline? How have DRG hospitals performed on HTPP measures that are also CCO measures compared to non-DRG hospitals? What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals? What kinds of barriers prevented any hospitals from meeting HTPP measurement goals? What kinds of changes in practice have hospitals made as a result of HTPP? What kinds of quality improvements or investments have hospitals made as a result of receiving HTPP payments?

What kinds of changes to quality incentive programs are CCOs and the State of Oregon considering as a result of lessons learned from HTPP?

?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

CHSE and CORE were required to answer seven questions through the evaluation.

Q6 Q2 Q7 Q4 Q3 Q5 Q1

How have DRG hospitals performed on all HTPP measures compared to the baseline? How have DRG hospitals performed on HTPP measures that are also CCO measures compared to non-DRG hospitals? What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals? What kinds of barriers prevented any hospitals from meeting HTPP measurement goals? What kinds of changes in practice have hospitals made as a result of HTPP? What kinds of quality improvements or investments have hospitals made as a result of receiving HTPP payments?

What kinds of changes to quality incentive programs are CCOs and the State of Oregon considering as a result of lessons learned from HTPP?

?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

CHSE and CORE were required to answer seven questions through the evaluation.

Q6 Q2 Q7 Q4 Q3 Q5 Q1

How have DRG hospitals performed on all HTPP measures compared to the baseline? How have DRG hospitals performed on HTPP measures that are also CCO measures compared to non-DRG hospitals? What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals? What kinds of barriers prevented any hospitals from meeting HTPP measurement goals? What kinds of changes in practice have hospitals made as a result of HTPP? What kinds of quality improvements or investments have hospitals made as a result of receiving HTPP payments?

What kinds of changes to quality incentive programs are CCOs and the State of Oregon considering as a result of lessons learned from HTPP?

?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

CHSE and CORE were required to answer seven questions through the evaluation.

Q6 Q2 Q7 Q4 Q3 Q5 Q1

How have DRG hospitals performed on all HTPP measures compared to the baseline? How have DRG hospitals performed on HTPP measures that are also CCO measures compared to non-DRG hospitals? What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals? What kinds of barriers prevented any hospitals from meeting HTPP measurement goals? What kinds of changes in practice have hospitals made as a result of HTPP? What kinds of quality improvements or investments have hospitals made as a result of receiving HTPP payments?

What kinds of changes to quality incentive programs are CCOs and the State of Oregon considering as a result of lessons learned from HTPP?

?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

CHSE and CORE were required to answer seven questions through the evaluation.

Q6 Q2 Q7 Q4 Q3 Q5 Q1

How have DRG hospitals performed on all HTPP measures compared to the baseline? How have DRG hospitals performed on HTPP measures that are also CCO measures compared to non-DRG hospitals? What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals? What kinds of barriers prevented any hospitals from meeting HTPP measurement goals? What kinds of changes in practice have hospitals made as a result of HTPP? What kinds of quality improvements or investments have hospitals made as a result of receiving HTPP payments?

What kinds of changes to quality incentive programs are CCOs and the State of Oregon considering as a result of lessons learned from HTPP?

?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

CHSE and CORE were required to answer seven questions through the evaluation.

Q6 Q2 Q7 Q4 Q3 Q5 Q1

How have DRG hospitals performed on all HTPP measures compared to the baseline? How have DRG hospitals performed on HTPP measures that are also CCO measures compared to non-DRG hospitals? What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals? What kinds of barriers prevented any hospitals from meeting HTPP measurement goals? What kinds of changes in practice have hospitals made as a result of HTPP? What kinds of quality improvements or investments have hospitals made as a result of receiving HTPP payments?

What kinds of changes to quality incentive programs are CCOs and the State of Oregon considering as a result of lessons learned from HTPP?

?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

CHSE and CORE were required to answer seven questions through the evaluation.

Q6 Q2 Q7 Q4 Q3 Q5 Q1

How have DRG hospitals performed on all HTPP measures compared to the baseline? How have DRG hospitals performed on HTPP measures that are also CCO measures compared to non-DRG hospitals? What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals? What kinds of barriers prevented any hospitals from meeting HTPP measurement goals? What kinds of changes in practice have hospitals made as a result of HTPP? What kinds of quality improvements or investments have hospitals made as a result of receiving HTPP payments?

What kinds of changes to quality incentive programs are CCOs and the State of Oregon considering as a result of lessons learned from HTPP?

?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

CHSE and CORE used three primary data sources for the evaluation.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Quality measures data for each hospital:

• Data collected from hospitals by OAHHS
• Medicaid claims and encounters from OHA
• Emergency Department Information

Exchange (EDIE) data

Q 1 Q 6 Q 2 Q 7 Q 4 Q 3 Q 5

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Q 1 Q 6 Q 2 Q 7 Q 4 Q 3 Q 5

Online survey of DRG hospitals

• All DRG hospitals completed the survey.
• Respondents for health systems answered

for all hospitals in the system.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Q 1 Q 6 Q 2 Q 7 Q 4 Q 3 Q 5

Stakeholder interviews

• Four CCO representatives
• One OHA representative

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

The following limitations should be considered when interpreting results:

• Data reflect the first two years of the

program, and only one year of pay for performance.

• Baseline Year data were incomplete or

unavailable for some measures at some hospitals.

• Hospitals were allowed to submit partial-year

data from the Baseline or Performance Year as a baseline for some measures.

• Measure rates used for the evaluation may

differ from rates reported by OHA.

!

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Key findings:

Performance incentives were associated with statistically significant improvements on 2 of 11 quality measures.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Key findings:

Specific activities were associated with change in performance between Baseline and Performance Years.

• Increasing collaboration with CCOs
• Changing workflows or protocols
• Investing in new data tools or software

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Key findings:

Surveys and interviews indicate that HTPP increased collaboration between hospitals and CCOs.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

How have DRG hospitals performed on all HTPP measures compared to the baseline?

Q 1

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

We used regression analysis to estimate change associated with performance incentives across all hospitals, holding selected factors equal. Unadjusted pre-post tests yielded the same findings.

Q 1

How have DRG hospitals performed on all HTPP measures compared to the baseline?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Performance incentives were associated with statistically significant improvements on 2 of 11 quality measures.

Q 1

How have DRG hospitals performed on all HTPP measures compared to the baseline? increase in Rate of Outreach Notifications to Primary Care for ED Use*

+15.7%

percentage point

increase in SBIRT in the ED: Screening Rate*

+11.3%

percentage points

* See appendix for full regression results.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Performance was significantly worse on 2 of 11 quality measures.

Q 1

How have DRG hospitals performed on all HTPP measures compared to the baseline? increase in Hospital-Wide All-Cause Readmission (lower is better)*

+0.5%

percentage point

Reduction in SBIRT in the ED: Brief Intervention Rate*

• 19.1%

percentage points

Hospitals tripled the number of patients who received a brief intervention; however, the number who received screening increased sevenfold. * See appendix for full regression results.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

How have DRG hospitals performed on HTPP measures that are also CCO measures compared to non-DRG hospitals?

Q 2

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

We used regression analysis to compare DRG and non-DRG hospitals on 30-Day All-Cause Readmissions. Comparison of DRG and non-DRG hospitals must be made with caution. The 30-Day All-Cause Readmissions rate was 2.6 percentage points higher for DRG hospitals; however, the difference was not statistically significant.

Q 2

How have DRG hospitals performed on HTPP measures that are also CCO measures compared to non-DRG hospitals?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals?

Q 3

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Hospitals made a broad effort to improve performance on HTPP quality measures.

Q 3

What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

At least three-fourths of hospitals worked to improve performance on 10 of 11 measures.

Q 3

What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals?

HTPP quality measure Hospitals reporting they worked to improve performance on this measure* SBIRT in the ED 100% Staff Gave Patient Discharge Information 93% Staff Always Explained Medicines 92% Hospital-Wide All-Cause Readmissions 86% Hospitals Share ED Visit Information 81% Adverse Drug Events Due to Opioids 79% CLABSI in All Tracked Units 78% CAUTI in All Tracked Units 78% Hypoglycemia in Inpatients Receiving Insulin 75% Excessive Anticoagulation with Warfarin 75% Follow-Up after Hospitalization for Mental Illness 64% * Percentage of DRG hospitals that responded to this survey item. Not all hospitals responded to all items. Responses for SBIRT in the ED, Staff Always Explained Medicines, and Hospitals Share ED Visit Information exclude one hospital to which the measures were not applicable because it does not have an emergency room.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

On average, two-thirds of hospitals (66%) said they devoted more effort to improve performance on measures than in the year before the Baseline Year.* On average, 35% of hospitals said they devoted the “about the same” effort to improve performance as in the year before the Baseline Year.*

Q 3

What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals?

* See appendix for survey item responses.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Hospitals engaged in a wide variety of activities to improve their performance on targeted measures.

Q 3

What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals?

Activity to improve performance on HTPP quality measures Percentage of hospitals reporting they used this activity* Trained staff to improve targeted outcomes 100% Redirected existing staff to work on targeted measures 93% Assembled teams or committees dedicated to targeted measures 93% Tracked performance to provide rapid feedback and reporting 93% Increased internal collaboration within hospital(s) 89% Changed workflows or protocols to improve targeted outcomes 78% Provided new materials, supplies, or other resources to staff or patients 70% Increased collaboration with non-CCO community partners 59% Invested in new data tools or software to support efforts 48% Hired new staff devoted to working on targeted measures 39% Increased collaboration with local CCOs 39% * Percentage of DRG hospitals that responded to this survey item. Not all hospitals responded to all items.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

The most common activities involved changing processes or redirecting existing staff.

Q 3

What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals?

Activity to improve performance on HTPP quality measures Percentage of hospitals reporting they used this activity* Trained staff to improve targeted outcomes 100% Redirected existing staff to work on targeted measures 93% Assembled teams or committees dedicated to targeted measures 93% Tracked performance to provide rapid feedback and reporting 93% Increased internal collaboration within hospital(s) 89% Changed workflows or protocols to improve targeted outcomes 78% Provided new materials, supplies, or other resources to staff or patients 70% Increased collaboration with non-CCO community partners 59% Invested in new data tools or software to support efforts 48% Hired new staff devoted to working on targeted measures 39% Increased collaboration with local CCOs 39% * Percentage of DRG hospitals that responded to this survey item. Not all hospitals responded to all items.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Slightly more than one-third of hospitals said they increased collaboration with local CCOs.

Q 3

What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals?

Activity to improve performance on HTPP quality measures Percentage of hospitals reporting they used this activity* Trained staff to improve targeted outcomes 100% Redirected existing staff to work on targeted measures 93% Assembled teams or committees dedicated to targeted measures 93% Tracked performance to provide rapid feedback and reporting 93% Increased internal collaboration within hospital(s) 89% Changed workflows or protocols to improve targeted outcomes 78% Provided new materials, supplies, or other resources to staff or patients 70% Increased collaboration with non-CCO community partners 59% Invested in new data tools or software to support efforts 48% Hired new staff devoted to working on targeted measures 39% Increased collaboration with local CCOs 39% * Percentage of DRG hospitals that responded to this survey item. Not all hospitals responded to all items.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

We used regression analysis to estimate the relationship between…

• Working on specific measures
• Using specific activities to improve

performance …and improvement between the Baseline Year and Performance Year.

Q 3

What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Relationship between working on specific measures and improvement:

Q 3

What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals?

* See appendix for full regression results.

in Rate of Outreach Notifications to Primary Care for ED Use*

+ 22.0%

percentage point greater increase

in CAUTI in All Tracked Units*

• 1 infection

per 1,000 days greater reduction

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Relationship between using specific activities and improvement:

Q 3

What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals?

* See appendix for full regression results.

Increasing Collaboration with CCOs:

in SBIRT in the ED: Screening Rate*

+ 14.0%

percentage point greater increase

• 0.2%

percentage point greater reduction

in Adverse Drug Events Due to Opioids*

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Relationship between using specific activities and improvement:

Q 3

What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals?

* See appendix for full regression results.

Changing Workflows or Protocols:

in Rate of Outreach Notifications to Primary Care for ED Use*

+ 30.5%

percentage point greater increase

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Relationship between using specific activities and improvement:

Q 3

What kinds of factors contributed to hospitals successfully meeting HTPP measurement goals?

* See appendix for full regression results.

in Adverse Drug Events Due to Opioids*

• 0.2%

percentage point greater reduction

Investment in New Data Tools or Software:

• 3.7%

percentage point lower increase

in Staff Always Explained Medicines*

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

What kinds of barriers prevented any hospitals from meeting HTPP measurement goals?

Q 4

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

74% of hospitals said statewide benchmarks were “very difficult” to achieve.

Q 4

What kinds of barriers prevented any hospitals from meeting HTPP measurement goals?

HTPP measurement goal Difficulty of achieving measurement goal* Very difficult About right Too easy Don’t know or not applicable Benchmarks 74% 26% 0% 0% Improvement targets 37% 63% 0% 0% * Percentage of DRG hospitals that responded to this survey item. Not all hospitals responded to all items.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

63% of hospitals said individual improvement targets were “about right.”

Q 4

What kinds of barriers prevented any hospitals from meeting HTPP measurement goals?

HTPP measurement goal Difficulty of achieving measurement goal* Very difficult About right Too easy Don’t know or not applicable Benchmarks 74% 26% 0% 0% Improvement targets 37% 63% 0% 0% * Percentage of DRG hospitals that responded to this survey item. Not all hospitals responded to all items.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Challenges stemmed from short timelines for:

• Program design and implementation
• Finalizing quality measures
• Demonstrating improved performance

Q 4

What kinds of barriers prevented any hospitals from meeting HTPP measurement goals?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Timeline challenge: program design and implementation

• The Oregon Legislature approved HTPP four

months before the Baseline Year began.

• This afforded little time to consider complex or

non-standard measures.

• All stakeholders wanted more time to design and

implement the program.

Q 4

What kinds of barriers prevented any hospitals from meeting HTPP measurement goals?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Timeline challenge: finalizing quality measures

• Measures were finalized shortly before the

beginning of the Performance Year.

• 50% of hospitals identified changing benchmarks

as the most significant challenge.*

• 50% of hospitals identified changing improvement

targets as their most significant challenge.*

Q 4

What kinds of barriers prevented any hospitals from meeting HTPP measurement goals?

* See appendix for survey item responses.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Timeline challenge: finalizing quality measures

The program needs to be defined and communicated early – well before the program year starts measures need to be known and preferably benchmarks and improvement targets should also be shared early.

• Hospital Survey Respondent

Q 4

What kinds of barriers prevented any hospitals from meeting HTPP measurement goals?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Timeline challenge: demonstrating performance improvement

• Performance was measured over one-year

periods.

• Hospitals said these periods afforded relatively

little time to improve performance.

Q 4

What kinds of barriers prevented any hospitals from meeting HTPP measurement goals?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Timeline challenge: demonstrating performance improvement

Some of the measures are complex, multifaceted and incredibly difficult to move in short periods of time.

• Hospital Survey Respondent

Q 4

What kinds of barriers prevented any hospitals from meeting HTPP measurement goals?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

What kinds of changes in practice have hospitals made as a result of HTPP?

Q 5

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Hospitals reported the following effects as a result of HTPP:

• 93% said HTPP helped their quality improvement

efforts and programs.*

• 39% said HTPP was “very important” for

improving quality.*

• 39% said they would “probably not” or “definitely

not” be performing as well on HTPP measures if HTPP had never existed.*

Q 5

What kinds of changes in practice have hospitals made as a result of HTPP?

* See appendix for survey item responses.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Hospitals reported the following effects as a result of HTPP:

• 35% increase staffing allocated to HTPP from the

Baseline to the Performance Year.*

• 77% maintained staffing allocated to HTPP from

the Performance Year to the year after.*

Q 5

What kinds of changes in practice have hospitals made as a result of HTPP?

* See appendix for survey item responses.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

The initial work to organize teams and begin implementing new processes and practices along with the education and roll-out, took a lot of time. Though we did not meet some of the measures [in the performance year], we can see the improvement today, At this date, those measures would have been met. It just took more time. However, we now have the structure, the awareness, and the cultural shift to make rapid improvements when data supports the need.

• Hospital Survey Respondent

Q 5

What kinds of changes in practice have hospitals made as a result of HTPP?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

HTPP catalyzed moderately greater collaboration between hospitals and CCOs.

• CCOs interviewed reported that collaboration

between hospitals and CCOs preceded HTPP.

• HTPP sparked discussions about ED information

sharing and substance use screening.

• CCOs expressed support for greater measure

alignment and continued collaboration.

Q 5

What kinds of changes in practice have hospitals made as a result of HTPP?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

One CCO representative likened the beginning of HTPP to the early stages of CCO implementation. The early stages of CCO implementation required extensive conversations and relationship building, which were needed before improvement on measures requiring cross-organizational collaboration could occur. The CCO representative

• bserved that increased communication represents a

necessary first step toward improving performance

• n collaborative measures.

Q 5

What kinds of changes in practice have hospitals made as a result of HTPP?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

What kinds of quality improvements or investments have hospitals made as a result of receiving HTPP payments?

Q 6

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Nearly half (46%) of hospitals said they invested a portion of HTPP payments into the HTPP program and allocated a portion for other things.

Q 6

What kinds of quality improvements or investments have hospitals made as a result of receiving HTPP payments?

Use of HTPP incentive payments Payments for reporting issued in April 2015* Payments for performance issues in June 2016* Reinvest a portion into the HTPP program and allocate a portion to the hospital budget for other things 46% 46% Allocate most to the hospital budget for other uses, like offsetting costs or investments unrelated to HTPP 29% 29% I don’t know 14% 14% Reinvest most into the HTPP program and related activities. 11% 11% * Percentage of DRG hospitals that responded to this survey item. Not all hospitals responded to all items.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Only 11% of hospitals said they reinvested most HTPP payments into the HTPP program and related activities.

Q 6

What kinds of quality improvements or investments have hospitals made as a result of receiving HTPP payments?

Use of HTPP incentive payments Payments for reporting issued in April 2015* Payments for performance issues in June 2016* Reinvest a portion into the HTPP program and allocate a portion to the hospital budget for other things 46% 46% Allocate most to the hospital budget for other uses, like offsetting costs or investments unrelated to HTPP 29% 29% I don’t know 14% 14% Reinvest most into the HTPP program and related activities. 11% 11% * Percentage of DRG hospitals that responded to this survey item. Not all hospitals responded to all items.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

What kinds of changes to quality incentive programs are CCOs and the State of Oregon considering as a result of lessons learned from HTPP?

Q 7

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

41% of hospitals participated in incentive programs

• perated by CCOs.

Q 7

What kinds of changes to quality incentive programs are CCOs and the State of Oregon considering as a result of lessons learned from HTPP?

Type of hospital incentive program Percentage of hospitals that participated* Percentage of hospitals that said incentive program measures and activities were aligned with HTPP* Very aligned Somewhat aligned Not very aligned I don’t know Federal 96% 19% 58% 23% 0% Commercial insurer 50% 15% 69% 8% 8% CCO 41% 18% 45% 27% 9% * Percentage of DRG hospitals that responded to this survey item. Not all hospitals responded to all items.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Overall, hospitals said HTPP was more closely aligned with federal and commercial incentive programs than with CCO incentive programs.

Q 7

What kinds of changes to quality incentive programs are CCOs and the State of Oregon considering as a result of lessons learned from HTPP?

Type of hospital incentive program Percentage of hospitals that participated* Percentage of hospitals that said incentive program measures and activities were aligned with HTPP* Very aligned Somewhat aligned Not very aligned I don’t know Federal 96% 19% 58% 23% 0% Commercial insurer 50% 15% 69% 8% 8% CCO 41% 18% 45% 27% 9% * Percentage of DRG hospitals that responded to this survey item. Not all hospitals responded to all items.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

CCOs interviewed for the evaluation said they do not plan to change their incentive programs in response to HTPP.

• CCOs expressed support for continued

collaboration with hospitals.

• CCOs expressed interest in closer alignment

between CCO and HTPP incentive measures.

Q 7

What kinds of changes to quality incentive programs are CCOs and the State of Oregon considering as a result of lessons learned from HTPP?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

OHA plans to add more measures reflecting hospital-CCO collaboration after Year 3.

• OHA emphasized that collaboration measures are

challenging and should be introduced gradually.

• OHA emphasized the value of HTPP for including

hospitals in health system transformation.

Q 7

What kinds of changes to quality incentive programs are CCOs and the State of Oregon considering as a result of lessons learned from HTPP?

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

The evaluation represents a preliminary assessment of HTPP.

• Only two years of program data were

available.

• Baseline Year data reflect rapid program

start-up.

• Evaluation should continue to accurately

assess HTPP’s effect on hospital practice and performance.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Appendix

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Regression-adjusted change associated with HTPP performance incentives.

Focus Area Measure Average, Baseline Year* Average, Performance Year* Regression- adjusted change† Hospital-CCO Collaboration

Hospitals Share ED Visit Information Rate of Outreach Notifications to Primary Care for Emergency Department Use 54.8% 65.6% 15.7% Care Guidelines Completion Rate 0.4% 1.1% 0.6% Follow-Up After Hospitalization for Mental Illness (7 days) 64.8% 64.4%

• 0.4%

SBIRT in the ED Screening Rate 14.9% 44.7% 11.3% Brief Intervention Rate 50.0% 24.4%

• 19.1%

Hospital

Hospital-Wide All-Cause Readmissions (lower is better) 10.9% 11.3% 0.5% Hypoglycemia in Inpatients Receiving Insulin (lower is better) 3.9% 3.8%

• 0.3%

Excessive Anticoagulation with Warfarin (lower is better) 1.5% 1.3%

• 0.2%

Adverse Drug Events Due to Opioids (lower is better) 0.5% 0.5% 0.0% Staff Always Explained Medicines 63.8% 64.0% 0.4% Staff Gave Patient Discharge Information 88.9% 89.4% 0.8% CLABSI in All Tracked Units (lower is better) 0.83 infections per 1,000 patient days 0.89 infections per 1,000 patient days 0.23 infections per 1,000 patient days CAUTI in All Tracked Units (lower is better) 0.83 infections per 1,000 patient days 0.99 infections per 1,000 patient days 0.04 infections per 1,000 patient days

* Statewide average unadjusted for covariates. † Adjusted for covariates. Statistical significance at P < 0.05 indicated in orange.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Percentage of DRG hospitals that worked on each HTPP quality measure by level of effort

HTPP Quality Measure Level of Effort* More than previous year About the same as previous year Less than previous year Don’t know SBIRT in the ED 88% 12% 0% 0% Staff Always Explained Medicines 83% 17% 0% 0% Staff Gave Patient Discharge Information 80% 16% 0% 0% Hospitals Share ED Visit Information 73% 27% 0% 0% Hypoglycemia in Inpatients Receiving Insulin 67% 33% 0% 0% CAUTI in All Tracked Units 62% 38% 0% 0% Hospital-Wide All-Cause Readmissions 58% 42% 0% 0% Excessive Anticoagulation with Warfarin 57% 43% 0% 0% Follow-Up after Hospitalization for Mental Illness (7 days) 53% 47% 0% 0% CLABSI in All Tracked Units 48% 52% 0% 0% Adverse Drug Events Due to Opioids 45% 55% 0% 0% * Percentage of DRG hospitals that responded to this survey item. Not all hospitals responded to all items.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Performance improvement associated with working on specific HTPP quality measures

HTPP Quality Measure* Improvement associated with working on each measure† Hospitals Share ED Visit Information: Rate of Outreach Notifications to Primary Care for ED Use 22.0% Hospitals Share ED Visit Information: Care Guidelines Completion Rate 0.3% Follow-Up After Hospitalization for Mental Illness (7 days)

• 1.4%

SBIRT in the ED: Screening Rate Omitted due to identification issue SBIRT in the ED: Brief Intervention Rate Omitted due to identification issue Hospital-Wide All-Cause Readmissions

• 0.2%

Hypoglycemia in Inpatients Receiving Insulin 0.8% Excessive Anticoagulation with Warfarin

• 0.6%

Adverse Drug Events Due to Opioids 0.1% Staff Always Explained Medicines 0.5% Staff Gave Patient Discharge Information

• 0.5%

CLABSI in All Tracked Units 0.35 infections per 1,000 days CAUTI in All Tracked Units

• 1.00 infections per 1,000 days

* Results for some measures exclude data for some hospitals. See HTPP evaluation report, Appendix B: Methodology for details. † Statistical significance at P < 0.05 indicated in orange.

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Performance improvement associated with using specific activities to improve performance on HTPP quality measures

HTPP Quality Measure* Improvement associated with activity† Changed workflows

• r protocols to

improve targeted

• utcomes

Invested in new data tools or software to support efforts Hired new staff devoted to working

• n targeted

measures Increased collaborations with local CCO(s) Hospitals Share ED Visit Information: Rate of Outreach Notifications to Primary Care for ED Use 30.5%

• 7.7%
• 15.1%

10.3% Hospitals Share ED Visit Information: Care Guidelines Completion Rate

• 2.0%

1.6% 1.3% 1.2% Follow-Up After Hospitalization for Mental Illness (7 days) 8.1% 1.4%

• 13.9%
• 11.8%

SBIRT in the ED: Screening Rate 15.6%

• 12.8%
• 1.5%

14.0% SBIRT in the ED: Brief Intervention Rate

• 45.1%

18.2% 18.9% 22.8% Hospital-Wide All-Cause Readmissions

• 0.1%

0.5% 0.5% 0.3% Hypoglycemia in Inpatients Receiving Insulin 1.1% 0.4%

• 0.9%

0.2% Excessive Anticoagulation with Warfarin 0.3%

• 0.2%

0.2% 0.2% Adverse Drug Events Due to Opioids 0.1%

• 0.2%

0.1%

• 0.2%

Staff Always Explained Medicines 3.3%

• 3.7%

0.9%

• 1.0%

Staff Gave Patient Discharge Information 0.0%

• 1.4%

1.8% 1.0% CLABSI in All Tracked Units

• 0.52 infections per

1,000 days 0.16 infections per 1,000 days 0.13 infections per 1,000 days 0.17 infections per 1,000 days CAUTI in All Tracked Units 0.20 infections per 1,000 days

• 0.30 infections per

1,000 days

• 0.16 infections per

1,000 days 0.35 infections per 1,000 days * Results for some measures exclude data for some hospitals. See HTPP evaluation report, Appendix B: Methodology for details. † Statistical significance at P < 0.05 indicated in orange.

†

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Percentage of DRG hospitals by most significant challenge achieving HTPP measurement goals

Challenge with achieving HTPP measurement goals Type of measurement goal* Benchmarks Improvement targets The goals have been changed, making it hard to know where we are 50% 60% There isn’t enough time to implement something and see results 25% 0% Some goals are too difficult to meet 10% 20% Some measures are unfair to hospitals of certain types, sizes, or locations 10% 20% Something else 5% 0% * Percentage of DRG hospitals that responded to this survey item. Not all hospitals responded to all items.

†

O H S U C E N T E R F O R H E A L T H S Y S T E M S E F F E C T I V E N E S S

Reported effect of HTPP on hospital quality improvement efforts and programs

Effect of HTPP on hospital quality improvement efforts and programs Percentage of hospitals* It has helped them 93% It hasn’t helped them 0% It hasn’t had a strong effect either way 7% * Percentage of DRG hospitals that responded to this survey item. Not all hospitals responded to all items.

†

Importance of HTPP for improving quality Percentage of hospitals* Very important 39% Somewhat important 54% Not very important 7% Don’t know 0% Would hospital be performing as well as it is today if HTPP never existed? Percentage of hospitals* Definitely not 11% Probably not 39% Probably yes 50% Definitely yes 0% Don’t know 0%

Reported importance of HTPP for improving quality Reported improvement on HTPP quality measures if HTPP never existed

HTPP years Change in FTE staffing allocated to HTPP efforts* Increased No change Decreased Baseline Year to Performance Year 35% 65% 0% Performance Year to Year 3 0% 77% 23%

Percentage of DRG hospitals that changed FTE staffing allocated to HTPP efforts between program years

Proposed Opioid measure continued discussion / Washington specs update

107

Proposed Opioid Metric: Where Landed

• An alternate metric based on work from Washington state was

proposed and agreed upon by the Committee.

• The proposed metric embraces the spirit of the CDC1 and OCEP2

guidelines.

• Draft specifications are in packet

The metric is in two-parts: 1) Average number of pills per opioid Rx in the ED. 2) Percent of ED visits that result in an opioid Rx. This would be report-

• nly, with results shared publicly, but not incentivized.

1http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm 2http://www.oregon.gov/oha/analytics/HospitalMetricsDocs/ORACEP%20Opioid%20Prescribing%20Guidelines.pdf

108

Opioid measure discussion

• OHA is still waiting for clarification from Washington

State on how they utilize the ‘days/supply’ metric’

• OHA developing master list of opioid products to help in

report development

• Questions for H-TAG:

– Do we have a common understanding of what we’re measuring? – Questions on specifications, as stand now? – Next Steps:

• Opportunity to work through specs, technically, and test data.
• How long needed to write a test report?

109

Wrap-up

• Next meeting: Tuesday, August 09, 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

110