Value-Based Purchasing: A Rural Hospital Perspective

Transcription

1 Value-Based Purchasing: A Rural Hospital Perspective Stratis Health & MHA Quality & Patient Safety PPS Hospital Learning Action Network Day Glen Kegley, Hutchinson Health Tuesday, May 3, 2016 Mall of America- Parkview Conference Facilities

2 Introduction to Value-Based Purchasing (VBP) Quality incentive program built on the Hospital Inpatient Quality Reporting (IQR) measure reporting structure Hospitals are paid for inpatient acute care services based on the quality of care, not just quantity of services provided Funded by a % reduction from participating hospitals base operation Diagnostic-Related Group (DRG) payments

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6 Cornerstones of Success Consider steering committee or other multi-disciplinary team to oversee direction and engage in decision-making Connect quality, infection prevention and finance staff Learn and identify work of current teams, committees to address VBP domains or dimensions Deploy tools to identify gaps Focus on domain/dimensions in next performance period Be aware of new measures added to IQR program Remain flexible, nimble and adaptable

7 From Humble Beginnings Core Measures Process of Care Work Group Hard Wiring Excellence into Patient Experience Infection Prevention and Control Committee Transforming Care at Bedside (TCAB) Others

8 Steering Committee Aligning Structure with Effort Purpose- To guide the organization to achieve and maintain continuous enhancements in quality and reductions in cost, as it pertains to CMS VBP domain and dimensions. CMS value-based incentive payment adjustment factor will be used as the metric. Responsibilities- Understand CMS VBP domains and dimensions and educate all staff on quality and financial impact and performance Identify and engage key stakeholders to take steps to proactively prepare the organization for upcoming performance period(s), including but not limited to, identification of activities previously implemented, completion of gap analysis, goal setting, and deployment of action items. Membership- Nursing, Clinical Documentation Improvement/UR, IPC, Quality/Safety, Finance, Coding, CMO, COO

9 Build and Strengthen Partnerships Beyond Your Hospital s Walls Transitional Care Management 30-day post discharge phone care for at-risk patients Community Resource-Based Care Coordination and Health Care Home Choosing Wisely initiative

10 Deploy Support Tools Core Measures Process of Care o Stickers o Tip Sheets Patient Safety Indicator (PSI) monitor Lake Superior Quality Innovation Network worksheet

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16 Mindfulness of Basic Principles Helps Assure Success Senior leaders and physicians as champions Project charters help drive outcome Rapid cycle improvement PDSA to harvest quick wins and identify opportunity for appropriate change Sustain performance by hardwiring process and practice changes and monitor frequently/ regularly Patient input adds practical perspective Celebrate success!

17 At the end of the day I think health care is more about love than about most other things. If there isn't at the core of this two human beings who have agreed to be in a relationship where one is trying to help relieve the suffering of another, which is love, you can't get to the right answer here. Don Berwick Former CMS Administrator,

18 Value Based Purchasing-Stratis Health and MHA Quality & Patient Safety PPS Hospital Learning Action Network Day Andrea Hager, MS, CPHQ May 3, 2016

19 Mercy Hospital- Coon Rapids, MN Truven Top 100 Hospital- 5 th time US News & World Report s Best Hospital rankings: 3 rd in metro and 5 th in state Employees=2287; Licensed Beds=271 Inpt hospital admissions=19,498 Outpt admissions= 150,572 ED visits=60,918 2

20 Where are we now? In July 2015, we received our payment summary reports for Program Year 4 (FY 2016). All 10 eligible Allina hospitals will gain back more than the 1.75% base operating reduction that was at risk, which translates to approximately $1.6 million for the Allina Health system. Mercy Hospital will receive back $491,974. Program Year 5 is complete and we are awaiting our FY 2017 payment summary reports (expected summer 2016). We are currently in the Performance Period for Year 6 for most measures, with 2% DRG payments at risk. This will impact payment in FY

21 General Structure at Mercy- Focused Work Senior Leadership Team & Medical Staff Quality Council Leader s Forum Patient Care Leadership, Quality, Performance Improvement Specific Topic OQCs (patient experience, quality/regulatory, infection prevention, & safety/risk) Unit Organizational Quality Committee s- front line staff engagement 4

22 Ownership & Leveraging Technology Concurrent (or close to it) monitoring with Dashboards built from our Enterprise Data Warehouse Eliminates bottleneck or hang ups with waiting for one point person Creates ownership and content expertise building Reduces paper (usually) Interaction in meetings 5

23 6 Dashboards

24 Year 4 (FY 2016) Results: Clinical Domain SCIP success tactics (of course removed in Year 5, but same type of model for new measures): Work was supported by Allina system-level workgroups that review monthly performance, identify opportunities, leverage system supports, and share improvement strategies. Mercy also identified a CNS to support the local work; set up a SCIP team; Quality indicator made 7

25 Mortality! Current performance period for the clinical domain is AMI, HF, & PN Mortalities. Examples of readmission work impacting mortality (hopefully) Community Paramedic Program Case Review on EVERY patient Nurse driving care- sees patients in the hospital, follows up after, and continues contact well beyond that particular episode of care 8

26 Year 4 (FY 2016) Results: Outcome Domain Domain Measure Threshold Benchmark Floor Points MCY AMI 30-Day Mortality Rate* HF 30-Day Mortality Rate* PN 30-Day Mortality Rate* Outcome AHRQ PSI NA CAUTI CLABSI SSI Abdominal Hyst SSI Colon Mercy Hospital VBP Outcome Earned Points 42 Mercy Hospital VBP Outcome Potential Points 80 Mercy Hospital VBP Outcome Domain Score =(Earned Points/Potential Earned Points) 53% 9

27 Year 6 Performance Standards Measure ID AHRQ PSI-90 Measure ID Description Performance Standards for Year 6 Safety Domain Complication/patient safety for selected indicators (composite) Description Achievement Threshold (Index Value) Benchmark (Index Value) 0.965* 0.710* Achievement Threshold (SIR) Benchmark (SIR) CLABSI Central Line Associated Bloodstream Infection SSI Surgical Site Infection Colon Abdominal Hysterectomy CAUTI Catheter-Associated Urinary Tract Infection MRSA Methicillin-resistant Staphylococcus Aureus bacteremia C Difficile Clostridium Difficile Measure ID Description Achievement Threshold % Benchmark % PC-01 Elective Delivery Prior to 39 Completed Weeks Gestation * Year 6 (FY 2018) AHRQ PSI-90 Threshold & Benchmark values updated in special release notice Feb

28 HACs C-Diff! Mercy has struggled with this diagnosis. But lots of work has and continues Mercy has a lower YTD Lab ID rate than the previous five years (approx. 15% decrease). Work around cleaning products/uv tech, testing appropriateness (nurse driven protocol), and much more. SSI- System wide emphasis; surveillance; observations; peer review of providers if over SIR of 1.0; traffic management CLABSI- None in 2015; so far 0 in 2016 CAUTI- 5 in 2015; so far 0 in newest initiative is two person insertion 11

29 Experience Domain Mercy Hospital received 50% of their possible points in Year 4. In current performance period of 2016, we are above the achievement point levels on each metric. Patient Experience Tactics: VP Patient Care/Nursing Patient Care Director Patient Experience OQC Unit OQC Hospital workgroups are focused on the drivers of performance improvement: Nursing bedside shift handover Physician 4Cs Connect, Cards, Care boards, Chairs Hourly rounding on patients Leader (all not just nursing)- Rounding on patients- compliments process observation Publicly show your data! 12

30 Year 4 (FY 2016) Results: Efficiency Domain Domain Measure Threshold Benchmark Floor Points MCY Efficiency Medicare Spending Per Beneficiary (MSPB) NA 5 Mercy Hospital VBP Efficiency Earned Points 5 VBP Efficiency Potential Points 10 Mercy Hospital VBP Efficiency Domain Score =(Earned Points/Potential Earned Points) 50% 13

31 Bending the Cost of Care Curve The Northwest Metro Alliance is working to achieve the triple aim, to improve population health, deliver excellent patient experience and make care more affordable. It also serves as a learning lab for Accountable Care Organizations. $22.2 million decrease in medical costs between ; impacting the cost of care for patient s in Mercy s geographical region. Tactics: Jointly developed strategies to increase generic drug use and to reduce variation in prescribing; expanded access for stress test for low risk heart patients with chest pain; colon cancer screening; pediatric obesity 14

32 15 Total Cost of Care

33 WIIFM- Recap Leverage technology AND relationships Create accountability & ownership Focused workgroups- pick what you believe will give you the biggest bang for your buck Who works the closest to the change point? Nurses, physicians, environmental services? Take a risk- think outside the box Always keep the patient first! *If you do what you ve always done, you will get what you have always gotten!* In this program, even if you are good, it wont stay that way you are either improving or sliding. 16

34 Questions? Thank you so much! 17