1 / 57

Medicare Linkage: Quality & Payment Washington State Hospital Association July 28, 2008

Medicare Linkage: Quality & Payment Washington State Hospital Association July 28, 2008. Presenters. Washington State Hospital Association Carol Wagner, Vice President, Patient Safety Claudia Sanders, Senior Vice President, Policy Lance Heineccius, Interim Director, Finance

noel-galloway
Télécharger la présentation

Medicare Linkage: Quality & Payment Washington State Hospital Association July 28, 2008

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Medicare Linkage: Quality & PaymentWashington State Hospital AssociationJuly 28, 2008

  2. Presenters Washington State Hospital Association • Carol Wagner, Vice President, Patient Safety • Claudia Sanders, Senior Vice President, Policy • Lance Heineccius, Interim Director, Finance • Jim Cannon, Executive Director, Health Information Program • AND, Gloria Kupferman, DataGen

  3. Why This Webcast? • This webcast is designed to: • Provide you with information on current and future Medicare links between payment and quality • Provide you with new WSHA tools to improve quality • Encourage a dialog between finance and quality at each hospital

  4. Preparing for the Future • Links between quality and payment currently apply only to PPS hospitals • It is advisable for hospitals of all sizes to report their measures to Hospital Compare and to ensure that they achieve high scores

  5. Information in Three Stages Medicare has already started to link quality and payment. • CMS is implementing pay for reporting • Reporting measures will change; addition of new measures under discussion • On the horizon, value based purchasing

  6. Slide Presentation Marked Likelihood of Medicare policy happening: • For sure () • Likely(?) • Possible (??) • Direction is cloudy

  7. Linking Quality and Payment in the Medicare Program

  8. Linking Quality and Payment Expand Inpatient Pay for Reporting 27 Measures Add Patient Satisfaction and 30-day Mortality Measures Minus 2.0 percentage points Expand Hospital Pay for Reporting 37 Measures ( 6 VTE’s) Minus 2.0 percentage points 2011 IPPS Proposed Quality Measures ?? Measures Minus ?? percentage points Inpatient Pay for Reporting 10 ProcessMeasures Minus 0.4 percentage points if not report 2010 IPPS Proposed Quality Measures 72 Measures Minus ?? percentage points Value-Based Purchasing Pending Congressional Approval Expand Hospital Pay for Reporting32 Measures Minus 2.0 percentage points FY 2006 2005 2006 2007 2008 2009 2010 2011 FY Expand Inpatient Pay for Reporting 21Measures Minus 2.0 percentage points Outpatient Pay for Reporting 7 Measures Minus 2.0 percentage points Candidate Hospital Acquired Conditions (9 additional conditions) Hospital Acquired Conditions (8 conditions) Potential Payment Reductions

  9. Medicare Quality Initiatives – Public Reporting  • Hospital Compare • Twenty four process measures • Two risk-adjusted mortality measures • Public reporting on the Web • Nursing Home Compare • Seventeen measures based on patient condition • Public reporting on the Web • Home Health Compare • Twelve measures based on patient condition • Public reporting on the Web • Physician Voluntary Reporting Program • Sixteen process measures • Confidential report back to physician

  10. Medicare Payment Update  • Reporting hospital quality data for annual payment update • Medicare Modernization Act (MMA) required Prospective Payment System hospitals to submit data on quality beginning in FFY 2005 and linked the update factor to reporting • Data displayed on the CMS Hospital Compare web site

  11. History of “Pay for Reporting”  • Inpatient PPS – • FFY 2005 and 2006, update factor minus 0.4 percent for non-compliance • FFY 2007, update factor minus 2.0 percent for non-compliance • Outpatient PPS – • CMS delayed adoption of quality measures (including a 2.0 percent for non-compliance) • Reporting in CY 2008 for payment in 2009 • Home Health PPS – • CY 2007, update factor minus 2.0 percent for non-compliance

  12. Inpatient PPS MeasuresAcute Myocardial Infarction (AMI)

  13. Inpatient PPS MeasuresHeart Failure

  14. Inpatient PPS MeasuresPneumonia ?

  15. Inpatient PPS MeasuresSurgical Care Improvement ?

  16. CMS 30-day Mortality Measures  • Risk adjustment methodology developed by Yale and Harvard • Based on administrative claims data • Takes into account medical care received during the year prior to patients hospitals admission • Patient inpatient, outpatient and physician practice claims • Model uses information adjust for patient mix • Patients with comfort care not excluded • Patients who are admitted to a hospital and then transferred are included in the measures

  17. Inpatient PPS MeasuresHCAHPS

  18. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Designed to allow comparison of patients’ perspectives on hospital care based on 27 questions in seven domains Doctor communication Nurse communication Cleanliness and quiet of the hospital environment Responsiveness of hospital staff Pain management Communication about medicines Discharge information Also includes two questions: overall satisfaction with and willingness to recommend the hospital 

  19. Patient Satisfaction • Hospital Environment Items • Cleanliness of hospital environment • Quietness of hospital environment • Discharge Information Composite • Discharge Information • Overall Ratings • Overall rating of this hospital • Willingness to recommend this hospital

  20. Inpatient Payment Rate with Full Update

  21. Inpatient Payment Rate Reduced by 2.0

  22. Proposals for Inpatient in 2009, 2010, 2011 . . .

  23. 2009 Inpatient Proposed Quality Measures ?? • CMS requires hospitals to submit data effective with discharges beginning January 1, 2009 • Forty-three new measures including: • One surgical care • Four nursing sensitive • Three readmission • Five stroke • Six venous thromboembolism (VTE) measures • VTE -1: VTE Prophylaxis • VTE- 2: VTE Prophylaxis in the ICU • VTE- 4: Patients with overlap in anticoagulation therapy • VTE - 5/6: (as combined measure) Patients with UFH dosages and platelet count monitoring and adjustment • VTE- 7: Discharge instructions: follow-up, compliance, dietary restrictions adverse drug reactions • VTE- 8: Incidence of preventable VTE

  24. 2010 Inpatient Proposed Quality Measures (72) ?? • Heart Attack (AMI) - 8 measures • Heart Failure (HF) - 4 measures • Pneumonia (PN) - 6 measures • Surgical Care Improvement Project (SCIP) - 8 measures • Mortality Measures - 3 measures • Patient’s Experience of Care (HCAHPS) • Readmission Measures (Medicare patients) - 3 measures • Inpatient Stroke Care - 5 measures

  25. 2010 Inpatient Proposed Quality Measures (72) continued. . . ?? • DVT Prophylaxis (from proposed 2009) - 6 measures • AHRQ Patient Safety Measures - 4 measures • AHRQ Inpatient Quality Indicators – 2 measures • AHRQ Composite Measures - 3 measures • Nursing Sensitive Measures - 4 measures • Cardiac Surgery Measures - 15 measures

  26. 2011 and Subsequent Years - Inpatient Proposed Measures ?? • Chronic Pulmonary Obstructive Disease Measures - ? measures • Complication of Vascular Surgery - 3 measures • Inpatient Diabetes Care Measures - ? measures • Healthcare Associated Infection - 2 measures • Central Line Associated Blood Stream Infections/Surgical Site Infections • Sexual Assault/Death or Injury Patient or Staff Assault

  27. 2011 and Subsequent Years - Inpatient Proposed Measures (continued…) ?? • Timeliness of Emergency Care Measures - 3 measures • Surgical Care Improvement Project (SCIP) - 2 measures • Complication Measures (Medicare Patients) - ? measures • Hospital Inpatient Cancer Care Measures - 5 measures • Average Length of Stay Coupled with Readmission Measure - ? measures • Healthcare Associated Conditions - 3 measures • Serious Reportable Events in Healthcare - 24 measures

  28. 2011 and Subsequent Years - Inpatient Proposed Measures (continued…) ?? • Preventable Hospital Acquired Conditions - 14 measures • Catheter-Associated Urinary Tract Infection (UTI) • Vascular Catheter-Associated Infection • SSI Following Elective Surgeries: • Total Knee Replacement • Laparoscopic Gastric Bypass and Gastroenterostomy • Ligation and Stripping of Varicose Veins • Legionnaire’s Disease • Glycemic Control • Iatrogenic Pneumothorax • Delirium • Ventilator Associated Pneumonia • DVT/PE • Staphylococcus Aureus Septicemia • C Diff Associated Disease • MRSA

  29. Hospital Outpatient Quality Data Reporting Program ?

  30. Outpatient Data Reporting ? • Start date for hospital outpatient encounters is period from April through June 2008 • Outpatient data due to CMS November 1, 2008 • Validation will NOT be implemented until CY 2009 • Validation will be implemented in CY 2009 beginning with July 2008 data • Delay public reporting until CY 2009 for data submitted beginning July 2008 • Data submitted for July 2008 services and forward will affect payment determinations for CY 2010

  31. Value-Based Purchasing

  32. Medicare Pay for Performance (P4P) “Better care should be rewarded . . . it is time that we pay for the quality of the health care provided to our beneficiaries, not simply the amount. We are working to apply this in every setting in which Medicare and Medicaid pays for care.” CMS Administrator Mark McClellan, M.D. Ph.D. January 31, 2005

  33. CMS Report on Value-Based Purchasing • CMS report to Congress released on November 21, 2007 • Mandate to implement by October 1, 2008 (Deficit Reduction Act of 2005) • CMS proposes a three-year transition to full payment for performance (P4P) • Year 1 – 100 percent pay for reporting • Year 2 – 50 percent pay for reporting and 50 percent on P4P • Year 3 – 100 percent on P4P

  34. Redistribution in Value-Based Purchasing • Scoring based upon data reported by hospitals in three quality “domains” • Clinical process of care, • Patients’ perspectives of care, and • Outcomes • Pool of incentive money funded via a carve-out from all hospital inpatient payments (2 to 5 percent) • Redistribution of pool dollars dependent upon hospitals’ scores

  35. Measures for Value-Based Purchasing • Process of care data reported since 2004 and publicly available on the CMS Hospital Compare site • HCAHPS Patients’ Perspectives of Care survey required as part of pay for reporting as of FFY 2008 and publicly available since March 2008 • Two outcomes measures, 30-day mortality of patients with AMI or heart failure, publicly available since June 2007

  36. Hospital Performance in Value-Based Purchasing • Overall hospital performance will be measured based on an aggregate of the scores in all three domains • Process measures for updates and HCAHPS Indicators • Each indicator receives a score between 1 and 10 • Each indicator score is the higher of two measures - attainment or improvement

  37. Hospital Performance in Value-Based Purchasing • The attainment score for an indicator is determined by comparing the hospital’s performance to national benchmark and threshold levels for the indicator • The benchmark -- the high performance measurement • The threshold -- the minimum acceptable performance measurement • Each domain will have its own methodology for setting benchmarks and thresholds • The improvement score for an indicator is determined by comparing the hospital’s performance to its own prior year performance

  38. HCAHPS in Value-Based Purchasing • HCAHPS scoring will include a score (between 0 and 20) for achieving minimum performance across all HCAHPS indicators • If all eight of a hospital’s HCAHPS indicator scores were above their respective 50th percentile (median) value, the hospital would receive the full 20 points • Otherwise, the minimum performance score would be based upon the indicator with the lowest percentile score and points awarded based upon how close that percentile rank is to the median

  39. Scores In Value-Based Purchasing • Each domain’s performance scores are aggregated as a percentage of the maximum possible score • Then the domain aggregates are combined to arrive at one overall VBP Total Performance Score • Combining individual scores into one aggregate percentage allows CMS to compare hospitals on one standardized measure

  40. Questions on Value-Based Purchasing • How will mortality (outcome) measures be scored and incorporated? (Report to Congress makes no mention) • Will indicators with small case counts be included? • How will new indicators be phased in? • How will the three domains’ scores be weighted to arrive at the Total VBP score? • What will the withhold percentage be in 2009?

  41. Basics of Value-Based Purchasing • Scores will be calculated at the start of each inpatient prospective payment system year • The baseline and measurement period will be April 1 through March 31 • FFY 2010 = October 1, 2009 – September 30, 2010 • The baseline period for FFY 2010 will be April 1, 2007 – March 31, 2008 • The measurement period for FFY 2010 will be April 1, 2008 – March 31, 2009 • Data only be 7 months old at the start of the FFY • Hence, hospitals will be submitting data within a tighter timeframe (60 days from close of quarter plus 30 days to resubmit data, if necessary)

  42. Hospitals’ Scores in Value-Based Purchasing • Overall scores from each of the three domains will be averaged together • Process measures will receive the highest weight • Current proposal: 70 percent Process, 30 percent HCAHPS • The hospital’s grand total score is entered into an equation to determine a payment percentage • If the maximum payment percentage is 100 percent of the hospital’s original pool contribution, there will be excess money left in the pool

  43. Payments for Value-Based Purchasing • A hospital’s payment percentage will be determined at the start of each payment year • The payment percentage will apply for the whole year • The VBP carve-out and payment percentage will be applied to inpatient prospective payments, excluding IME, DSH, outliers, and capital

  44. Excess Pool Funds in Value-Based Purchasing • Question: What becomes of the excess pool funds? • The industry wants assurances that the entire pool will be distributed • MedPAC also recommends that there be no savings achieved through this program • How will distribution of excess dollars be handled?

  45. Key Factors in Value-Based Purchasing • Hospitals’ P4P scores and payment percentages established prospectively based upon prior performance • Data reported between April 1, 2008 and March 31, 2009 will be the measurement year for FFY 2010 and the base year for FFY 2011 • Only top performers will be made whole • Once transition to VBP, hospitals still must participate in reporting of all data to qualify for incentive payments • Measures for VBP • Measures for public reporting • Measures being tested

  46. WSHA Work on Quality and Payment

More Related