Hospital Metrics TAG August 09, 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 • Opioid Metric Test Group • Opioid-related Discharge Data • Presentation: Public Health Home Visiting Program (re: Year 5 maternal/child health measure) • Year 4 EDIE Report • Best Practice Collaboration Discussion 3
Updates 4
Committee Meeting Debrief • Orientation for new members was held in July • No meeting was held in July • The next meeting will be scheduled for September with new committee membership. Agenda items include: – Discussing Year 4 benchmarks – Discussing challenge pool metric(s) – Beginning discussion of Year 5 core / menu set 5
HTPP 4: CMS Discussions • Years 4+ (2017 on) are part of OHA’s Medicaid waiver renewal proposal; OHA continues working with CMS - Proposal has been submitted 6
HTPP Year 3 Improvement Target Reports • Sent to all hospitals on 29 July • Includes final Year 2 performance and Year 3 improvement targets • Exception is follow-up after hospitalization for mental illness – To ensure equitable year-to-year comparison, OHA is rerunning Year 2 for both hospitals and CCOs. – These revised data will be used in calculating Year 3 benchmarks and improvement targets. – OHA anticipates that the Year 3 benchmark, improvement targets, and progress reports will be available by mid-August. 7
Final Year 3 Benchmarks Measure Year 3 Benchmark CLABSI Improvement target only CAUTI Improvement target only Adverse drug events due to Opioids 3% Excessive anticoagulation due to Warfarin 3% Hypoglycemia in inpatients receiving insulin 5% National 90 th percentile (91.0%) Shriners, 92.6% HCAHPS – discharge National 90 th percentile (73.0%) HCAHPS – medication 90 th percentile HTPP Year 2 (8.4%) All-cause readmissions 90 th percentile HTPP baseline, Year 1 (84.4%) EDIE 90 th percentile HTPP Year 2, hosp only rate (TBD) Follow-up after hospitalization 90 th percentile HTPP Year 2, brief (83.5%) SBIRT – brief screen 90 th percentile HTPP Year 2, full (71.3%) SBIRT – full screen 8
Questions? 9
Opioid Reporting Test Group and Opioid-related Discharge Data 10
Opioid Related Inpatient Discharges • We wanted to provide some additional context to the hospitals as we develop specification around opioid related metrics. • We want to provide information to help hospitals to assess their own individual opioid related impacts. 11
Analysis Methods • Followed CDC guidelines for assessing opioid poisonings: • https://www.cdc.gov/drugoverdose/pdf/pdo_guide_to_icd-9- cm_and_icd-10_codes-a.pdf • Selected ICD codes for prescription opioid poisoning (overdose) including diagnosis codes 965.00, 965.02, 965.09 and ecodes E850.1 and E850.2 • Selected ICD codes for opioid dependency including 304.0, 304.00, 304.01, 304.02, 304.03 • Calculated rate per 1,000 discharges for both prescription opioid poisonings and for opioid dependency as a complicating condition 12
Findings: Prescription Poisonings • Includes prescription use of opioid (methadone, oxycotin, vicodin, etc) and excludes heroin. • DRG hospitals have remain consistent 2008-2015 in the rate of prescription opioid poisoning discharges. DRG mean is 2.65 discharges per 1,000. • DRG’s range of rates from 0 – 6.56 per 1,000. 13
2015 Values Total DRG Hospitals 2.65 Total Type B 2.15 Total Type A 2.57 Total Statewide 2.61 14
Prescription Poisonings Date Range: 2008-Q3 2015 15
Prescription Poisonings Date Range: 2008-Q3 2015 16
Prescription Poisonings Date Range: 2008-Q3 2015 17
Findings: Opioid Dependency • Includes secondary diagnosis codes indicating opioid dependency as a complication to the principle condition • Includes heroin use • Rates have more than doubled in past 5 years • DRG hospitals average 20.54 discharges per 1,000 with a range of 0-75. • Most common principle diagnoses associated with opioid dependency are drug withdrawal, septicemia, and cellulitis. • Evidence for high levels of detox boarding. 18
2015 Values Total DRG Hospitals 20.54 Total Type B 12.59 Total Type A 11.02 Total Statewide 19.60 19
Opioid Dependency Date Range: 2008-Q3 2015 20
Opioid Dependency Date Range: 2008-Q3 2015 21
Opioid Dependency Date Range: 2008-Q3 2015 22
Opioid Dependency Date Range: 2008-Q3 2015 23
Additional notes • There is some overlap between patients counted as an opioid poisoning and as opioid dependency due to coding issues, but generally the categories are exclusive. • Ecode use is inconsistent, and missing for about half of diagnosed overdose/poisonings 24
Conclusions • While specific prescription overdoses have remained consistent, the rate of opioid dependency seen in hospitals has significantly increased • The majority of these cases represent avoidable hospitalizations 25
Opioid Metric Development – Next Steps • OHA is still awaiting clarification from WA State on how they utilize the ‘days/supply’ metric’ • OHA is developing a master list of opioid products to help in report development • Run test reports • Go! 26
Year 4 Baseline / Reporting Clarification • OHA’s proposal to CMS requests that new measures be pay-for-reporting, rather than pay-for-performance • However, given that Year 4 reporting may need to start as early as October (pending new waiver negotiations with CMS), hospitals should plan that new measures will be pay-for-performance in Year 4 27
Opioid Metric – Baseline / reporting clarification • Assuming pay-for-performance in Year 4: – Baseline period will be through March 31, 2017 (regardless of start date for Year 4) – Hospitals must have a minimum of 30 consecutive days of baseline data within this period in order to be eligible to participate in the measure (i.e., must be able to begin reporting by March 2, 2017) – The performance period will be from April 1, 2017 through the last day of Year 4 (date TBD per CMS) • Assuming pay-for-reporting in Year 4: • Hospitals must still be able to begin reporting by March 2, 2017 28
Opioid Metric – Baseline / reporting clarification 29
Opioid Measure Test Group • OHA strongly recommends hospitals begin running test reports now • Recruiting hospitals to be involved in subgroup of H-TAG to run test reports, learn from one another, and provide input for any changes / clarifications needed to the specifications 30
Opioid Measure Test Group • Scope: – Provide input on any technical problems in running reports per the measure specifications – Provide feedback on needed technical clarifications needed to specifications – Chance to trouble shoot report writing issues related to this measure with other hospitals • Participants: – Report writers / technical experts and QI leads 31
Opioid Measure Test Group • Commitment (2-3 meetings lasting 60 minutes each): – Meeting 1: 23-25 August (specific date/time TBD when group identified) • Review specifications, talk through details together • Ensure report writers have what they need to write report – Meeting 2, 19-23 September (specific date/time TBD when group identified) • Discuss issues encountered in running reports • Review data, assess validity together – Meeting 3, scheduled if needed 32
Opioid Measure Test Group If interested in participating, please email metrics.questions@state.or.us by 15 August. 33
Public Health Nurse Home Visiting Programs Hospital Technical Advisory Group Meeting August 9, 2016 Anna Stiefvater, Perinatal Nurse Consultant Cate Wilcox, Maternal and Child Health Manager Public Health Division PUBLIC HEALTH DIVISION Maternal and Child Health Section
Background: Proposed Metric • Proportion of hospital births screened for eligibility for home visiting programs other types of parenting support – Hospitals would check to see if this screening was done prenatally (which is preferred) – Hospitals would conduct the screening if it was not done prenatally PUBLIC HEALTH DIVISION Maternal and Child Health Section 35
Background: Oregon’s Home Visiting System • Work to develop the system happening since 2010 • More need than capacity • Programs include – Healthy Families Oregon – Public Health Nurse Home Visiting Programs – Early Head Start – Children’s Relief Nurseries – Family Support and Connections – Local initiatives PUBLIC HEALTH DIVISION Maternal and Child Health Section 36
Public Health Nurse (PHN) Home Visiting Programs • Implemented by Local Health Departments with support and technical assistance from the State Public Health Division and the Oregon Center for Children & Youth with Special Health Needs • Referrals from clinical providers, WIC, hospitals • Services are voluntary • Programs include: Maternity Case Management, Nurse Family Partnership, Babies First, CaCoon PUBLIC HEALTH DIVISION Maternal and Child Health Section 37
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