1 © 2013 amphion medical solutions 1 b renda b artkowski, cma, cca, bs hpa m anager, c linical d...
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1© 2013 Amphion Medical Solutions 1
BRENDA BARTKOWSKI, CMA, CCA, BS HPA
MANAGER, CLINICAL DATA ABSTRACTION
AMY WIRTHSALES EXECUTIVE
JULY 17, 2013
What’s Hot & What’s Notin the Core Measure Field
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What’s Hot & What’s Not
DISCLAIMER: This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference. This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.
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Value-Based Purchasing (VBP)
What is hospital value-based purchasing?
A Centers for Medicare & Medicaid Services (CMS) initiative Rewards acute-care hospitals for quality of care to Medicare recipients
What’s
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Value-Based Purchasing (VBP)
Why?
Rewards based on following best clinical practices How well hospitals enhance patients’ experiences of care Patients receive higher quality care
What’s
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Value-Based Purchasing (VBP)
How?
Must report on minimum of 4 Hospital VBP measures Minimum of 10 cases per measure
What’s
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Value-Based Purchasing (VBP)
When?
Began with FY2013 Participating hospitals already receiving incentive payments
What’s
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This information on Hospital Value Based Purchasing was retrieved from the National Provider Call on HVBPg from March 14, 2013 .
What’s
FY 2015 Finalized Domains and Measures/Dimensions
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What’s
12 Clinical Process of Care Measures
1 AMI-7a Fibrinolytic Therapy Received within 30 Minutes of Hospital Arrival
2 AMI-8 Primary PCI Received within 90 Minutes of Hospital Arrival3 HF-1 Discharge Instructions4 PN-3b Blood Cultures Performed in the ED Prior to Initial
Antibiotic Received in Hospital5 PN-6 Initial Antibiotic Selection for CAP in Immunocompetent
Patient6 SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour Prior
to Surgical Incision7 SCIP-Inf 2 Prophylactic Antibiotic Selection for Surgical Patients8 SCIP-Inf-3 Prophylactic Antibiotics Discontinued within 24 Hours
After Surgery9 SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m.
Postoperative Serum Glucose10 SCIP-Inf-9 Postoperative Urinary Catheter Removal on
Postoperative Day 1 or 211 SCIP-Card-2 Surgery Patients on a Beta Blocker Prior to Arrival
That Received a Beta Blocker During the Perioperative Period12 SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous
Thromboembolism Prophylaxis within 24 Hours
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What’s
8 Patient Experience of Care Dimensions
1 Nurse Communication2 Doctor Communication3 Hospital Staff
Responsiveness4 Pain Management5 Medicine Communication
6 Hospital Cleanliness & Quietness
7 Discharge Information8 Overall Hospital Rating
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What’s
5 Outcome Measures
1 Efficiency Measure
Represents a new measure for the FY 2015 program that was not in the FY 2014 program.
1 MSPB-1 Medicare Spending per Beneficiary measure
Measure / Dimension RateClinical Process of Care Measures Higher is betterPatient Experience of Care Dimensions Higher is betterMortality Measures (Survivability) Higher is better
1 MORT-30-AMI – Acute Myocardial Infarction (AMI) 30-day mortality rate
2 MORT-30-HF – Heart Failure (HF) 30-day mortality rate3 MORT-30-PN – Pneumonia (PN) 30-day mortality rate4 PSI-90 – Patient safety for selected indicators (composite)5 CLABSI – Central Line-Associated Bloodstream Infection
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How will hospitals be evaluated?
Achievement Points
Awarded by comparing an individual hospital’s rates during the performance period with all hospitals’ rates from thebaseline period.
Improvement Points
Awarded by comparing an individual hospital’s rates duringthe performance period to that same individual hospital’srates from the baseline period.
What’s
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What’s
Proposed Weights VBP
Measure 2015 2016 2017Process of Care 20% 10% 10%Patient Experience 30% 25% 25%Outcome 30% 40% 50%Efficiency 20% 25% 25%Safety 15%
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EPs that began participation in 2011 or 2012 EPs that began participation this year (2013) EPs that plan to begin participation in 2014
What’s
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What’s
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▪ MU Stages 1 & 2 Comparisons▫ Must meet 19 objectives in Stage 1▫ Clinical Quality Measure Reporting (CQM) required▫ No incentive payment if any of the objectives are not met
▪ Timelines▫ MU Stage 1 Final Rule = July 2010▫ MU Stage 2 Final Rule = August 2012▫ MU Stage 2 Final Rule Effective FY 2014 = October 1, 2013
What’s
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▪ Clinical Quality Measures for Stage 1▫ ED = 2▫ STK = 7▫ VTE = 6
▪ Clinical Quality Measures for Stage 2▫ ED = 3 ▫ PN = 1 ▫ Early Hearing Detection = 1▫ STK = 7 ▫ SCIP = 3 ▫ Healthy Newborn =
1▫ VTE = 6 ▫ PC = 2▫ AMI = 4
What’s
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▪ Highlights of MU Stage 2 Objectives▫ Use CPOE ▫ Use certified HER technology▫ Record demographics ▫ Medication reconciliation and▫ Record/chart changes summary of care▫ Record smoking status ▫ Submit electronic data▫ Use clinical decision support ▫ Automatically track medications▫ Provide patients access to their info▫ Protect electronic health info▫ Import lab results▫ Generate lists
What’s
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Medicare EPs: How to Avoid Payment Adjustments▫ Mandated to begin January 1, 2015▫ Based on MU data submitted prior to 2015▫ Applied to Medicare physician fee schedule amount▫ Will increase if MU is not demonstrated in subsequent years
What’s Not
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What’s Not
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Measure Suspension▫ AMI – 1 ▫ AMI – 3▫ AMI – 5▫ SCIP-Inf-6
▪ Measure Retirement▫ AMI ▫ IMM
○ AMI-2 ○ IMM-1○ AMI-10 ▫ SCIP
▫ PN ○ SCIP-Inf-10○ PN-3b
▫ HF○ HF-1○ HF-3
What’s Not
▪ Measure Refinement ▫ SCIP-Inf-4
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HBIPS▫ CMS is not collecting data on HBIPS1▫ CMS is collecting data on HBIPS-2, 3, 4, 5, 6, 7
○ HBIPS-2 – 7 are required○ HBIPS-2, 3 are event measures○ HBIPS-4 – 7 are discharge measures
○ No validation for HBIPS data
What’s Not
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Validation▫ ED▫ STK / VTE▫ Quarterly Appeals
What’s Not
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What’s Not
Hospital Readmissions Reduction Program
◊ Affordable Care Act ◊ October 1, 2012◊ ADDITIONAL penalty from CMS
▫ Up to 1%▫ Grows to 3% by October 1, 2014
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Readmission Measures▫ Defined readmission▫ Adopted readmission measures▫ Established methodology to calculate▫ Established policy of using the risk adjustment methodology▫ Established an applicable period
○ For FY 2013○ For FY 2014
▪ Readmissions Adjustment Factor▫ FY 2013 – the higher of the Ratio or 0.99 (1% reduction)▫ FY 2014 – the higher of the Ratio or 0.98 (2% reduction)▫ FY 2015 – the higher of the Ratio or 0.97 (3% reduction)
What’s Not
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Medicare’s Hospital VBP Scores are now available:http://www.medicare.gov/hospitalcompare/data/VBP/hospital-vbp.aspx
Details on how to calculate MSPB measure scores, and more on VBP, please view The Official Website for the Medicare Hospital Value-based Purchasing Program:http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html?redirect=/Hospital-Value-Based-Purchasing/
OR
https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1228772039937 Medicare’s “Hospital Compare”:http://www.hospitalcompare.hhs.gov/hospital-search.aspx?AspxAutoDetectCookieSupport
CMS’s readmissions reduction program:http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html
and https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1228772412458
Proposed Rule Site: http://www.ofr.gov/OFRUpload/OFRData/2013-16555_PI.pdf
Comment Site: http://www.regulations.gov/#!submitComment;D=CMS-2013-0154-0001
NFQ Website: http://www.qualityforum.org/Home.aspx
Resources
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What’s right now?Outsourcing Core Measures!
What’s Not?
Overworked hospital staff
Amphion’s Core Measures Solutions
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For more information on Amphion’s solutions, contact Amy Wirth at
888-830-2644 x1634 [email protected]
Thank you for the opportunity to speak with you today