Navigating Value Based Care with Crimson

Transcription

1 PROVIDER ENGAGEMENT Navigating Value Based Care with Crimson Eric Fontana Practice Manager Mark Schario System Director of Quality Mindy McStott Vice President of Quality Joan Rigby Crimson Coordinator

2 Road Map Value Based Purchasing Hospital Sisters Health System Tift Regional 4 5 Willis-Knighton Health System Q&A

3 3 Moving From Volume to Value A Multitude of New Initiatives Aligning with CMS Goals US Department of Health and Human Services (HHS) Commits to Value Based Payments..HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and Hospital Readmissions Reduction Program. Better, Smarter, Healthier HHS January 26, 2015 Source: CMS, Financial Leadership Council analysis.

4 4 CMS Charting a Path Toward Greater Risk Continuum of Medicare Risk Models Pay-for- Performance Bundled Payments Shared Savings Shared Risk Full Risk Hospital VBP Program Hospital Readmissions Reduction Program HAC Reduction Program Merit-Based Incentive Payment System Comprehensive Care for Joint Replacement (CCJR) Model Bundled Payments for Care Improvement Initiative (BPCI) MSSP Track 1 (50% sharing) MSSP Track 2 (60% sharing) MSSP Track 3 (up to 75% sharing) Next-Generation ACO (80-85% sharing) Next-Generation ACO (optional full performance risk) Medicare Advantage (providersponsored) Increasing Financial Risk Source: Health Care Advisory Board interviews and analysis.

5 P4P: HAC, Readmissions, VBP 5 Pay-For-Performance Refresher 6% of Inpatient Reimbursement at Risk From FY 2017 Onwards Comparing Major Pay For Performance Programs Discharge 1% penalty for 30 day Readmit Maximum Penalty FY % FY % FY 2015 onward 3% worst performing quartile TABLE Hospital Readmissions Reduction Program Hospital Inpatient Value-Based Purchasing Program Hospital-Acquired Conditions Reduction Program Payment Impact Began: FY 2013 Payments (October 1, 2012) FY 2013 Payments (October 1, 2012) FY 2015 Payments (October 1, 2014) Incentive Structure: Penalty only, 3% max for FY 2015 onwards Penalty or bonus depending on performance, 1.75% at risk in FY 2016 Penalty only, 1% FY 2015 onwards Payment Unit to be Modified: Base Operating DRG Payment Amount Base Operating DRG Payment Amount Revenue after adjustment for Readmissions and VBP programs Comment: Compares your facility to national average performance based on retrospective three year period Budget neutral, creates winners vs. losers scenario Wholly different program from HAC Present on Admission (POA) program; more significant financial impact Source: CMS, Advisory Board Analysis

6 P4P: HAC, Readmissions, VBP 6 A Look Back at FY 2015: Few Escaped Penalties Expect a Similar Impact When Final VBP/HAC Data Released Hospitals Receiving FY 2015 P4P Penalties 1 Readmissions Penalty 1,071 (32%) No Penalties 423 (13%) Medicare Hospital Inpatient Pay-for- Performance Update View our archived webinar for a complete rundown of the impact of three major inpatient quality based P4P programs on FY 2015 hospital payments 961 (29%) 288 (9%) 318 (9%) VBP Penalty 152 (5%) 43 (1%) HAC Penalty 112 (3%) 48% Hospitals receiving multiple P4P penalties ) The Based Advisory on Readmissions,VBP, Board Company HAC advisory.com adjustment factors from FY 2015 IPPS Final Rule. Source: CMS, Advisory Board Analysis.

7 Hospital Readmissions Reduction Program 7 It Pays to Think Well Ahead CMS Announces 2016 Penalties, Yet 2017 Data Collection Already Closed July 1 FY 2015 June 30 July 1 FY 2016 June 30 July 1 FY 2017 June 30 ICD-10 not applicable for FY 2017 penalty July 1 July 1 FY 2018 June 30 FY 2019 June 30 Finalized Timeframes Likely Timeframes 1 We are here: October 29 th, ) Not finalized by CMS. Based on assumption that current timeframes will roll forward in accordance with program specifications and methodology. Source: CMS, Advisory Board Analysis

8 Hospital Acquired Conditions Reduction Program 8 Current Performance To Have Far-Reaching Impact Data Collection Patterns Suggest Future Performance Periods Underway July 1 FY 2015 PSI-90 June 30 Jan 1 FY 2015 CDC/NHSN Dec 31 July 1 FY 2016 PSI-90 June 30 Jan 1 FY 2016 CDC/NHSN Dec 31 July 1 FY 2017 PSI-90 June 30 Jan 1 FY 2017 CDC/NHSN Dec 31 July 1 FY 2018 PSI-90 June 30 Finalized Timeframes Likely Future Timeframes 1 1) Not yet finalized by CMS. Based on assumption that current timeframes will roll forward in accordance with program specifications and methodology. Jan 1 FY 2018 CDC/NHSN We are here: October 29 th, 2015 Dec Source: CMS, Advisory Board Analysis

9 Hospital Value-Based Purchasing (VBP) Program 9 Finalized Performance Periods for FY 2018 VBP Starting January All Performance Periods Will be Live Jan 1 PC-01 2 Dec 31 Jul 1 PSI-90 1 June 30 Oct 1 AMI/HF/PN Mortality 1 June 30 Jan 1 Jan 1 Jan 1 HCAHPS/CTM-3 2 Dec 31 CDC-NHSN 2 Dec 31 Efficiency 2 Dec 31 We are here: October 29 th, 2015 Finalized Proposed 1) Baseline periods run same duration as performance periods and start 4 years prior. 2) Baseline periods run same duration as performance period and start 2 years prior. Source: CMS, Advisory Board Analysis

10 Hospital Value-Based Purchasing (VBP) Program 10 Don t Forget About Future Performance Periods Data Collection as Far Ahead as 2020 Commencing Soon July 1 FY 2019 Mortality 1 June 30 Jan 1 FY 2019 THA/TKA 1 June 30 July 1 July 1 FY 2019 PSI-90 2 June 30 FY 2020 Mortality 1 June 30 July 1 FY 2020 THA/TKA 1 June 30 July 1 FY 2020 PSI-90 2 June 30 July 1 FY 2021 Mortality 1 June 30 Apr 1 FY THA/TKA 1 Mar 30 We are here: October 29 th, ) Baseline period starts 5 years prior and run same duration 2) Baseline period starts 4 years prior and run same duration Source: CMS, Advisory Board Analysis

11 11 Lessons Learned for Successful Quality Initiatives 1 Executive Buy In Ensure you have the support of your leadership team to help push VBP initiatives, and communicate with the teams involved. 2 Team Structure Create multidisciplinary teams based on the quality initiative. Ensure roles and accountability are assigned. 3 Documentation Start with documentation to understand which outcomes are coding/documentation opportunities, versus quality issues.

12 Road Map Value Based Purchasing Hospital Sisters Health System 4 5 Tift Regional Willis-Knighton Health System Q&A

13 13 About Hospital Sisters Health System A multi-institutional health care system comprised of 14 hospitals and an integrated physician network across Illinois and Wisconsin. 3M 2B Population Served Operating Revenue 14K System-wide Employees 186M Community Benefit Physician Clinical Integration Network (PCIN) Formed in 2012 as a clinically integrated network Physician-led organization with 2,800+ providers Focused on quality, performance improvement, and patient safety Engaged in shared savings and efficiency operations with a goal of improving and moving toward population health

14 14 About Mark Schario Mark E. Schario, MS, RN, FACHE Director, Quality Hospital Sisters Health System As a senior health care executive Mark is considered an expert with extensive experience in many aspects of health care, including hospital operations, clinical integration, and population health. In his current position as system director of quality, Mark oversees quality and operational initiatives for the Physician Clinical Integration Network, an affiliate of Hospital Sisters Health Systems, which includes 1,200 physicians and 800 mid-level providers. Mark has designed hospital efficiency contracts for computerized physicians, led a full implementation of the Crimson Clinical Advantage platform for quality measures and clinical integration, and led the acquisition of technologies for population health management. In conjunction with business development at PINC, Mark recruited 600 physicians and added two additional chapters into the network within a six-month period. Mark is a seasoned veteran of the health care world with over 30 years of expertise. His experience is vast, pulling from many facets of the industry, including 12 years with The Joint Commission. Mark is a Johnson & Johnson Wharton Fellow and holds a master of science degree from the University of Maryland and a bachelor of science in nursing from the University of Akron. As lieutenant colonel in the U.S. army, Mark achieved numerous distinctions including the Army Commendation Medal, Army Achievement Medal, and Military Outstanding Volunteer Service Medal..

15 15

16 16

17 17

18 Utilizing the Guidelines Module in Crimson to Track Your Order Sets 18 HSHS uploaded their standardized care pathways to Crimson in order to track compliance.

19 Road Map Value Based Purchasing Hospital Sisters Health System 4 5 Tift Regional Willis-Knighton Health System Q&A

20 20 About Tift Regional Medical Center 12 Counties Served in Georgia 135+ Physicians, with expertise in over 30 specialties With a reputation as an innovative provider of quality care, Tift Regional Health System (TRHS) is a growing, not-for-profit hospital system serving 12 counties in South Central Georgia. TRHS provides a wide-range of care, including signature services in surgery, oncology, cardiovascular care, women s health, neurodiagnostics, geriatric psychiatric care, radiology and more. The Main Campus is Tift Regional Medical Center (TRMC), a 191-bed regional referral hospital located in Tifton. TRMC was named a top 10 Georgia medium-size hospital by Georgia Trend magazine in both 2012 and Tift Regional Medical Center s West Campus is an outpatient facility which houses various diagnostic services and the region s largest multi-specialty physician practice. Located in Adel, Cook Medical Center is a 60-bed acute care facility which includes a 12-bed geriatric psychiatric unit.

21 21 About Mindy McStott Mindy McStott Vice President of Quality Tift Regional Medical Center Mindy McStott is the VP of Quality at Tift Regional Medical Center in Tifton, Georgia. Mindy has a strong clinical background as a Registered Nurse in hospital, home health and hospice settings. She has extensive experience in directing operations for a number of successful home health and hospice organizations including St. Vincent s Healthcare, Bethesda Home Care, and MedShares Home Care. Her recent experiences have also included administrative responsibilities for Soleus Health Care Services and Intrepid, USA providing Medicare, Medicaid, and Commercial Insurance home health services. Her current position includes administrative responsibilities for the Case Management Department, Infection Prevention, Regulatory Compliance, Quality Management and Risk Management for a 190 bed acute care hospital. Mindy has led her current organization toward reducing readmissions and improving patient satisfaction.

22 Crimson Continuum of Care Using Crimson to Drive Reduction in Post-Operative Respiratory Failure Rate Tift Regional Medical Center, 176 bed hospital, Tifton, GA Case Study Challenge: High Rate of Post-Operative Respiratory Failure (PSI-11). Solution: Use Crimson to track instances of PSI-11 for review by a task-force. Implemented changes in registration, coding, and physician documentation as a result of findings. Impact: 49% reduction in PSI-11 rate. Impact Highlights 49% Reduction in PSI-11 rate Reviewing All Cases of PSI-11 Leads to Effective Action Plan Opportunity identified Director of Quality uses Crimson to identify that TRMC s rate of PSI-11 is almost 50% higher than the AHRQ target rate. Diagnosing the Root Cause The Quality Department uses Crimson to track the rate from month to month and identify cases for chart review. A physician-led committee is established to meet monthly, review the cases, and make recommendations. Three main causes are found: 1) Classification of Admission Type; 2) Coding; 3) Physician Documentation Strategy implementation A strategy is selected for each root cause. The Director of Quality works with registration to ensure admission type is classified correctly. A quality analyst provides additional training to the coders. A physician from the committee develops and conducts peer-to-peer training on necessary physician documentation The Advisory Board Company advisory.com

23 23 Initiative Results in Significant PSI-11 Rate Comparison Reduction to Baseline PSI-11 Rate Trend for Intervention started in February 2013 Interested in learning more about Crimson? Contact us at or visit M Street NW, Washington DC I P I F I advisory.com/crimson

24 Create a Value Based Purchasing Scorecard with your Data from Crimson 24 Compile your data across the different measures to share with the teams and individuals involved. Value Based Purchasing Scorecard Patient Safety Indicators Hospital Acquired Conditions Board members Share your overall VBP measures tracked to your Board and teams involved. Core Measures HCAHPS Measures Infection Prevention Measures Physicians Engage your physicians around their outcomes and data, such as core measures and HCAHPS.

25 Road Map Value Based Purchasing Hospital Sisters Health System Tift Regional 4 5 Willis-Knighton Health System Q&A

26 26 About Willis-Knighton Health System Willis-Knighton has offered many firsts: the Center for Women s Health, an eye institute and the Willis- Knighton Heart & Vascular Institute. 4 Hospitals included in the health system Since 1924, Willis-Knighton has served the needs of its community with an eye toward the future. The years have brought changes in technology and treatment along with tremendous growth. Willis-Knighton has operated with the same CEO for 50 years (the longest-tenured hospital administrator in the United States). Willis-Knighton is a not-for-profit corporation operated in the public interest. The health system is operated by a volunteer board of trustees made up of people who live and work in the communities Willis-Knighton serves. From one small hospital, Willis-Knighton has grown to encompass multiple facilities, spanning the entire continuum of care for residents in northwest Louisiana and the Ark-La-Tex (Arkansas-Louisiana-Texas). Today the health system includes four hospitals as well as a retirement community and a full range of support services. Willis-Knighton has offered many firsts: the Center for Women s Health, the WK Eye Institute and the Willis-Knighton Heart & Vascular Institute. Willis-Knighton South was the first satellite hospital established in Louisiana. For more than two decades Willis-Knighton has collaborated with LSU School of Medicine in Shreveport, a public/private partnership that has enhanced healthcare for all residents in the community. In 2014, Willis-Knighton began delivering proton therapy at its cancer center using the world s first compact pencil beam proton therapy delivery system.

27 27 About Joan Rigby Joan Rigby Crimson Coordinator Willis-Knighton Health System Joan Rigby serves as the Crimson coordinator at Willis-Knighton Health System. Joan has worked in the healthcare sector for 33 years and has served in her current role since Joan also works closely with the patient safety and quality and performance improvement initiatives at the health system. As the Crimson Coordinator, Joan oversees the Crimson Initiative at Willis- Knighton Health System. Working with both the health system administrative and medical staff leadership, Joan credits the success of Crimson at Willis- Knighton Health System to these dedicated teams. Crimson is utilized to drive physician engagement and organizational improvement and redesign throughout the health system. Willis-Knighton Health System is consistently ranked in the Top Quartile for utilization of the Crimson tool and continues to trend upward.

28 Crimson Continuum of Care Using Crimson to Engage Patient Safety Officer & Drive Reduction in Post-Operative PE/DVT Rate Willis Knighton Health System, 862 beds- Shreveport, LA Case Study Challenge: High Rate of Postoperative Pulmonary Embolism or Deep Vein Thrombosis Rate (PSI-12). Solution: Crimson Coordinator share quarterly reports with Patient Safety Officer tracking instances of PSI-12 for review by a task-force led. Implemented changes in registration, coding, and physician documentation as a result of findings. Impact: 50% reduction in PSI-12 rate. Impact Highlights 50% Reduction in PSI-12 rate Reviewing All Cases of PSI-12 Leads to Effective Action Plan Opportunity identified Corporate Director of Patient Safety and Quality receives monthly Crimson Hospital Acquired Conditions (HACs) and Patient Safety Indicator (PSIs) reports that includes PSI- 90.Reports are shared with Facility Patient Safety Officers,Facility VPs and CNOs Medical Staff Peer Review-Medical Staff Advisor Diagnosing the Root Cause Strategy implementation Areas of physician opportunities are reviewed by medical staff departmental peer review panels Process steps include: Facility Patient Safety Officers conduct in-depth review of monthly occurrences tracked in Crimson tool Validation of coding Core Measure Analysts conduct in-depth analysis, assessing possible DVT risk factors in patients that went unrecognized prior to the occurrence of the DVT. Analysts also look at when/how the DVT was discovered, tested, and treated. Assessment of any trends or any possible preventative measures that were inadequate or overlooked altogether for future cases to prevent the HAC postop DVT are also reviewed The Advisory Board Company advisory.com

29 29 Initiative Results in Significant Reduction PSI-12 Rate Comparison to Baseline Oct2013-Aug2014 Sept 2014-June2015 PSI-12 Rate Trend Post Intervention Interested in learning more about Crimson? Contact us at or visit M Street NW, Washington DC I P I F I advisory.com/crimson

30 Utilize the Patient Safety Indicator Table in Crimson to Identify Cases for Documentation Review 30

31 Click Into the Case Count In Order to Review Encounter Level Data 31

32 Road Map Value Based Purchasing Hospital Sisters Health System Tift Regional 4 5 Willis-Knighton Health System Q&A

33 33 Lessons learned for successful quality initiatives 1 Executive Buy In Ensure you have the support of your leadership team to help push VBP initiatives, and communicate with the teams involved. 2 Team Structure Create multidisciplinary teams based on the quality initiative. Ensure roles and accountability are assigned. 3 Documentation Start with documentation to understand which outcomes are coding/documentation opportunities, versus quality issues.

34 34 Open to the Audience: Questions for our panelists?