powerpoint presentation - etouches€¦ · personalized nursing practice across the continuum of...

9/25/2017

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NMC 2017 – Las Vegas

VBP & EHR Alphabet Soup

Value Based Purchasing (VBP) & the EHR

D’Andre T. Carpenter, DNP, MS-ISM, RN-BCCorporate Director, Clinical Informatics

BaylorScott&White All Saints Medical CenterBaylorScott&White Andrews Women’s Hospital

[email protected]

Making Sense of Alphabet Soup!



BaylorScott&White

• Largest Integrated Delivery Network in TX

• Over 900 access points

• 5.1 patient encounter annually

• 48 Hospitals and 900+ Patient Care Site

• 40,000+ employee organization

• Internationally known for Quality STEEEP Program



Course Objectives

By the end of this session, you will understand:• The main concepts of VBP • 21 measures associated with the FY17 program• 4 different domains: Clinical Care, Patient Exp,

Efficiency, Safety• How to incorporate performance improvement (PI)

leveraging the EHR• Data overview to track performance overtime

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Why Are We Here?



Transition: FFS to Value Based Care



Transition: FFS to Value Based Care

• Over 65% of payers and providers have already switched

• US Department of Health and Human Services set a goal to shift 85% medicare FFS to Value Base care by 2016

• Some private payer sources have started to shift towards value based care.

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Shifting Revenue Mix



Precision Nursing

• Patient centered, highly reliable, evidence based and personalized nursing practice across the continuum of care that supports:– Quality outcomes

– Safety

– Decreased Costs

– Efficiency

– Nurse Satisfaction

– Length of Stay



Triple Aim: Value Based Care

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Measure Based Model



Current State: Quality MetricsPROGRAMS

Meaningful Use (MU)Medicare Value Based

PurchasingMedicare Readmission Reduction

ProgramMedicare Healthcare Acquired

Conditions (HAC's)Medicaid Potentially

Preventable Events (PPE)State-based initiatives

MEASURES

Data Capture and sharing, advanced clinical

processes, improved outcomes

Patient Experience, Core Measures,

Outcomes, Efficiency of Care FY17: Mortality,

Safety

AMI, HF, PNE, THA/TKA, and COPD 30-day readmissions

HAI: CAUTI, CLABSI, & Patient Saftey Indicators (PSI 90)

Readmission Based on APR DRG's (not those from

medicare)

Example: Texas DHSH Medicaid PPC program

RISK (Incentive vs. Penalty)

Incentive payouts & Penalties

Incentive payouts & Penalties

Penalty (All medicare payments to "affected" hospital will be reduced)

Penalty (Reimbursement affected for hospital services)

Penalty Based State Specific



Value Based Care FY 17

• Effective for discharges from October 1, 2016 – September 30, 2017

• Program Includes a total of 21 measures

• Represented in 4 domains

– Clinical Care

– Patient Experience of Care (HCAHPS)

– Efficiency

– Safety

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Value Based Care FY 17

• The Diagnosis-related groups (DRGs) based operating payments increase from 1.75 to cap 2.00 percent





Clinical Care

• 30% of the score for reimbursement is based on Clinical Care measures

• FY 2017 - Clinical Care is broken into two categories

– Process (5 percent weight)

– Outcomes (25 percent weight)

– Totaling 30%

https://az414866.vo.msecnd.net/cmsroot/studergroup/media/studergroup/pages/what-we-do/learning-lab/aligned-goals/measurement-hcahps-vbp/valuebasedpurchasingfy2017_ataglance.pdf

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Clinical Care



Clinical Care



Patient Experience

• Patient Experience of Care (HCAHPS) survey will determine 25 percent of reimbursement in FY 2017

• The 25 percent weight remains unchanged from FY 2016 to FY 2017

• A total of eight measures and scores

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Patient Experience



Safety

SAFETY FORMULA = PATIENT SAFETY INDICATORS + HEALTHCARE ASSOCIATED INFECTIONS • The Safety domain was added in FY 2017• includes Patient Safety Indicators (PSIs)• Healthcare-Associated Infections (HAI) measures• The Safety domain accounts for 20% of

reimbursement



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Efficiency

• Efficiency domain was added in FY 2015

• Remains in FY 2017

• Proposed by CMS to examine all Medicare (Part A and Part B) spending

• Measures begins three days prior to admission through 30 days after discharge.

• 25% of the score that determines reimbursement will be based on efficiency



Efficiency

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Shift of Weighted Measures



Shift: Value Based Measures & HAC



More Than Meeting the Measure

• EHR Goals that impact Value Based Care

– Standardization

– Quality

– Compliance

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Connecting VBP w/ the EHR

Improves:

• Safety, Quality, & Convenience

• Accuracy of Diagnosis & Health

Outcomes

• Overall Care Coordination &

Continuum of Care

• Accuracy in reimbursement practices

& required documentation

• Organizational process efficiencies

resulting in cost savings



VBP & EHR



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D’Andre T. Carpenter, DNP, MS-ISM, RN-BCCorporate Director, Clinical Informatics

BaylorScott&White All Saints Medical CenterBaylorScott&White Andrews Women’s Hospital

[email protected]: 804-502-2151

mailto:[email protected]

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