Quality Incentive Programs By: Amy Yearwood RN, BSN Physicians Network Quality Manager Huntsville Hospital
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Objectives • Huntsville Hospital’s merit -based incentive contracts • Learn the performance categories Huntsville Hospital uses in their incentive contracts • Learn which specialties have merit-based incentive contracts
Who is Huntsville Hospital? • 941 bed community-based not-for-profit hospital in North Central Alabama • State’s second largest hospital • 24-Physicians Network-owned practices with 76+ providers
What Specialties do we have? HH Physicians Care Hampton Cove HH Physicians Care Madison HH Physicians Care Lowell Drive HH Physicians Care Bailey Cove HH Maternal Fetal Medicine HH Physicians Care Gurley HH Lung Center Huntsville Surgical Associates (Trauma) HH Neurology Associates HH Endocrinology & Diabetes Clinic HH Surgical Associates of Madison TN Valley Pediatric Surgery HH Pediatric Neurology HH Surgical Associates - Huntsville North Alabama Hospitalists HH Pediatric Intensivists HH Pediatric Hospitalists Hazel Green Pediatrics St. Jude’s Clinic at Huntsville Hospital TN Valley Gynecological Oncology Associates HH Digestive Disease Center HH Walk in Clinic at Airport Road Huntsville Hospital Spine and Neuro OB/ED Hospitalist
Core Protocol for Incentives • Specialty • Quality • Service • Financial
HH Surgical Associates Quality-Principal Weight = 50% Surgical site infections rate less than the comparative general surgeons on staff. Compliance with hospital approved and suggested Operation Room Policies and Procedures: Including but not limited to: Service- Principal Weight=25% In the last 12 months, when you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed? Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider? In the last 12 months, how often did you see this provider within 15 minutes of your appointment time? Financial Performance - Principal Weight=25% Meet budgeted expenses Achieve coding accuracy Submit charge data within 7 days
Pediatric- Neurology Quality- Principal Weight Achieve 60% CPOE MU 2 Goal is 60% Achieve 50% ePrescribing MU 2 Goal is 50% Provide patient-specific educational material MU 2 Goal is 10% Provide a summary of care for transition out MU 2 Goal is 10% Service- Principal Weight Achieve overall patient satisfaction Financial Performance- Principal Weight Achieve coding accuracy
Hospitalists Quality-Principal Weight=50% 30 day Readmission rate: Readmission as an admission to a hospital within 30 days of a discharge from the same or another hospital. Risk adjusted mortality index (compared to large hospitals) VTE Prophylaxis (ICARE) LOS average observed vs. expected (compared to large hospitals) Participate in the High Value Care Team Initiatives 30 day Readmission rate for COPD Service-Principal Weight=25% How well the hospitalist kept the patient informed about the care and treatment How well the hospitalist coordinated care How well the hospitalist program was explained Financial Performance -Principal Weight=15% Meet the wRVUs for the National Region of MGMA ( 2014 Report) 4,141 Achieve coding accuracy Reduce cost per case as compared to other Internal Medicine physicians at HH Manage the program within national benchmarks for provider subsidy ($156,063.00 2014 SHM) Attend the quarterly meetings (each meeting is worth 25% of the payout) Complete the ProAssurance Seminar
HH Neurological Associates Quality-Principal Weight Achieve 60% CPOE Achieve 50% ePrescribing All prescriptions written must include the medication name, dosage, route, directions and PRN indication if necessary Provide patient-specific educational material Service-Principal Weight In the last 12 months, how often did the provider explain things in a way that was easy to understand? (Clear Communication by provider) In the last 12 months, how often did the provider listen carefully to you? (Provider listened carefully to you) Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider? (Provider overall rating) Financial Performance -Principal Weight Achieve coding accuracy
Hazel Green- Pediatrics Quality & Efficiency Outcome Scorecard Principal Weight=50% Provide HPV vaccine for children that meet the recommended guidelines within 9 months after the start of the series Provide reminders for the 11 and 12 year olds of their preventative visit Receive PKU results within 4 weeks Service-Principal Weight=25% In the last 12 months, when you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed? Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider? In the last 12 months, how often did you see this provider within 15 minutes of your appointment time? Financial Performance -Principal Weight=25% Meet budgeted expenses Achieve coding accuracy Submit charge data within 7 days
Digestive Disease Center Quality & Efficiency Outcome Scorecard Principal Weight=50% Body Mass Index ("BMI)" documentation completed and education of patients’ proper BMI completed 95% of the time Achieve adenoma detection rate of 15% for colon cancer screening patients Achieve colonoscopy withdrawal time of at least 6 minutes in 90% of patients undergoing screening colonoscopies Colon cancer screening documentation completed at least 90% of the time Completion of medical records in the office and hospital accordance with medical staff bylaws Routine continuing education provided for clinical staff in the endoscopy labs located at HH, Madison Hospital, Madison Office, Huntsville office Service-Principal Weight=25% Started as Employed Practice 1/1/2015 Financial Performance -Principal Weight=25% Meet budgeted expenses Achieve coding accuracy Submit charge data within 7 days
Primary Care Quality & Efficiency Outcome Scorecard Principal Weight=50% Diabetic Foot Exam completion Physician Composite Star Rating for Blue Advantage, Humana and HealthSpring- 3 stars BP Control- Increase the percentage of individuals 18-65 years of age with a diagnosis of hypertension whose BP was adequately controlled (<140/90) during the previous 12 months. 65 or older BP was adequately controlled (≤ 150/90) Breast Cancer Screening-members who are female between 50-74 years of age who had a mammogram to screen for breast cancer during the measurement year or the prior year. Colorectal Cancer Screening-members who are between 50-75 years of age who had appropriate screening for colorectal cancer. A1c Control- Diabetes, provider must ensure that eligible patients most recent A1c is no greater than 8. Red, White & Blue Medicare Wellness visits Reduce COPD Readmissions less than or equal to 6% Provider must exceed the performance standard for their assigned member population. The readmission rate = (# of readmissions) / (# of admissions). This includes inpatient admissions to any facility exclusive of psychiatry, maternity, SNF and rehabilitation visits Completion of Medicare & Medicare Advantage Forms Service-Principal Weight=25% In the last 12 months, when you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed? Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider? In the last 12months, how often did this provider spend enough time with you? Financial Performance -Principal Weight=25% Meet budgeted expenses Achieve coding accuracy Medical Records completed within 7 days
Ho How w HH HH mee meets ts th the e cha hall llen enge ges s of of mea measu suring ring an and d rep epor orting ting qu quality ality • • Currently participate in In the process of applying Meaningful Use. for National Committee for Quality Assurance (NCQA) • HH monitors each provider’s recognition for Patient quality based on specialty. Centered Medical Home • Quality incentive contracts (PCMH). are in place with most of the • Reviews are coordinated employed providers and with payers to see each renewed each year. provider’s quality outcomes • Reviewing new EMRs for to make necessary better workflow, adjustments for the future. documentation and reporting capabilities. • Collect patient satisfaction results to drive practice improvements.
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