Quality & FinanceIndun WhetsellMarch 6, 2015

Quality & Finance

Contributed

Potential Gain/At Risk

VBP $408,893 $1,054,593*

RRP $817,786 $817,786**

HAC $272,595 $272,595**

BCBS $1.2 million*

TOTAL$1,499,274 $3,344,974

*potential gain**at risk

Recoupment

VBP $285,678

RRP $681,489

HAC 0

BCBS $716,457

TOTAL $1,683,624

NOTE: BCBS % increase on compounded dollars

35% loss of CMS monies contributed

BCBS models CMS programs; however, no penalties associated – only gain

VBP45%

RRP8%

HAC16%

BCBS30%

Readmissions - RRP HF, AMI, PN, COPD, THA, TKA Loss $136298 – reduction program; cannot make $ Risk of $817,787 loss

Value Based Purchasing – VBP Core Measures, Patient experience, Mortality, EfficiencyMade $408,803 but could have made $1,054,593Reducing Core Measures & heavier focus on outcome & safety

Hospital acquired conditions - HAC PSI 90, CLABSI, CAUTI All or nothing Loss $ 272,608

BCBS Currently models CMS – however talks to change to BCBS Compiles every year Made $716,457– loss $515,833 Composite of VBP, pt experience, HCAPS, HAC, mortality readmission, OP measures Based on numerical score either better than national average or 10% better than your last score

FFY15 Total Loss- ~$1.7 million

CLABSI

MSP

B

HF re

adm

it

PN re

adm

it

CAUTI

Wou

nd d

ehisc

ence

D/C in

form

atio

n

HF m

orta

lity

PN m

orta

lity

Hospi

tal S

taff re

spon

se

Overa

ll ra

ting

0

50,000

100,000

150,000

200,000

250,000

FFY15 Loss greater than $50,000 by Measure

CLABS

I

PN B

ld cul

ture

s

PN a

ntib

iotic

SCIP a

ntib

iotic

SCIP a

ntib

iotic

SCIP a

ntib

iotic

SCIP F

oley

PN m

orta

lity

CAUTI

Post

op

seps

is

Wou

nd d

ehisce

nce

0

50000

100000

150000

200000

250000

Associated Infection Control Loss- $700,000 (41% of total)

$ Loss

Hospital Staff Response $53,873

Overall Hospital Rating $53,873

Doctor Communication $22,146

Medicine Communication $25,310

Nurse Communication $25,310

Pain management $22,146

D/C information $57,037

Cleanliness & Quietness $44,382

TOTAL LOSS $304,077

Patient Experience of Care Loss

FFY15(ended 12/13)

FFY16 (1/13 – 12/14)

FFY17 (1/14 – 12/15)

Comments

PSI 90 (aggregate) $95.408 $95.408 $68144

WEIGHT 35% 35% 25%

PSI 3 Pressure Ulcer $11,926 $11,926 $8518

PSI 6 Iatrogenic pneumothorax

$11,926 $11,926 $8518

PSI 7 CLABSI $11,926 $11,926 $8518 Based on coded data (not aligned with NHSN)

PSI 8 Post op hip fracture $11,926 $11,926 $8518

PSI 12 Periop PE or DVT $11,926 $11,926 $8518

PSI 13 Postop sepsis $11,926 $11,926 $8518

PSI 14 Postop wound dehiscence

$11,926 $11,926 $8518

PSI 15 Accidental laceration $11,926 $11,926 $8518

Hospital Acquired Conditions (HAC)

FFY15(ended 12/13)

FFY16 (1/13 – 12/14)

FFY17 (1/14 – 12/15)

Comments

CDC NHSN $177,186 $177,186 $204,446

WEIGHT 65% 65% 75%

CLABSI $88,593 $44,296 $51,111

CAUTI $88,593 $44,296 $51,111

SSI Colon $44,296 $51,111

SSI Ab Hysterectomy $44,296 $51,111

TOTAL DOLLARS AT RISK

$272,595 $272,595 $272,595

HAC

Numbers here only account for rewards – not savings in cost (antibiotics, LOS, lives, etc)

Lot of people “in the chart” – silo approach Data not concurrent Worst with infection (10 of 10) Need focus on Prevention infection

◦ CLABSI (improvement in 2014)◦ CAUTI ◦ SSI◦ c. Diff and MRSA◦ Pneumonia

Prevent Readmissions Decrease mortality Need focus on nursing homes Superior results with PSI related to surgery Heavier weights to outcomes going forward BCBS – did well FFY15 n FFY17 measures not available FFY 16 already “done”

TAKE AWAY

Physician driven Concurrent coding Mortality reviews Daily tracking board “Unexpected deaths” – RCA Need to increase RCAs Infection Control monitoring lines daily HAC rate by doc & unit Integrate nursing care with plan 24/7 operation MD mandatory madness Antibiotic stewardship TeamsTEPPS Restructure: HRO & Infection Control CQO leadership Pressure ulcer prevention Nursing home alignment Palliative Care Continued focus on surgical prevention of complications Focus on ZERO harm

Recommendations

Warroom w

monitors

Core Measures

(Lighthouse)

Concurrent coding

Safety concerns(Huddles)

Care Transitions

Infection Issues (CL,

foley, c. diff, Asp risk,

MRSA, SSI)

Data transparency & monitoring

CEO

CQO

LEAN

HLC

D/C Clinic

Care Planning

RM

Safety

IC

Medical Staff Services

Medical School Affiliation

Peer Review, FPPE, OPPE, credentialing

Data Analysts inclusive of CDI & Core Measures (War Room)

Director of Quality

DACS•Sepsis•Readmit•Asp PN•PC

SERVICE LINES•Medicine (LOS, Readmit, Cost, Antibiotic Stewardship, Palliative Care, NH Liason)•Surgery (Trauma), NSQIP, CC, SCIP, Bariatric)•Specialty Medicine (Stroke)•Radiology•Maternal Child (Early delivery, Infant M&M, CS)•ED

FUNCTIONAL (not org) CHART

•VBP•Core Measures•HAC•RRP•BCBS

Pt. Exp