Quality Forum August 17th, 2016 Richard Bubach, MSA Senior Director Of Operations
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1 Quality Forum August 17th, 2016 Richard Bubach, MSA Senior Director Of Operations This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11S0W-GPQIN-ND-GEN-27/0815
2 Presentation Outline Brief Demographics 5 minutes Population/Physician Office Measures 20 minutes Nursing Home Measures 5 minutes Home Health Measures 5 minutes Hospital Measures 6 minutes AHRQ Dashboard 10 minutes Q & A s - 1 minute 2
3 DEMOGRAPHICS
4 Urban/Rural Population Distribution Data Source, Medicare enrollment data, U.S. Census Bureau Total Rural Population = 320,003 (42.3%) Total Urban Population = 436,924 (57.7%) Total Rural Medicare Population = 57,352 (48.3%) Total Urban Medicare Population = 61,338 (51.7%) 4
5 North Dakota Medicare Beneficiary Distribution 2015 Data Source, Medicare enrollment data 77 to to 1,000 1,000 to 2,000 2,000 to 5,000 >5,000 5
6 % of Medicare Beneficiary Over Age Data Source, Medicare enrollment data 6 to 10% 11 to 12% 13 to 14% State Avg 13.0% 15 to 16% 17 to 22% 6
7 Demographics 20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Medicare % of Total Population Urban Rural
8 Demographics 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% % of Medicare Population over 85 Urban Rural
9 Keillor-esque Welcome to Lake Wobegon, where all the women are strong, all the men are good-looking, and all the children are above average. - Garrison Keillor 9
10 Keillor-esque Welcome to Lake Wobegon, where all the women are strong, all the men are good-looking, and all the children are above average. - Garrison Keillor Welcome to North Dakota, where all the health care institutions are good, all the health care providers are proficient, and all the health care indicators are above average. 10
11 Population Health / Physician Office Behavioral Risk Factor Survey Data CDC Cancer Prevalence Data Claims Based Prevention and Treatment data North Dakota Physician Quality Reporting System (PQRS)-based Quality Indicator Data Physician Office E.H.R. Penetration Data 11
12 ND=24% Rank #1 12
13 Smoke Daily ND=14.4% Rank #15 13
14 Smoking Trends Over Time ND US
15 ND=32.2% Rank #7 15
16 Consumed vegetables one or more times per day ND=72.6% Rank #46
17 Consumed fruit one or more times per day ND=59.7% Rank #31
18 ND=45.3% Rank #42
19 ND is 5 th highest 19
20 ND is 19 th highest 20
21 According to 2014 BRFSS data North Dakota ranked 40th in CRC screening. According to 2014 BRFSS data North Dakota ranked 36 th in mammography screening. 21
22 North Dakota Colorectal Cancer Screening Rates Medicare Claims Data (Age 50-75): 4Q2014 through 3Q2015 Analysis provided Great Plains Quality Innovation Network April 2016
23 North Dakota Mammography Rates Medicare Claims Data: 1Q2014-4Q2015 (Females Age 50-74) Analysis provided by Great Plains Quality Innovation Network August 2016
24 North Dakota Pneumococcal Pneumonia Vaccination Rates Medicare Claims Data: 1Q2015-4Q2015 * The rates reflected in this map include only billed immunizations, and do not capture immunizations given at federally designated Rural Health Centers, the Veteran s Administration, or any other entity that does not bill Medicare using roster, electronic, or standard Medicare claim forms. Analysis provided by Great Plains Quality Innovation Network August 2016
25 80.0% Rural Versus Urban 70.0% 60.0% 50.0% 40.0% 30.0% Rural Urban 20.0% 10.0% 0.0% CRC Screening Mammography Pneumococcal
26 North Dakota Hypertension Rates Medicare Beneficiaries with Hypertension Diagnosis on Medicare Part A and B Claims 10/01/14-09/30/15 Analysis provided Great Plains Quality Innovation Network June 2016
27 North Dakota Diabetes Prevalence 2015 Analysis provided Great Plains Quality Innovation Network June 2016
28 Chronic Disease 60 % of Benes with Hypertension/Diabetes by place of residence Urban Rural 10 0 Hypertension Diabetes
29 North Dakota Diabetes Screening Rates Hemoglobin A1C Medicare Claims Data: 4Q2014 through 3Q2015 Analysis provided by Great Plains Quality Innovation Network May 2016
30 North Dakota Diabetes Screening Rates Annual Eye Exam Medicare Claims Data: 4Q2014 through 3Q2015 Analysis provided by Great Plains Quality Innovation Network May 2016
31 North Dakota Diabetes Screening Rates Lipids Medicare Claims Data: 4Q2014 through 3Q2015 Analysis provided by Great Plains Quality Innovation Network May 2016
32 Diabetes Care 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Rural versus Urban Eye Exam A1c Screening Lipid Rural Urban
33 Physician Quality Reporting System (PQRS) 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% (> 9.0) Diabetes Measures/Indicators (<100 mg/dl) A1c uncontrolled LDL controlled Eye Exam Foot Exam
34 Physician Quality Reporting System (PQRS) 60.0% Screening/Prevention Measures 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Ages > 6 months Influenza Immunization Ages >65 Pneumococcal Immunization Ages 50 through 74 Breast Cancer Screening Ages 50 through 75 CRC Screening
35 Physician Quality Reporting System (PQRS) Cardiac Related 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% < 140/ % 0.0% Controlling High BP Smoking Screening/Intervention IVD Aspirin Use
36 SD MN UT NC AL ND WI VT IA WY AR OR WA IL MT SC GA MO IN MA NE OK AZ VA KS MD CO ID NH KY ME MI MS OH PA TX CA NM NV NY NJ WV TN DE AK CT HI FL LA RI Percent of Physicians that Adopted Any EHRs (2014) % Data Source Office of the National Coordinator 36
37 MN SD NC VT OR WI IA MT UT ND SC AZ AL IL AR WY MA NE MD PA NY WV GA IN NM ID WA NH OH TX MO KS CA NV NJ VA MS MI LA OK CO ME TN DE CT HI KY DC FL RI AK Percent of Physicians that Adopted Certified EHRs (2014) % Data Source Office of the National Coordinator 37
38
39 Nursing Homes Quality Indicators Nursing Home Quality Composite Measure Use Antipsychotic Medications in Residents 39
40 Composite Summary by Quality Measure (Sept 2015 Feb 2016) Measure National Weighted Avg ND Weighted Avg Variance Composite Score Falls w/major injury UTI Pain Pressure Ulcer Incontinence Catheter Physical Restraints ADL Weight Loss Depression Antipsychotic Meds Influenza Vaccine Pneumococcal Vaccine
41 10 Nursing Home Composite Scores ND National Goal Collab. NHs months ending 41
42 Percent of Long-Term Residents Who Received an Antipsychotic by Quarter Rank 37 Rank 24 Rank 13 Rank 9 US ND MN MT SD Q3 13 Q4 14 Q1 14 Q2 14 Q3 14 Q4 15 Q1 15 Q2 15 Q3 15 Q4
43 North Dakota Percent of Long-Term Residents Who Received an Antipsychotic (2015 Q4) by Nursing home %
44 Home Health Quality Indicators Process of Care Measures Experience of Care Measures 44
45 HOME HEALTH QUALITY INDICATORS DASHBOARD Measure National North Dakota Variance Rank How often patients got better at walking or moving around How often patients got better at getting in and out of bed How often patients got better at bathing How often the home health team checked patients for pain How often the home health team treated their patients pain How often patients had less pain when moving around How often the home health team treated heart failure patients symptoms How often patients breathing improved How often patients wounds improved or healed after an operation How often the home health team checked patients for the risk of developing pressure ulcers How often the home health team included treatments to prevent pressure ulcers in the plan of care How often the home health team took doctor-ordered action to prevent pressure ulcers
46 Home Health Quality Measures 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0%. How often patients got better at walking or moving around
47 Home Health Quality Measures How often the home health team included treatments to prevent pressure ulcers in the plan of care 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0%.
48 Home Health Quality Indicators Measure How often the home health team began their patients care in a timely manner How often the home health team taught patients (or their family caregivers) about their drugs National North Dakota Variance Rank How often patients got better at taking drugs correctly by mouth How often the home health team checked patients risk of falling How often the home health team checked patients for depression How often the home health team made sure that their patients have received a flu shot for the current flu season How often the home health team made sure that their patients have received a pneumococcal vaccine (pneumonia shot) For diabetic patients, how often the home health team got doctor s orders, gave foot care, taught patients about foot care How often home health patients had a hospital admission How often patients receiving home health care needed any urgent, unplanned care in the hospital emergency room - without being admitted to the hospital
49 Home Health Quality Measures 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0% How often the home health team made sure that their patients have received a pneumococcal vaccine
50 Home Health Quality Indicators (HCAHPS) Measure Would patients recommend the home health agency to friends and family Did the home health team discuss medicines, pain, and home safety with patients National North Dakota Variance Rank T T 3 How often the home health team gave care in a professional way T 7 How well did the home health team communicate with patients T 5 How do patients rate the overall care from the home health agency T 6
51 Home Health (HCAHPS) 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0%. Would patients recommend the home health agency to friends and family
52 Hospital Reporting Growth In 2003 there were 12 publicly reported hospital measures In 2016 there are more than
53 Hospital Value-Based Purchasing Components Clinical Process Measures Patient Experience Measures Outcome Measures Efficiency Measures 53
54 Hospital Value Based Purchasing Total Performance Score St. A's Sanford Bismarck Altru Trinity Essentia Sanford Fargo
55 Hospital Value Based Purchasing Clinical Process Measures Essentia Sanford Fargo St. A's Trinity Altru Sanford Bismarck
56 Hospital Value Based Purchasing HCAHPS Measures Altru Essentia St. A's Trinity Sanford Bismarck Sanford Fargo
57 Hospital Value Based Purchasing Outcome Measures St. A's Sanford Bismarck Trinity Altru Essentia Sanford Fargo
58 Hospital Value Based Purchasing Efficiency Measure Medicare Spending Per Beneficiary St. A's Sanford Bismarck Trinity Altru Essentia Sanford Fargo Total Part A and Part B spending within 3 days prior to admission, the admission period, and 30 days post admission LOWER is BETTER
59 Critical Access Hospitals (ND vs US) 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% IMM-2 Process of Care Measures PN-6 ND National
60 Critical Access Hospitals (ND vs US) 100.0% HCAHPS 90.0% 80.0% 70.0% 60.0% 50.0% ND 40.0% 30.0% National 20.0% 10.0% 0.0% Recommend Hospital Hospital Rate 9-10 Nursing Communication Physician Communication Pain Control
61 ND Critical Access Hospitals HCAHPS - Rate Hospital as a 9 or 10
62 Care Transitions Admission Rates per 1000 beneficiaries Readmission Rates per 1000 beneficiaries Hospice Care 62
63
64
65
66
67 AK WY NY VT ND SD HI KY CA NH WA MD NV MA ME MN TN MT NM IL CT NJ CO NC AK OR IN NE DE ID PA KS RI WI MO MS MI LA AZ OK AL TX SC IA GA OH FL UT Percent of Medicare Beneficiaries accessing Hospice Care (2013) % Data Source 67
68 AHRQ State Dashboard Overall Ranking NQS Priority Bundle Access to Care Diseases and Conditions Setting of Care 68
69 All STATE-BASED AHRQ MEASURES SUMMARY 9th 69
70 70
71 Care Coordination Bundle 6th 71
72 Care Coordination Bundle 72
73 Care Coordination Bundle 73
74 Care Coordination Bundle 74
75 75
76 Patient Centeredness Bundle T 25th 76
77 77
78 Mental Health and Substance Abuse Bundle T 48th 78
79 Mental Health and Substance Abuse Bundle 79
80 80
81 Nursing Home Bundle T 18th 81
82 WANT MORE??? Google AHRQ State Snap Shot Scroll all the way down Click on link Link:
83 THE END!!!! WHEW! THANK YOU
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