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Universit y of Louisville Healt h Wat ch US A Disclaimer: All information presented at this conference is the express opinion of the presenters, moderators and/ or participants regarding various subj ects of healthcare policy, patient

SLIDE 1

Universit y of Louisville Healt h Wat ch US A

Disclaimer: All information presented at this conference is the express opinion of the presenters, moderators and/ or participants regarding various subj ects of healthcare policy, patient engagement, value purchasing and healthcare overutilization.

SLIDE 2

 Many methods are now used to j udge

healthcare quality. These methods give different results and use different types of measurements.

SLIDE 3

 The facility has the needed resources to

deliver the care. Examples of these include

- Nursing Turnover Rate.
- Nurse Practice Environment.

SLIDE 4

Kavanagh KT , Cimiot t i JP , Abusalem S , Cot y MB. Moving Healt hcare Quality Forward Wit h Nursing- S ensit ive Value-Based Purchasing. J Nurs S

cholarsh. 2012 Oct 15. doi: 10.1111/ j .1547-

5069.2012.01469.x. [Epub ahead of print ]

SLIDE 5

Figure 1. Public reporting of structure measures by Norton Healthcare.

Kavanagh KT , Cimiot t i JP , Abusalem S , Cot y MB. Moving Healt hcare Quality Forward Wit h Nursing- S ensit ive Value-Based Purchasing. J Nurs S

cholarsh. 2012 Oct 15. doi: 10.1111/ j .1547-5069.2012.01469.x.

SLIDE 6

 These measures are debated with many

recent articles showing a poor correlation with overall quality.

Jha A K, Joynt KE, Orav EJ & Epstein AM. The long-term effect of premier pay for performance on patient outcomes. New England Journal of Medicine, 2012::366(17), 1606– 1615. Ingraham AM, Cohen ME, Bilimoria KY , Dimick JB, et al. Association of surgical care improvement proj ect infection-related process measure compliance with risk-adj usted outcomes: Implications for quality

measurement. Journal of the American College of S

urgeons, 2010:211(6), 705– 714. Ryan AM, Nallamothu BK, & Dimick JB. (2012). Medicare’s public reporting initiative on hospital quality had modest or no impact on mortality from three key conditions. Health Affairs, 2012:31(3), 585– 592.

SLIDE 7

 Infections  Pressure S

 Mortality

These are highly dependent upon proper staffing.

SLIDE 8

Kavanagh KT , Cimiot t i JP , Abusalem S , Cot y MB. Moving Healt hcare Quality Forward Wit h Nursing- S ensit ive Value-Based Purchasing. J Nurs S

cholarsh. 2012 Oct 15. doi: 10.1111/ j .1547-

5069.2012.01469.x. [Epub ahead of print ]

SLIDE 9

 Ranking method includes “ as many hospitals

as possible, areas that had the greatest effect on patient safety, measures that were focused on outcomes, instead of processes… ”

 Rankings include infections, readmissions,

unnecessary testing and communication with patients.

S

urce: Ashish Jha. Hospital rankings Get S

erious. An Ounce of Evidence| Health Policy Blog. Aug 14, 2012 Consumer Reports accompaniment to “ Hospital Rankings Get S

erious. Aug 14, 2012. John S

anta, MD, MPH.

SLIDE 10

 Focuses on chances of getting hurt or killed

in a facility from adverse events.

 Composite S

afety S core: Comprises Infections, S taffing, and S tructure Measures.

S

urce: Ashish Jha. Hospital rankings Get S

erious. An Ounce of Evidence| Health Policy Blog. Aug 14, 2012

SLIDE 11

 Based 32.5%

On Reputation.

 5%

n Patient S

afety.

 S

urvival S cores 32.5% .

 Other Care Related Indicators 30%

(Technology, Nurse S taffing).

http:/ / health.usnews.com/ health-news/ best-hospitals / articles/ 2012/ 07/ 16/ best-hospitals-2012-13-how-they-were

ranked?

page=2

SLIDE 12

Note: 99%

f facilities which received a Top Hospital ranking in

Cardiology and Pulmonology by US News and World report were Maj or or Minor Teaching Hospitals.

S

urce: Ashish Jha. Hospital rankings Get S

erious. An Ounce of Evidence| Health Policy Blog. Aug 14, 2012

SLIDE 13

 The User Can Compare

- Outcome Measures (Infections & Mortality).
- Process Measures.
- Readmissions.
- Patient S

urvey.

 Can compare individual hospitals. Most results

are also related to the national average.

 Infections are related to an S

IR and “ National Benchmark” the accuracy of which is in question and a topic for a presentation later today.

SLIDE 14

 Obtaining the best healthcare at an

affordable cost.

 The Center’s for Medicare and Medicaid

(CMS ) are actively involved in this process.

SLIDE 15

 For 2013:

- 30%

HCAHPS (Patient S urvey).

- 70%

Process Measures.

Weight Given To Measure

HCAHPS Process

SLIDE 16

2014 Measures Will Comprise Of:

 - 13 Core Measures  - 8 HCAHPS  - 3 Mortality  - 8 Hospital Acquired Conditions  - 2 Composite PSI  - 1 Efficiency (cost per beneficiary)

SLIDE 17

Universit y of Louisville Healt h Wat ch US A

Disclaimer: All information presented at this conference is the express opinion of the presenters, moderators and/ or participants regarding various subj ects of healthcare policy, patient engagement, value purchasing and healthcare overutilization.

 Many methods are now used to j udge

healthcare quality. These methods give different results and use different types of measurements.

 The facility has the needed resources to

deliver the care. Examples of these include

Figure 1. Public reporting of structure measures by Norton Healthcare.

 These measures are debated with many

recent articles showing a poor correlation with overall quality.

urgeons, 2010:211(6), 705– 714. Ryan AM, Nallamothu BK, & Dimick JB. (2012). Medicare’s public reporting initiative on hospital quality had modest or no impact on mortality from three key conditions. Health Affairs, 2012:31(3), 585– 592.

 Infections  Pressure S

 Mortality

These are highly dependent upon proper staffing.

 Ranking method includes “ as many hospitals

as possible, areas that had the greatest effect on patient safety, measures that were focused on outcomes, instead of processes… ”

 Rankings include infections, readmissions,

unnecessary testing and communication with patients.

S

erious. An Ounce of Evidence| Health Policy Blog. Aug 14, 2012 Consumer Reports accompaniment to “ Hospital Rankings Get S

anta, MD, MPH.

 Focuses on chances of getting hurt or killed

in a facility from adverse events.

 Composite S

afety S core: Comprises Infections, S taffing, and S tructure Measures.

S

erious. An Ounce of Evidence| Health Policy Blog. Aug 14, 2012

 Based 32.5%

On Reputation.

 5%

afety.

 S

urvival S cores 32.5% .

 Other Care Related Indicators 30%

(Technology, Nurse S taffing).

http:/ / health.usnews.com/ health-news/ best-hospitals / articles/ 2012/ 07/ 16/ best-hospitals-2012-13-how-they-were

page=2

Note: 99%

Cardiology and Pulmonology by US News and World report were Maj or or Minor Teaching Hospitals.

S

erious. An Ounce of Evidence| Health Policy Blog. Aug 14, 2012

 The User Can Compare

urvey.

 Can compare individual hospitals. Most results

are also related to the national average.

 Infections are related to an S

IR and “ National Benchmark” the accuracy of which is in question and a topic for a presentation later today.

 Obtaining the best healthcare at an

affordable cost.

 The Center’s for Medicare and Medicaid

(CMS ) are actively involved in this process.

 For 2013:

HCAHPS (Patient S urvey).

Process Measures.

Weight Given To Measure

HCAHPS Process

2014 Measures Will Comprise Of:

 - 13 Core Measures  - 8 HCAHPS  - 3 Mortality  - 8 Hospital Acquired Conditions  - 2 Composite PSI  - 1 Efficiency (cost per beneficiary)

Domain Weighting

Efficiency Out comes Clinical Process Pat ient Experience

Efficiency Domain: 20% Patient Experience Domain: 30% Outcomes Domain: 30% Clinical Process Domain: 20%