5-Star Ratings and How to Position Your Agency

Transcription

1 2017 Annual Conference 5-Star Ratings and How to Position Your Agency Educational Objectives 1. Define the 5 Star Ratings programs and understand the differences and requirements for participation 2. Describe the key impacts of the 5 Star Ratings programs on organizations 3. Identify the 3 Process Measures, 5 Outcome Measures, and 1 Claims based item and why these data elements are important as they relate to the home health OASIS assessments 4. Define ways to improve Quality of Patient Care Star Ratings 2 Agenda 5 Star Ratings: An Overview o Background How 5 Star Came to Be and Why o Composition of 5 Star Ratings o Why 5 Star Matters Methodology, Calculation, Data Insights Three Journeys to 5 Star o Fidelity Health Care o Eliza Jennings Senior Care Network o Interim Healthcare Q&A 3 1

2 Introductions Our Panel Today 4 Agenda 5 Star Ratings: An Overview o Background How 5 Star Came to Be and Why o Composition of 5 Star Ratings o Why 5 Star Matters Methodology, Calculation, Data Insights Three Journeys to 5 Star o Fidelity Health Care o Eliza Jennings Senior Care Network o TSO Management Q&A 5 Affordable Care Act (ACA) 2010 Patient Protection & Affordable Care Act, or Affordable Care Act (ACA) or Obamacare is a US federal statue enacted by President Obama on March 23, 2010 The most significant regulatory change to our healthcare system since 1965 and the passage of Medicare & Medicaid The intent of ACA was to improve quality, affordability & availability of health care for all Americans while expanding coverage & reducing costs The Act allowed the creation of Accountable Care Organizations (ACO s) for Medicare patients, the CMS Innovation Center, and the Bundled Payments for Care Initiative 6 2

3 The Institute for Healthcare Improvement VALUE = QUALITY + SERVICE/COST 7 From Volume to Value 8 STAR Ratings The ACA called for transparent, easily understandable publically reported provider quality information STAR Ratings can assist consumers by summarizing current measures of health care provider performance and provide data needed to make informed health care choices Consumer research has shown that summary quality measures & use of symbols to represent performance, are valuable to consumers STAR Ratings can also assist agencies in identifying areas for improvement 9 3

4 Consumer Opinion 10 STAR Ratings STAR ratings were first published as an additional measure available on the Home Health Compare website in July 2015 Other consumer tools available include: Hospital Compare Nursing Home Compare Physician Compare Dialysis Facility Compare 11 HHA Eligibility for Participation in STAR Ratings All Medicare certified HHAs are potentially eligible to receive a Quality of Patient STAR Rating HHA must be able to report at least 20 complete quality episodes for data for each measure to be reported on HHC Smaller agencies may not generate STAR Ratings each quarter since they may not meet these requirements consistently HHA must be able to report 5 of the 9 measures to have a STAR rating computed STAR Ratings were first published on HHC in July 2015 and will be updated quarterly thereafter based upon new HHC data 12 4

5 Composition of STAR Ratings Quality of Care Patient STAR Rating is based upon OASIS assessments and Medicare claims data An episode of care is defined as a matching pair of OASIS assessments (admission & discharge) for a patient discharged during the reporting period Quality of Patient STAR Rating methodology now includes 9 of the 23 currently reported process and outcomes quality measures 3 process measures 6 outcome measures 13 Quality of Care Measures Process Measures Measure Timeframe Risk Adjusted Timely Initiation of Care SOC/ROC Non-Risk Adjusted Drug Education All Meds Discharge Non-Risk Adjusted Flu Vaccine Received Discharge Non-Risk Adjusted Outcome Measures Improvement of Ambulation SOC/ROC and discharge Risk Adjusted Improvement in Bed Transfers SOC/ROC and discharge Risk Adjusted Improvement in Bathing SOC/ROC and discharge Risk Adjusted Improvement in Pain SOC/ROC and discharge Risk Adjusted Improvement in Dyspnea SOC/ROC and discharge Risk Adjusted 60-Day Hospitalization Claims based Risk Adjusted 14 Experience of Care Measures Five HHCAHPS Survey STAR Ratings will appear on HHC: 3 Composite Measures Care of Patients Communication between Providers & Patients Specific Care Issues 1 Overall Rating of Care provided by Home Health Agency 1 Survey Summary STAR Rating (simple average of 4 HHCAHPS measure STAR ratings) 15 5

6 HHCAHPS Survey Key Date Ranges for HHCAHPS Participation for CY 2018 APU For APU 2018 START Date End Date HHCAHPS Survey Data Collection Period April 1, 2016 March 31, 2017 Reference Period April 1, 2015 March 31, 2016 If your vendor STARTS collecting data In these months START Date Quarter January, February, March January 1, (year) First Quarter April, May, June April 1, (year) Second Quarter July, August, September July 1, (year) Third Quarter October, November, December October 1, (year) Fourth Quarter 16 Why 5 Star Matters Referral sources Inclusion in ACOs Competitive edge/marketing Public opinion Recruiting and Retention Positioning for M&A 17 Agenda 5 Star Ratings: An Overview o Background How 5 Star Came to Be and Why o Composition of 5 Star Ratings o Why 5 Star Matters Methodology, Calculation, Data Insights Three Journeys to 5 Star o Fidelity Health Care o Eliza Jennings Senior Care Network o TSO Management Q&A 18 6

7 Calculation of STAR Ratings Quality of Care STAR ratings are based upon 9 of the 18 process and outcome quality measures currently tracked and reported by CMS The methodology used by CMS to generate the overall STAR ratings for each agency, computes how agencies compare to each other A 3-STAR rating indicates performance at the same level as other agencies throughout the country, and the majority of agencies will receive a 3-STAR rating each quarter This differs from other industry STAR ratings, i.e, for hotels, which compare a provider to pre-determined quality standards 19 Calculation of STAR Ratings Outcome measures are risk adjusted Methodology is based upon a combination of individual measure rankings and statistical significance of the difference between the performance of an individual HHA on each measure and the performance of ALL HHAs Each HHA quality scores are compared to the national agency median, and its rate adjusted to reflect the differences relative to other agencies quality measure scores These adjusted ratings are then combined into one overall rating that summarizes agency performance across all 9 individual measures 20 Calculation Methodology Methodology is based upon a combination of individual measure rankings and statistical significance of the difference between the performance of an individual HHA on each measure and the performance of ALL HHAs Each HHA s quality scores are compared to the national agency median, and its rate adjusted to reflect the differences relative to other agencies quality measure scores These adjusted ratings are then combined into one overall rating that summarizes agency performance across all 9 individual measures 21 7

8 Steps in Calculation of STAR Ratings 1. All HHAs scores on each of the 9 measures are sorted low to high and divided into 10 equal sized groups (deciles) of agencies For all measures except ACH, a higher value means a better score 2. Each HHA s score for each measure is assigned a decile location as a preliminary rating Each decile is assigned an initial rating from 0.5 to 5.0 in 0.5 increments 3. The initial rating is adjusted according to the statistical significance of the difference between the agency s individual quality measure score and the national agency median for that quality measure 4. The adjusted ratings are averaged across the 9 measures and rounded to the nearest 0.5, to get one overall score for each HHA An overall STAR rating is assigned to each agency so that ratings will range from 1.0 to 5.0 in half STAR increments 9 STAR categories and 3.0 STAR is the middle category of the distribution 22 Reported STAR Rating Overall score after averaging across QMs & rounding to nearest half STAR Reported Quality of Patient STAR Rating 4.5 & Steps in Calculation of STAR Ratings 1. All HHAs scores on each of the 9 measures are sorted low to high and divided into 10 equal sized groups (deciles) of agencies For all measures except ACH, a higher value means a better score 24 8

9 Steps in Calculation of STAR Ratings 2. Each HHA s score for each measure is assigned a decile location as a preliminary rating Each decile is assigned an initial rating from 0.5 to 5.0 in 0.5 increments 25 Steps in Calculation of STAR Ratings 3. The initial rating is adjusted according to the statistical significance of the difference between the agency s individual quality measure score and the national agency median for that quality measure 26 Steps in Calculation of STAR Ratings Because all the measures are proportions (e.g., proportion of patients who improved in getting in and out of bed), the calculation uses a binomial significance test If the agency s initial rating for a measure is anything other than a 2.5 or 3.0 (the two middle decile categories), and the binomial test of the difference yields a probability value greater than.05 (meaning not significantly different from the national agency median), the initial rating is adjusted to the next half star level closer to the middle categories. The results from these analyses are referred to as the adjusted ratings. Nerd Corner: In statistics, the binomial test is an exact test of the statistical significance of deviations from a theoretically expected distribution of observations into two categories. 27 9

10 Steps in Calculation of STAR Ratings 4. The adjusted ratings are averaged across the 9 measures and rounded to the nearest 0.5, to get one overall score for each HHA An overall STAR rating is assigned to each agency so that ratings will range from 1.0 to 5.0 in half STAR increments 9 STAR categories and 3.0 STAR is the middle category of the distribution 28 Data Availability Timeline HHC displays data with a 6 month lag for OASIS & 9 month lag for claims July 2017 HHC Refresh: OASIS data from January 2016 to December 2016 Claims data from October 2015 to September quarters of Quality of Patient Care STAR Rating currently completed 29 Provider Review Process & Reporting Agencies receive preview reports of STAR Ratings in their CASPER report folders approximately 3-4 months before the rating appear on HHC An agency which has evidence that errors in data submission may have resulted in an incorrect STAR rating has an opportunity to submit missing or corrected information with a plan and timeline for correction. ( Instruments/Homehealthqualityinits/HHQIHomeHealthSTARRatings.html) STAR ratings are updated on a quarterly basis, January, April, July and October 30 10

11 Data Insights Look at opportunities where agency scores are near the next cutpoint or where the rounding is in your favor 31 National Improvement 10.8% 19.9% 32 National Improvement 8.5% 33 11

12 Agenda 5 Star Ratings: An Overview o Background How 5 Star Came to Be and Why o Composition of 5 Star Ratings o Why 5 Star Matters Methodology, Calculation, Data Insights Three Journeys to 5 Star o Fidelity Health Care o Eliza Jennings Senior Care Network o TSO Management Q&A 34 Fidelity Health Care Mary Walters, MSN, RN, CRNI, NEA-BC Vice President and Chief Nursing Officer 35 Fidelity Health Care Located in Dayton, Ohio Affiliated with Premier Health (5 hospitals) Service area includes 17 counties Average daily census -2,

13 Home Health Compare

14 40 41 Strategies Quality Review Nurses Case work load review Individual clinician scorecards Education Constant review and editing Know where you are in the market 42 14

15 Eliza Jennings Senior Care Network Lisa Green Executive Director 43 Eliza Jennings Cleveland, Ohio Not-for-profit Est Full continuum of care supports quality outcomes Three campuses Independent and assisted living, skilled nursing and rehabilitation Home and community-based services o Skilled home care, adult day, geriatric clinics, NP house call, SAIDO Learning Eliza Jennings Communities Eliza Jennings Health Campus Five-star quality measures rating Devon Oaks Deficiency-free Renaissance Retirement Campus Life Plan Community 15

16 Who We Serve Internal Resident population External Individuals coming through our network for clinical and skilled support Clinical Care Management - Exercise Staff education Multi-disciplinary approach Nurses, therapists, and members of the health care team Focus: Improvement in care coordination Network Approach Network-wide support Multi-disciplinary focus on patients to achieve patient goals o Includes ancillary staff (dining, housekeeping) Keen observation Early intervention 16

17 Case Study John s Story John was previously homeless Lacked food, meds, and assistive devices Hearing loss Eliza Jennings assessment Interdisciplinary team intervention Medication and education Communication board Assistive devices Meals on wheels John achieved independence in self-care and improved quality of life OASIS Extensive training OASIS certification Tracking Outcomes Outcome audit tool Manual process Performance improvement plans 17

18 Interim Healthcare Sue Blockberger, MSN, RN Director of Performance Improvement TSO Management 52 Interim Healthcare Franchise/Columbus, OH 5 States/3 Regions 19 CCN s/66 Offices Journey to Improved Star Ratings PERFORMANCE Past & Present 18

19 Journey to Improved Star Ratings Key Factors Culture- change is ok! Consistency Education Data commonalities/multi-locations Monitoring Process, process, process! Journey to Improved Star Ratings Journey to Improved Star Ratings Patient Hospitalizations Data review!! **30 day readmission focus** Utilize Risk Tool at SOC Hospital Readmission Review for every patient 19

20 Patient Experience of Care -7 Touches Program- When Who Phone Contact Script Day One Admission Nurse Admission Visit/First Visit Day Two Office Personnel Check in phone call with patient Day Three Office Personnel Verify MD follow up apointmentmade Day Four Office Personnel Do you have any questions? Day Five Office Personnel Has your nurse talked to you about medications? Day Six Office Personnel Are you being informed as to when nurse/therapist is coming to visit you? Day Seven Office Personnel Are you able to rate the care you have received at a 9/10? Agenda 5 Star Ratings: An Overview o Background How 5 Star Came to Be and Why o Composition of 5 Star Ratings o Why 5 Star Matters Methodology, Calculation, Data Insights Three Journeys to 5 Star o Fidelity Health Care o Eliza Jennings Senior Care Network o TSO Management Q&A 59 Our Panel Today Sue Blockberger, MSN, RN Director of Performance Improvement TSO Management sblockberger@interim-health.com Lisa Green Executive Director Eliza Jennings Senior Care Network lgreen@elizajen.org Chris Attaya Vice President of Product Strategy Strategic Healthcare Programs (SHP) cattaya@shpdata.com Des Varady Chief Executive Officer Corridor dvarady@corridorgroup.com Mary Walters, MSN, RN, CRNI, NEA-BC Vice President and Chief Nursing Officer Fidelity Health Care mkwalters@premierhealth.com 60 20