VALUE-BASED PURCHASING

Transcription

1 VALUE-BASED PURCHASING Presented By: Melinda A. Gaboury, CEO Healthcare Provider Solutions, Inc. targetedprobeandeducate.com Value Based Purchasing (VBP) Pilot 3 8% payment at risk for incentive payments Not a withholding of funds like some have believed.set aside or allocated for distribution Phase in to 8% Payment Adjustment Timeline 5 performance years beginning in Performance = 2018 payment adjustment (3%) 2017 Performance = 2019 payment adjustment (5%) 2018 Performance = 2020 payment adjustment (6%) 2019 Performance = 2021 payment adjustment (7%) 2020 Performance = 2022 payment adjustment (8%) Updates to the rule can be issued at any time beginning with 2019! One possibility is updating payments every 6 months versus annually! 1

2 Outcome & Process Measures VBP Source Home Health Compare Timely Initiation of Care Multiple Improvement In Ambulation/Locomotion M1860 Improvement In Transferring M1850 Improvement In Bathing M1830 Improvement In Management of Oral Meds M2020 Improvement In Pain M1242 Improvement In Dyspnea M Day Acute Care Hospitalization Rate Claims 60-Day Emergency Department Use Claims Discharged to Community M2420 Prior ADL/IADL Functioning M1900 Influenza Immunization Received M1046 Pneumococcal Vaccine Ever Received M1051 Drug Education for all Meds (not VBP eff 1/1/18) M2016 Reason Pneumococcal Vaccine Not Received Influenza Vaccine Data Collection Period Types and Sources of Assistance M1056 M1041 M2102 Star Rating Effect of Data Across Programs HHCAHPS Measures VBP Source Home Health Compare Communication HHCAHPS Star Rating Care of Patients HHCAHPS Specific Care Issues HHCAHPS Overall Rating HHCAHPS Would Definitely Recommend HHCAHPS 2

3 Value Based Purchasing (VBP) Pilot Achievement Threshold calculated as the median of all HHAs (in the state) performance on the specified quality measure during the baseline Benchmark calculated as the mean of the top 10% of all HHAs (in the state) performance on the specified quality measure during the baseline period 2015 will consistently be used as the baseline period in order to evaluate the degree of change that may occur over the multiple years of the model. Value Based Purchasing (VBP) Pilot Achievement Scoring HHA with performance =/> than benchmark receives 10 points HHA with performance =/> achievement threshold receives 1 9 points based on formula: HHA with performance < achievement threshold receives 0 points All rounding will now be to 3 rd decimal point, example: will be

4 Value Based Purchasing (VBP) Pilot Improvement Scoring HHA with performance =/> than benchmark receives 10 points HHA with performance > its baseline period receives 1 9 points based on formula: HHA with performance =/< baseline period score receives 0 points Value Based Purchasing (VBP) Pilot Total Performance Score (TPS): higher of achievement or performance score in each measure All Outcome and Process measures have equal weight and account for 90% of TPS Points only for applicable measures (20 episodes per year) 0 to 10 points on each Outcome and Process measure Three New Measures reported accounts for 10% if reported get the full 10 points (10 or 0 points on New Measures) 4

5 VALUE BASED PURCHASING REPORTS Value Based Purchasing Review Quarterly Quality Reports July 2016 FIRST report (for 1 st Quarter 2016) 15 days to request recalculation of scores CMS will not be required to provide backup for the calculation agencies will need to monitor their own data Opportunity to review Total Performance Score (TPS) and payment adjustment calculations August 1, 2018 FIRST notification 15 days to request recalculation Final report no later than November 1, 2018 to reflect payment adjustments for

6 VALUE BASED PURCHASING REPORTS Finalized that if it is determined that the calculation was correct and deny the HHA request for recalculation of the Annual TPS and Payment Adjustment Report, or if the HHA disagrees with the results of a CMS recalculation of such report, the HHA may submit a reconsideration request for the Annual TPS and Payment Adjustment Report. The reconsideration request and supporting documentation would be required to be submitted via the form on the HHVBP Secure Portal within 15 calendar days of CMS' notification to the HHA contact of the outcome of the recalculation request for the Annual TPS and Payment Adjustment Report. Finalized that a HHA may request reconsideration of the outcome of a recalculation request for its Annual TPS and Payment Adjustment Report only. Understanding IPR Reports Achievement Points Improvement Points Care Points (comparing Achievement to Improvement) New Measures Total Performance Scores 6

7 Measures Achievement Points HHA Performanc e Score Data Period 12 Month Ending Achievemen t Threshold Benchmar k Current Achieveme nt Points Oasis-Based Measures Drug Education on All Medications Provided to Patient/Caregiver during all Episodes of Care Influenza Immunization Received for Current Flu Season Pneumococcal Polysaccharide Vaccine Ever Received Improvement in Bathing Improvement in Bed Transferring Improvement in Ambulation- Locomotion Improvement in Management of Oral Medications Improvement in Dyspnea Improvement in Pain Interfering with Activity Discharged to Community Claims-Based Measures Emergency Department Use Without Hospitalization Acute Care Hospitalizations HHCAHPS Measures Care of Patients Communications Between Providers and Patients Specific Care Issues Overall Rating of Home Health Care Willingness to Recommend the Agency Measures Improvement Points HHA Data Period 12 Performanc Month Ending e Score Baseline Period Score Benchmar k Current Improvement Points Oasis-Based Measures Drug Education on All Medications Provided to Patient/Caregiver during all Episodes of Care Influenza Immunization Received for Current Flu Season Pneumococcal Polysaccharide Vaccine Ever Received Improvement in Bathing Improvement in Bed Transferring Improvement in Ambulation- Locomotion Improvement in Management of Oral Medications Improvement in Dyspnea Improvement in Pain Interfering with Activity Discharged to Community Claims-Based Measures Emergency Department Use Without Hospitalization Acute Care Hospitalizations HHCAHPS Measures Care of Patients Communications Between Providers and Patients Specific Care Issues Overall Rating of Home Health Care Willingness to Recommend the Agency

8 *Source: 2017 Home Health Final Rule Make sure to reference your actual VBP Reports from the portal as illustrated on the two previous slides. 15 Measures Oasis-Based Measures Drug Education on All Medications Provided to Patient/Caregiver during all Episodes of Care Care Points Sufficient Data for Measure Inclusion (0= No; 1=Yes) Current Achievement Points Current Improvement Points Current Care Points Influenza Immunization Received for Current Flu Season Pneumococcal Polysaccharide Vaccine Ever Received Improvement in Bathing Improvement in Bed Transferring Improvement in Ambulation- Locomotion Improvement in Management of Oral Medications Improvement in Dyspnea Improvement in Pain Interfering with Activity Discharged to Community Claims-Based Measures Emergency Department Use Without Hospitalization Acute Care Hospitalizations HHCAHPS Measures Care of Patients Communications Between Providers and Patients Specific Care Issues Overall Rating of Home Health Care Willingness to Recommend the Agency Total Available Measures For TPS Calculation

9 Calculation of Applicable Measures Total Performance Score Classifications Applicable Measures (AM) Raw Total Points (RTP) Total Applicable Measure Points (RTP/AM)*10 Weight Applicable Measures Final Weighted Score (AMFWS) Points % Cumulative Applicable Measures Score Calculation of New Measures Classifications Available Points (AP) Raw New Measure Points (RNMP) Total New Measure Points (RNMP/AP)*100 Weight New Measures Final Weighted Score (NMFWS) Points % 10 Cumulative New Measure Score 10 Percentile Ranking within Cohort 75 Total Performance Score Summary Classifications Final Weighted Score (FWS) Percentile Ranking within Cohort Applicable Measure Final Weighted Score (AMFWS) New Measure Final Weighted Score (NMFWS) 10 Total Performance Score (TPS) Percentile TPS rankings are presented in wide ranges 9

10 Overall projection table from 2017 payment rule Consider Wide ranges in the IPR percentile rankings Revenue weighting can impact results in LEF calculation Some states of small and large cohorts to consider 19 State specific projection tables from 2017 payment rule 20 10

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12 Finalized Changes 2018 Home Health Care Consumer Assessment of Healthcare Providers and System (HHCAHPS) Surveys proposing to change the required number of completed surveys returned in order to calculate a performance score (currently 20 and proposed to be 40). If finalized, this proposed change will be applied to the FIRST performance year (2016) before it is finalized in the Fall/Winter Proposing to remove the OASIS-based measure Drug Education on All Medications Provided to Patient/Caregiver during All Episodes of Care. If finalized this measure will be removed beginning with performance year 3 (2018). 23 Finalized Changes 2018 Quality Measures for future consideration of proposal.not officially being proposed in this rule Total Change in ADL/IADL Performance by HHA Patients this measure would report the average, normalized, total improved functioning across the 11 ADL/IADL item on the current OASIS-C2. The patient s discharge score would be subtracted from the Start of Care (SOC)/Resumption of Care (ROC) score and then divided by the maximum improvement value based the number of response options for that item. All eligible episodes would be considered including episodes where the patient WAS INDEPENDENT at the SOC/ROC

13 Finalized Changes 2018 Composite Functional Decline Measure this measure would report the percentage of episodes where there was a decline on one or more of the 8 ADL items used in the measure. Behavioral Health Measures HHA Correctly Identifies Patient s Need for Mental or Behavioral Health Supervision using multiple factors including items from Neuro/Emotional/Behavioral Status OASIS-C2 items. Caregiver Can/Does Provide for Patient s Mental or Behavioral Health Supervision Need - using multiple factors including items from Neuro/Emotional/Behavioral Status OASIS-C2 items. 25 HH CAHPS - Communication With Patients It is not acceptable, however, for an HHA to do the following: Mail or information to patients in advance alerting them about the survey, other than the information provided to all patients; Provide a copy of the HHCAHPS Survey questionnaire or cover letters to the patients; Include words or phrases verbatim from the HHCAHPS Survey in its marketing or promotional materials (CMS is encouraging HHAs not to use text from HHCAHPS questions in their marketing and promotional materials); Attempt to influence their patients answers to the HHCAHPS Survey questions; 13

14 HH CAHPS - Communication With Patients Tell the patients that the agency hopes or expects that its patients will give it the best or highest rating or to respond in a certain way to the survey questions; Offer incentives of any kind to the patients for participating (or not) in the survey; Help the patient answer the survey questions, even if the patient asks for the home care provider s help; Ask patients why they gave a certain response or rating to any of the HHCAHPS Survey questions; and Include any messages or materials promoting the HHA or the services it provides in survey materials, including mail survey cover letters and questionnaires and telephone interview scripts. HH CAHPS Texas Nation 28 14

15 HH CAHPS Texas Nation 29 Lowest Scoring Categories Seemed informed and up to date? Ensure that POC is always available and present for each visit Review chart for updates before entering the home Keep you informed about arrival time? Call /confirm visits the night before or morning of Provide a range for the visit time

16 Lowest Scoring Categories Listen carefully to you? Repeat to patient what they have said to you. Make eye contact when patient speaks Provide solutions/answers to problems and concerns Specific care issues: Use the language in these questions in the day to day care of the patient: purpose, over-thecounter, safely, etc. 31 HHCAHPS - How Do We Improve? Share your results Engage your staff in improvement all staff! Be deliberate and focused Be specific Develop standards, scripts and behaviors Don t forget identifying processes that create problems & correct them Call patient s family after admission and periodically Hold managers and staff accountable 32 16

17 Speaker Contact Info Melinda A. Gaboury Chief Executive Officer Healthcare Provider Solutions, Inc. 810 Royal Parkway, Suite 200 Nashville, TN Phone Fax 17