hospital rewards program: data reporting and scoring

© 2006 The Leapfrog Group and Thomson Medstat

Hospital Rewards Program:Data Reporting and Scoring

J. Dennis Bush

February 7, 2006

Leapfrog Hospital Rewards Program: Data Reporting and Scoring

© 2006 The Leapfrog Group and Thomson Medstat2/07/2006

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Leapfrog Hospital Rewards Program Data & Reporting Requirements

Objectives• Minimize additional reporting burden for

hospitals• Rely on existing reporting systems, i.e., LFG

hospital survey, JCAHO Core Measures• Parallel formats and processes already in

place for any new data, e.g., data formats, severity adjustment processes



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Leapfrog Hospital Rewards Program Data Requirements

Leapfrog Hospital Quality and Safety Survey

JCAHO Core Measures

Leapfrog Resource-Based Efficiency Measures

1

2

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Data Reporting: Process Flow

Hospital

Leapfrog

Leapfrog PatientSafety Survey

JCAHO Quality-only Vendor*

JCAHO CoreMeasures Data

LFG Efficiency Measures

Leapfrog

Survey Results

Clinical Area-specificScores:• Quality• Resource-Based Efficiency

DataLicensees

ProgramLicensees

New

Aggregationand

Scoring

1

2

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Hospital Feedbackvia Vendors

Full-ServiceData Vendor

* Hospitals may split data submission: - quality data through existing “quality-only” JCAHO CMV - efficiency data through Leapfrog-approved full-service vendor



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• Leapfrog Hospital Quality and Safety Survey– Required for LHRP participation in ANY clinical

area– Current survey, including affirmations

• Latest (new cycle) survey as of May 31 for Jul 1 results• Latest survey as of Nov 30 for Jan 1 results• LHRP participating hospitals also complete

“authorization & release” at on-line survey

– Partial completion: no points earned for that componentExample: process compliance not measured

1



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• JCAHO Core Measures– Objective: no additional reporting burden– Core Measures must be reported for clinical

area(s)– Copy of JCAHO data submission to LFG

• add LFG hospital identifier• split HCO into component hospitals (<1%)• extraneous data ignored on submission, e.g., heart

failure, unused measures

– Timing• quarterly• 15-30 day lag after JCAHO deadlines

2



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• Leapfrog Resource-Based Efficiency Measures– By clinical area for which hospital participates in

LHRP– Actual length of stay (LOS), routine and special*– Severity-adjusted expected LOS, routine and

special**– # cases with readmit following discharge, within 14

days, same hospital, any condition at readmit

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* Total length of stay for Deliveries

** See details about risk adjustment models at http://leapfrog.medstat.com/hpr



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Leapfrog Hospital Rewards Program Scoring

• Weights• Scoring component measures• Composite score• Rankings on each axis

– Quality– Resource-Based Efficiency rankings

• Performance groups (4)

. . . by clinical area

. . . for participating hospitals



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Leapfrog Hospital Rewards Program Quality Weighting

• % Weight is assigned to each measure• Represents maximum points available for a measure• Add to 100%; possible composite score 0 – 100%• Basis1:

– 46% for mortality-related measures– 29% for morbidity-related measures– 25% for complication-related measures– Allocated evenly for measures within category,

unless evidence of odds-ratio differences

1 Pauly, M.V., Brailer, D.J., Kroch, E., and O. Even-Shoshan. "Measuring Hospital Outcomes from a Buyer's Perspective." American Journal of Medical Quality. Vol. 11(8):112-122, Fall 1996.

See Weighting details in addenda and at http://leapfrog.medstat.com/hpr



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Scoring Example: PneumoniaTotal

Weight IPS Weight WeightHospital N n % Earned Status Earned EarnedHosp A1 79 41 51.9% 3.89% ½ 4.50% 20.40%Hosp A2 72 29 40.3% 3.02% Full 13.50% 18.90%Hosp A3 63 58 92.1% 6.90% Full 13.50% 35.16%Hosp A4 30 1 3.3% 0.25% Full 13.50% 14.27%Hosp A5 62 39 62.9% 4.72% ¼ 0.00% 11.53%Hosp A6 45 13 28.9% 2.17% ¼ 0.00% 2.69%Hosp A7 44 41 93.2% 6.99% ¼ 0.00% 16.33%Hosp A9 69 47 68.1% 5.11% ¼ 0.00% 9.68%Hosp B1 61 57 93.4% 7.01% ½ 4.50% 26.49%Hosp B5 55 27 49.1% 3.68% Full 13.50% 20.49%Hosp B6 62 61 98.4% 7.38% ½ 4.50% 14.97%Hosp C4 33 4 12.1% 0.91% ½ 4.50% 6.62%Hosp C5 47 7 14.9% 1.12% ½ 4.50% 11.56%Hosp C6 47 11 23.4% 1.76% ½ 4.50% 7.64%Hosp C7 44 15 34.1% 2.56% ½ 4.50% 8.37%Hosp C8 74 21 28.4% 2.13% Full 13.50% 17.38%Hosp D2 38 29 76.3% 5.72% ¼ 0.00% 15.40%Hosp D3 44 28 63.6% 4.77% ¼ 0.00% 4.19%Hosp D4 43 24 55.8% 4.19% ¼ 0.00% 7.02%Hosp D5 32 28 87.5% 6.56% Full 13.50% 32.24%Hosp E2 23 7 30.4% 2.28% ¼ 0.00% 2.54%Hosp E3 19 17 89.5% 6.71% ¼ 0.00% 16.09%Hosp F6 19 14 73.7% 5.53% ¼ 0.00% 16.82%Hosp H5 23 3 13.0% 0.98% Full 13.50% 27.72%(masked) 117 93 79.5% 5.96% ¼ 0.00% 18.16%(masked) 86 59 68.6% 5.15% Full 13.50% 30.34%(masked) 82 44 53.7% 4.02% Full 13.50% 27.76%(masked) 78 20 25.6% 1.92% ¼ 0.00% 8.86%

Mortality-Related (cont'd)JCAHO: Smoking Cessation Counseling (PN-4) LFG: IPS



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Leapfrog Hospital Rewards Program Scoring Component Measures –

Efficiency• Derive relative severity index from expected

LOS• Standardize actual LOS for severity

differences• Adjust total standardized LOS for

readmissions = std LOS * (1 + readmit rate)• Score = # standard deviations better/ (worse)

than all-group average adjusted LOS




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Scoring Example: Overall – DeliveriesOverall OverallQuality Effic'y

Hospital Rate Rate Quality Effic'y OverallHosp A1 88.90% 0.982 1st 1st 1stHosp A2 49.24% 0.273 2nd 2nd 2ndHosp A3 87.37% 0.046 1st 2nd 2ndHosp A4 65.67% -2.300 1st 4th 4thHosp A5 84.48% -1.413 1st 4th 4thHosp A6 81.16% 0.798 1st 1st 1stHosp A7 32.02% -0.417 2nd 2nd 2ndHosp A8 23.14% -1.332 3rd 4th 4thHosp A9 40.53% 0.719 2nd 2nd 2ndHosp B1 15.11% 0.720 4th 1st 4thHosp B5 33.68% 0.422 2nd 2nd 2ndHosp B6 63.05% 1.355 2nd 1st 2ndHosp B7 3.83% 0.480 4th 2nd 4thHosp B8 57.44% -0.636 2nd 3rd 3rdHosp C1 21.66% -2.246 3rd 4th 4thHosp C2 8.33% 0.499 4th 2nd 4thHosp C4 51.99% 0.589 2nd 2nd 2ndHosp C5 20.56% -0.512 4th 3rd 4thHosp C6 17.56% 0.819 4th 1st 4thHosp C7 47.47% 0.209 2nd 2nd 2ndHosp C8 38.32% 1.262 2nd 1st 2ndHosp C9 25.45% 0.363 3rd 2nd 3rdHosp D2 59.61% 0.358 2nd 2nd 2ndHosp D3 39.07% 1.265 2nd 1st 2nd(masked) 21.41% 0.298 3rd 2nd 3rd(masked) 82.25% 0.914 1st 1st 1st(masked) 11.39% 0.595 4th 2nd 4th(masked) 67.43% 0.238 1st 2nd 2nd(masked) 6.94% 0.431 4th 2nd 4th(masked) 73.60% 0.264 1st 2nd 2nd

Performance Group



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Leapfrog Hospital Rewards ProgramRanking Overall Quality and

Efficiency Scores• Four tiers along each axis

– 1: Best quartile– 2: Not significantly below best quartile (p > .10)– 3: Significantly below best quartile (p < .10)– 4: Significantly below best quartile (p < .05)

• Cohorts – performance on both axes– Top cohort = 1st tier (best quartile) on both axes– Bottom cohort = 4th tier on either axis




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(2.5)

(2.0)

(1.5)

(1.0)

(0.5)

0.0

0.5

1.0

1.5

2.0

2.5

20% 30% 40% 50% 60% 70% 80% 90%

(2.5)

(2.0)

(1.5)

(1.0)

(0.5)

0.0

0.5

1.0

1.5

2.0

2.5

20% 30% 40% 50% 60% 70% 80% 90%

(2.5)

(2.0)

(1.5)

(1.0)

(0.5)

0.0

0.5

1.0

1.5

2.0

2.5

20% 30% 40% 50% 60% 70% 80% 90%

Hospitals Arrayed in Four GroupsExample: Pneumonia

(2.5)

(2.0)

(1.5)

(1.0)

(0.5)

0.0

0.5

1.0

1.5

2.0

2.5

20% 30% 40% 50% 60% 70% 80% 90%

Quality

Res

ou

rce-

Bas

ed E

ffic

ien

cy

Cohort 4

Average

Cohort 3

Cohort 2

Cohort 1

© 2006 The Leapfrog Group and Thomson Medstat

Addenda

Scoring Details



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Leapfrog Hospital Rewards Program Scoring Component Measures –

Quality• Continuous measures, e.g., % compliance

Example: AMI - aspirin at arrival (weight 16.06%)– 72.3% compliance x 16.06% = 11.61% contribution to total score– multiple compliance measures within category are further weighted

by denominators of each measure

• Graded/categorical measures, e.g., LFG partial credit results

Example: Pneumonia - Leapfrog Quality Index (weight 12.5%)– Fully implemented = full weight (12.50%)– Good progress = 2/3 of weight (8.33%)– Good early stage effort = 1/3 of weight (4.17%)



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Leapfrog Hospital Rewards Program Scoring Component Measures – Quality

(cont’d)

• Risk-adjusted rates, e.g., % mortality rate

Example: Deliveries – 3rd/4th degree lacerations (weight 8.33%)Percent rank (0 – 100%), where 0 = worst, 100 = best,times weight

• All or none, e.g., LFG NICU average census

Example: NICU average daily census 15+ for hospitals electively admitting high-risk deliveries (weight 23.0%)Yes = 23.0%No (or no NICU) = 0.0%



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Weighting & Scoring – AMIMeasure Source Weight Scoring

Inpatient mortality JCAHO

(AMI=9)

15.33% • Percent rank (0% = worst, 100% = best) times

• 15.33% weight

Aspirin at arrival JCAHO

(AMI-1)

16.06% % compliance times weight

Beta blocker at arrival JCAHO

(AMI-5)


Aspirin prescribed at discharge JCAHO

(AMI-2)


Beta blocker prescribed at discharge JCAHO

(AMI-6)


ACEI for LVSD JCAHO

(AMI-3)


Thrombolytic agent received within 30 minutes of arrival

JCAHO

(AMI-7a)


PCI with door-to-balloon time within 90 minutes of arrival

LFG 4.83% % compliance times weight

Adult smoking cessation advice/ counseling

JCAHO

(AMI-4)




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Weighting & Scoring – AMI (cont’d)

Measure Source Weight Scoring

Computerized physician order entry (CPOE)

LFG 8.33% • Fully implemented: Full credit (8.33%)• Good progress: 2/3 credit (5.55%)• Good early stage effort: 1/3 credit (2.78%)

… else no credit

Intensivist ICU staffing (IPS) LFG 8.33% • Fully implemented: Full credit (8.33%)• Good progress: 2/3 credit (5.55%)• Good early stage effort: 1/3 credit (2.78%)

… else no credit

Leapfrog Quality Index (NQF Safe Practices)


… else no credit



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Weighting & Scoring – CABGMeasure Source Weight Scoring

Mortality LFG 34.00% Full credit if• Public risk-adjusted mortality rate better than state median

OR• STS risk-adjusted mortality rate better than national

average

… else no credit

Volume LFG 12.00% Full credit if• Volume ≥ 450

… else no credit

Prophylactic antibiotic received within one hour prior to surgical incision

JCAHO

(SIP-1b)


Prophylactic antibiotic selection for surgical patients

JCAHO

(SIP-2b)


Prophylactic antibiotics discontinued within 24 hours after surgery end time

JCAHO

(SIP-3b)


Process measures:• CABG using internal mammary artery• Aspirin at discharge• Beta blocker within 24 hours after

surgery• Beta blockers prescribed at discharge• Lipid-lowering therapy prescribed at

discharge• Extubation within 24 hours after

surgery

LFG 9.25%

+

9.25%

% compliance times weight for two highest compliance rates of up to six measures reported

… else no credit if not measured



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Weighting & Scoring – CABG (cont’d)




… else no credit


… else no credit



… else no credit



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Weighting & Scoring – PCIMeasure Source Weight Scoring

Mortality LFG 34.00% Full credit if• Public risk-adjusted mortality rate better than state median

OR• ACC risk-adjusted mortality rate better than national

average

… else no credit

Volume LFG 12.00% Full credit if• Volume ≥ 400

… else no credit

Process measures:• Aspirin at arrival• 1st balloon inflation within 90 minutes

LFG

14.50%14.50%

% compliance times weight for each measure

… else no credit if not measured



… else no credit



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Weighting & Scoring – PCI (cont’d)



… else no credit



… else no credit



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Weighting & Scoring – PneumoniaMeasure Source Weight Scoring

Initial antibiotic received within 4 hours of hospital arrival

JCAHO

(PN-5b)

5.50% • Percent rank (0% = worst, 100% = best) times

• 5.50% weight

Influenza vaccination JCAHO

(PN-7)


Pneumococcal vaccination JCAHO

(PN-2)


Adult smoking cessation advice/ counseling

JCAHO

(PN-4)



… else no credit

Oxygenation assessment JCAHO

(PN-1)


Blood cultures (collected prior to antibiotic administration)

JCAHO

(PN-5b)




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Weighting & Scoring – Pneumonia (cont’d)




… else no credit



… else no credit



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Weighting & Scoring – DeliveriesMeasure Source Weight* Scoring

Inpatient neonatal mortality JCAHO

(PR-2)

23.00%or

60.50%

• Percent rank (0% = worst, 100% = best) times

• 23.00% or 60.50% weight

NICU census * LFG 23.00%or

0.00%

Full credit if• NICU census ≥ 15

… else no credit

Antenatal steroids for certain high-risk deliveries *

LFG 29.00%or

0.00%

% compliance times weight (if measure is applicable)

Third- or fourth-degree lacerations JCAHO

(PR-3)

8.33%or

13.17%

• Percent rank (0% = worst, 100% = best) times

• 8.33% or 13.17% weight


LFG 8.33%or

13.17%

• Fully implemented: Full credit (8.33% or 13.17% )• Good progress: 2/3 credit (5.55% or 13.17% )• Good early stage effort: 1/3 credit (2.78% or 13.17% )

… else no credit


LFG 8.33%or

13.17%

• Fully implemented: Full credit (8.33%)• Good progress: 2/3 credit (5.55%)• Good early stage effort: 1/3 credit (2.78%)

… else no credit

* For a hospital indicating in its Leapfrog survey responses that it electively admits high-risk deliveries (mothers expected to deliver complicated newborns), NICU census and Antenatal steroids measures do not apply. The weights associated with these measures are allocated to the remaining measures and the second set of weights applies.

hospital rewards program: data reporting and scoring

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