Hospital Transformation Performance Program (HTPP)

Funding Allocation Methodology

Elyssa TranFebruary 7, 2014

Under Oregon’s Triple Aim, portion of the transformation savings will come from reduced utilization of hospital services

Oregon hospitals will need to pursue new models of care and business structures

2013-2015 OHA Budget created a new hospital incentive pool, the Hospital Transformation Performance Program (HTPP)

BACKGROUND

Funding is from the Federal equivalent value of the funds available from a 1% additional tax rate

Requires CMS approval

Available to DRG hospitals that are subjected to provider tax assessment

Must meet specific performance goals set by OHA and approved by CMS

HTPP FUNDING

Established basis for determining the level of incentive funds available to earn for each hospital

Example: Available funds is $100 millionHosp A = $40 milHosp B = $30 milHosp C = $20 milHosp D = $10 mil

ALLOCATION METHODOLOGY

Hosp A

Hosp B

Hosp C Hosp D

Share of HTPP for 1st Round

Different from “What performance criteria and targets must a hospital meet in order to earn its share of the pie?”

Answer to this question is based on the recommendations of this OHA-led workgroup

ALLOCATION METHODOLOGY

M 1

M 2

M 3

M 4

Hosp A

$40 mil

OAHHS workgroup Drew on expertise of the Provider Tax Advisory Committee

Drew on guidance from CMS expert consultants

Recommendation include: A base/minimum amount for each DRG hospital Remaining amount

50% based on share of total Medicaid discharges 50% based on share of total Medicaid inpatient days

Shared and accepted by the OHA

Hospitals must meet performance benchmarks or improvement targets to receive payment

ALLOCATION METHODOLOGY

All funds would be distributed each year (no carryover)

Data source for calculations is Hospital Inpatient Discharge Data collected by OHPR

Funds not distributed in the first round would go to a “challenge pool”

ALLOCATION METHODOLOGY

Challenge Pool

Only those hospitals that received distributions in the first round are eligible

Part of the committee’s work is to recommend measures for the challenge pool

Earnings from the challenge pool could potentially be based on fewer and/or different measures from the first round

ALLOCATION METHODOLOGY

Hospital Performance Potential Measures

Diane WaldoFebruary 7, 2014

OAHHS formed a workgroup of hospital representatives to brainstorm a possible measure approach

Workgroup reviewed lists of possible measures – similar to what the Advisory Group will do today

Workgroup included multi-disciplinary representation from member hospitals

Work group met twice during April 2013 and created a measure approach for consideration

BACKGROUND

Early Elective Deliveries Preventable Readmissions Stage 1 Meaningful Use

MEASURES FOR CONSIDERATION

Early Elective Deliveries Description/definition

Patients with elective vaginal or elective C/S at greater than or equal to 37 and less than 39 weeks completed gestation (Joint Commission definition)

Alignment with CCO Important patient safety effortCost savings

MEASURES FOR CONSIDERATION

Preventable ReadmissionsDescription/definition

Reducing preventable readmissions has value as an indicator of quality; may reflect poor coordination of services and transitions of care at discharge or in the immediate post discharge period

Potentially preventable readmissions (PPR) as calculated by Apprise Health Insights, using 3M software

MEASURES FOR CONSIDERATION

Stage 1 Meaningful Use Hospitals that achieved Stage 1 meaningful use

(attested and received payment)

MEASURES FOR CONSIDERATION

Falls with injury All documented patient falls with an injury level of

minor or greater (NQF measure)

Catheter-Associated Urinary Tract Infection (CAUTI) Rate of patients with catheter-associated urinary

tract infections per 1000 urinary catheter days-all tracked units

OTHER POTENTIAL MEASURES

Collective thinking of the hospital work group

Align with current work now being done in hospitals

Believe that this measure approach reflects transformative potential in alignment with the Triple Aim

Recognize that this is a starting point for discussion with the Advisory Committee

SUMMARY