VALUE BASED PURCHASING/HOME HEALTH QUALITY REPORTING

Transcription

1 VALUE BASED PURCHASING/HOME HEALTH QUALITY REPORTING HPS ALLIANCE MEMBERS ONLY WEBINAR FEBRUARY 16, 2018 MELINDA A. GABOURY, CEO HEALTHCARE PROVIDER SOLUTIONS, INC FINALIZED CHANGES TO VBP 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). THIS CHANGE WILL BE APPLIED TO THE FIRST PERFORMANCE YEAR (2016) BEFORE IT IS FINALIZED IN THE FALL/WINTER FINALIZED TO REMOVE THE OASIS-BASED MEASURE DRUG EDUCATION ON ALL MEDICATIONS PROVIDED TO PATIENT/CAREGIVER DURING ALL EPISODES OF CARE. THIS MEASURE WILL BE REMOVED BEGINNING WITH PERFORMANCE YEAR 3 (2018). 1

2 CONSIDERING FOR THE FUTURE 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. CONSIDERING FOR THE FUTURE 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. 2

3 PAYMENT ADJUSTMENT CALCULATION TENNESSEE STATS 3

4 FLORIDA LARGE COHORT 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 M2016 Reason Pneumococcal Vaccine Not Received Influenza Vaccine Data Collection Period Types and Sources of Assistance M1056 M1041 M2102 Star Rating 4

5 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. 9 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, 10 OVER-THE-COUNTER, SAFELY, ETC. 5

6 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 11 HOLD MANAGERS AND STAFF ACCOUNTABLE OVERVIEW OF CURRENT QOPC STAR RATING METHODOLOGY HHAS MUST BE ABLE TO REPORT 5 OF 9 MEASURES TO HAVE A STAR RATING COMPUTED ONCE THE INFLUENZA MEASURE IS REMOVED YOU WILL NEED 5 OF 8 MEASURES TO GET A STAR RATING REPORTING REQUIRES AT LEAST 20 EPISODES OF CARE DURING THE REPORTING PERIOD PROCESS (NOT RISK ADJUSTED) TIMELY INITIATION OF CARE DRUG EDUCATION ON ALL MEDICATIONS PROVIDED TO PATIENT/CAREGIVER INFLUENZA IMMUNIZATION RECEIVED FOR CURRENT FLU SEASON OUTCOME (RISK ADJUSTED) IMPROVEMENT IN AMBULATION IMPROVEMENT IN BED TRANSFERRING IMPROVEMENT IN BATHING IMPROVEMENT IN PAIN INTERFERING WITH ACTIVITY IMPROVEMENT IN DYSPNEA ACUTE CARE HOSPITALIZATION (CLAIMS-BASED) 6

7 QOPC STAR RATING SIMULATION WITH THE FLU MEASURE REMOVED HISTORY OF CHANGE MEDICARE LEARNING NETWORK (MLN) CALL ON JANUARY 19, 2017 INCLUDED TWO PROPOSALS: REMOVE MEASURE: INFLUENZA IMMUNIZATION RECEIVED FOR CURRENT FLU SEASON (BASED ON OUTCOME AND ASSESSMENT INFORMATION SET [OASIS] DATA) ADD MEASURE: EMERGENCY DEPARTMENT USE WITHOUT HOSPITALIZATION (CLAIMS-BASED DATA) STAKEHOLDERS DID NOT SUPPORT THE ADDITION OF EMERGENCY DEPARTMENT USE WITHOUT HOSPITALIZATION MEASURE 7

8 OVERVIEW OF CURRENT QOPC STAR RATING METHODOLOGY AND PROPOSED CHANGE OVER 12,000 HOME HEALTH AGENCIES 23 QUALITY MEASURES ON HOME HEALTH COMPARE (HHC) 7 OASIS-BASED PROCESS MEASURES 7 OASIS-BASED OUTCOME MEASURES 4 CLAIMS-BASED UTILIZATION MEASURES 5 HHCAHPS-BASED MEASURES SEPARATE STAR RATINGS FOR QUALITY OF PATIENT CARE AND PATIENT EXPERIENCE (BASED ON SURVEY DATA FROM HOME HEALTH CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS [HHCAHPS]) OTHER EXISTING CMS STAR RATINGS PROGRAMS: NURSING HOME COMPARE, PHYSICIAN COMPARE, DIALYSIS FACILITY COMPARE AND HOSPITAL COMPARE PROPOSED CHANGE TO QOPC STAR RATING METHODOLOGY: REMOVE INFLUENZA IMMUNIZATION MEASURE CMS WILL REMOVE THE INFLUENZA IMMUNIZATION RECEIVED FOR CURRENT FLU SEASON MEASURE FROM THE QOPC STAR RATING REMOVAL WILL BE EFFECTIVE WITH APRIL 2018 HOME HEALTH COMPARE REFRESH THIS MEASURE WILL CONTINUE TO BE REPORTED ON HOME HEALTH COMPARE TO ENCOURAGE VACCINATION CMS WILL MONITOR THE INFLUENZA IMMUNIZATION RECEIVED FOR CURRENT FLU SEASON MEASURE TO ENSURE RATES DO NOT DECREASE 8

9 HH QRP SEEKING PUBLIC COMMENT ON WHICH SOCIAL RISK FACTORS MIGHT BE MOST APPROPRIATE FOR REPORTING STRATIFIED MEASURE SCORES AND POTENTIAL RISK ADJUSTMENT OF A PARTICULAR MEASURE. EXAMPLES: DUAL ELIGIBLE/LOW-INCOME SUBSIDY, RACE AND ETHNICITY AND GEOGRAPHIC AREA OF RESIDENCE. FINALIZED - DATA ELEMENTS FOR REMOVAL FROM OASIS WE ARE FINALIZING TO REMOVE 247 DATA ELEMENTS FROM 35 OASIS ITEMS COLLECTED AT SPECIFIC TIME POINTS. THESE ELEMENTS ARE NOT USED IN THE CALCULATION OF QUALITY MEASURES NOR ARE THEY USED FOR PAYMENT, SURVEY, VBP OR CARE PLANNING. STANDARDIZED ASSESSMENT ACROSS POST ACUTE CARE (PAC) PROVIDERS FOLLOWING WERE FINALIZED FOR COLLECTION TO BEGIN 2019: SKIN INTEGRITY AND CHANGES IN SKIN INTEGRITY DOMAIN PERCENT OF RESIDENTS OR PATIENTS WITH PRESSURE ULCERS THAT ARE NEW OR WORSENED (SHORT STAY) IS TO BE REPLACED WITH A MEASURE ENTITLED CHANGES IN SKIN INTEGRITY POST-ACUTE CARE: PRESSURE ULCER/INJURY. FUNCTIONAL STATUS, COGNITIVE FUNCTION, AND CHANGES IN FUNCTION AND COGNITIVE FUNCTION DOMAIN APPLICATION OF PERCENT OF LONG-TERM CARE HOSPITAL PATIENTS WITH AN ADMISSION AND DISCHARGE FUNCTIONAL ASSESSMENT AND A CARE PLAN THAT ADDRESSES FUNCTION (NQF #2631). 9

10 STANDARDIZED QUALITY MEASURES ACROSS PAC PROVIDERS FUNCTIONAL STATUS CMS WILL APPLY THE ASSESSMENT ITEMS FOR THE MEASURE APPLICATION OF PERCENT OF LONG-TERM CARE HOSPITAL PATIENTS WITH AN ADMISSION AND DISCHARGE FUNCTIONAL ASSESSMENT AND A CARE PLAN THAT ADDRESSES FUNCTION (NQF #2631), TO MEET THE REQUIREMENTS FOR THIS DOMAIN. MEDICAL CONDITIONS AND CO-MORBIDITIES CMS WILL USE ELEMENTS NEEDED TO CALCULATE THE MEASURE FOR PRESSURE ULCERS, SUCH AS DIABETES, INCONTINENCE, PERIPHERAL VASCULAR DISEASE OR PERIPHERAL ARTERIAL DISEASE, MOBILITY, AS WELL AS LOW BODY MASS INDEX (BMI), TO MEET THE REQUIREMENTS FOR THIS DOMAIN. CMS IS NOT FINALIZING THE STANDARDIZED ASSESSMENT ITEMS FOR THE DOMAINS OF COGNITIVE FUNCTION AND MENTAL STATUS; SPECIAL SERVICES, TREATMENTS AND INTERVENTIONS; AND IMPAIRMENTS AT THIS TIME. STANDARDIZED QUALITY MEASURES ACROSS PAC PROVIDERS CMS FINALIZED ITS PLANS TO BEGIN PUBLIC REPORTING IN 2019 ON THE FOLLOWING OASIS AND CLAIM BASED MEASURES THAT AGENCIES BEGAN COLLECTING IN PERCENT OF PATIENTS OR RESIDENTS WITH PRESSURE ULCERS THAT ARE NEW OR WORSENED; DRUG REGIMEN REVIEW; MEDICARE SPENDING PER BENEFICIARY; DISCHARGE TO COMMUNITY; AND POTENTIALLY PREVENTABLE 30-DAY POST-DISCHARGE READMISSION 10

11 CONSIDERING FOR FUTURE YEARS HOME HEALTH COMPARE KEY DATES 11

12 QUALITY ASSESSMENT ONLY (QAO) 12

13 Speaker Contact Info MELINDA A. GABOURY CHIEF EXECUTIVE OFFICER HEALTHCARE PROVIDER SOLUTIONS, INC. 810 ROYAL PARKWAY, SUITE 200 NASHVILLE, TN PHONE FAX 13