4/25/2017. Linking Up with Corridor. Value Proposition. STAR RATINGS Quality Reporting in the Accountable Care Marketplace

Transcription

1 STAR RATINGS Quality Reporting in the Accountable Care Marketplace Presented By: Robbin Boyatt, MPH, Vice President of Revenue Management Services Joanne Erickson, RN, MSN, Director of Advisory & Consulting Services May 3, 2017 Linking Up with Corridor Corridor is a trusted business partner to non-acute providers, delivering quality services and results for more than 30 years. Leading national provider of business services to non-acute healthcare clients 30 years of operating history, excellent industry reputation & long-term client relationships Acquisition of Transpirus, December 2016 WHAT WE DO For non-acute healthcare providers, Corridor delivers industry expertise and proven solutions for Revenue Cycle, Coding, Advisory & Consulting, and Products & Education. Services: Clinical Documentation and OASIS review Revenue Cycle Management AR recovery, billing & collections, appeals & audits Advisory & Compliance operations & regulatory, M&A, interim leadership Education elearning, policies & procedures, quality & compliance references 2 Value Proposition With a focus on our clients operational and financial success, Corridor specializes in quality, reimbursement, compliance and education services. Revenue Cycle Management Billing Process Assessment A/R Recovery Outsourced Billing Supplemental Staffing Denial & ADR Management Coding/OASIS Review Coding Clinical Documentation/ OASIS Review Pre-Bill Auditing Pre-Claim Review Advisory & Compliance Mergers & Acquisitions Strategic Planning Market Analysis Survey Readiness CorridorComply Products & Education Operations Assessment Interim Management Policies & Procedures CHEX elearning 3 1

2 Educational Objectives 1. Understand why STAR Ratings were added to Home Health Compare (HHC) 2. Outline the Meaning & Composition of STAR Ratings 3. Provide an Understanding of how Measures are Selected 4. Understand how STAR Ratings are Calculated & Reported 5. Consideration of STAR Ratings in Value Based Payment Models 4 Content Outline 1. Home Health Compare: An Overview o Home Health Compare (HHC) o Definition of STAR Ratings o Why add STAR Ratings to HHC? 2. Composition of Ratings o Quality of Patient Care o Patient Survey o HHA Eligibility for Participation in STAR Ratings 5 Content Outline 3. Selection of Key Measures o Criteria for Selection o Process Measures o Outcomes Measures o Experience of Care Measure o Future Measures 4. Calculation & Reporting of Ratings o Methodology of Calculation Process o Provider Preview Process o Reporting Schedule 5. Improving Your STAR Measures o Operational Considerations o Value Based Payment Considerations 6 2

3 Click Definitions to edit Master title style ACH: Acute Care Hospitalization APU: Annual Payment Update ED: Emergency Department HHA: Home Health Agency HHC: Home Health Compare HHCAHPS: Home Health Consumer Assessment of Healthcare Providers & Systems IHI: Institute for Healthcare Improvement OASIS: Outcome & Assessment Information Set QoPC: Quality of Patient Care TEP: Technical Expert Panel 7 1. Home Health Compare: An Overview ohome Health Compare (HHC) odefinition of STAR Ratings owhy add STAR Ratings to HHC? 8 Click Home to Health edit Master Compare title style CMS established The Home Health Compare (HHC) website as a tool for consumers to use when choosing a home health provider HHC originally reported 27 process, outcome & patient experience of care quality measures Initially, patients could search for all Medicare-certified HH providers that serve their city or zip code and find agencies providing the care they needed A subset of the HH quality measures have been reported on HHC since 2003 so consumers can select multiple agencies to compare agency performance

4 10 Click Affordable to edit Care Master Act title (ACA) style2010 Patient Protection & Affordable Care Act, or Affordable Care Act (ACA) or Obamacare is a US federal statue enacted by President Obama on March 23, 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 11 Click The IHI to Triple edit Aim Master title style VALUE = QUALITY + SERVICE/COST Patient Experience Population Health Affordability 12 4

5 From Volume to Value 13 Click STAR to Ratings edit Master title style The ACA called for transparent, easily understandable publically reported provider quality information Consumer research has shown that summary quality measures & use of symbols to represent performance, are valuable to consumers STAR Ratings can assist consumers by summarizing current measures of health care provider performance and provide data needed to make informed health care choices STAR Ratings can also assist agencies in identifying areas for improvement Stakeholders had/have opportunities to contribute to development and updates 14 Click Consumer to edit Opinion Master title style 15 5

6 Click STAR to Ratings edit Master title style 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 and Dialysis Facility Compare Composition of STAR Ratings Quality of Patient Care Patient Survey HHA Eligibility for Participation in STAR Ratings 17 Click Composition to edit Master of STAR title Ratings style 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 18 6

7 Click Composition to edit Master of STAR title Ratings style Separate STAR ratings for Quality of Patient Care & Patient Experience are based on survey data from HHCAPHS, and were first published on Health Care Compare in January 2016 In a January 19, 2017 National Provider Call, CMS reported there are over 12,000 Home Health Agencies (HHAs) reporting 23 quality measures on HHC 7 OASIS based process measures 7 OASIS based outcome measures 4 Claims based utilization measures 5 HHCAHPS based measures Resources to assist agencies include hhc_star_ratings_helpdesk@cms.hhs.gov 19 Click Patient to Survey edit Master STAR title Ratings style HHCAHPS STAR Ratings assist consumers in accessing patient experience of care information on HHC The HHCAHPS summary STAR rating combines all 4 HHCAHPS STAR ratings into a single metric If no HHCAHPS STAR Rating is reported on HHC, that means the agency did not have enough surveys to calculate a meaning STAR rating Agencies need to understand the STAR ratings system and achieve and maintain high marks to be competitive in the marketplace 20 Click HHA Eligibility to edit for Master Participation title style 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 21 7

8 3. Selection of Key Measures in STAR Ratings ocriteria for Selection oprocess Measures ooutcomes Measures oexperience of Care Measure/HHCAHPS ofuture Measures 22 Click Selection to edit Criteria Master title style Measure must apply to a substantial portion of HH patients, and have sufficient data to report for a majority of HHAs Measure should show a reasonable amount of variation among HHA and it should be possible for an agency to show performance improvement Measure should have high face validity & clinical relevance Measure should demonstrate stability in respect to random variation over time 23 Click Process to edit Measures Master title style Initial Process Measures Proposed Changes to Process Measures Timely Initiation of Care Continue Drug education on all meds provided to patient/caregiver Influenza immunization received for current flu season Pneumococcal Vaccine ever received Continue Remove from STAR Rating but continue to report on HHC Continue 24 8

9 Click Outcomes to edit Measures Master title style Initial Outcomes Measures Improvement in ambulation Improvement in bed transferring Improvement in bathing Improvement in Pain interfering w activity Improvement in dyspnea Acute Care Hospitalization Proposed Changes to Outcomes Measures Continue Continue Continue Continue Continue Continue (only calculated for Medicare FFS patients) Add ED Use without Hospitalization (Claims Based Measure) 25 Click Home to Health edit Master Care CAHPS title style Survey In the CY 2015 PPS Final Rule, CMS stated the HH quality measures reporting requirements for Medicare certified agencies includes HHCAHPS Survey for the CY 2015 APU The HHCAHPS survey is part of a family of CAHPS surveys that asks patients to rate their experiences with healthcare Set of standardized questions about HHC providers and quality of their HH care CMS has maintained the HHCAHPS data requirements for the continuous monthly data collection & quarterly data submission of HHCAHPS data 26 Click HHCAHPS to edit Survey Master title style All Medicare certified HHAs must participate monthly in the HHCAHPS Survey to obtain the full Annual Payment Update (APU) from CMS ( ) Two exceptions: Medicare certification received after the cutoff date for a given APU period (one-time exception) 27 The HHA did not provide services to at least 60 Medicare eligible patients during the Reference Period that the APU covers 9

10 Click HHCAHPS to edit Survey Master title style HHA Responsibilities: Contract with approved HHCAHPS vendor Register for credentials to access private links Send completed and notarized Consent Form to HHCAHPS Coordination Team (address on form) 28 Authorize an HHCAHPS survey vendor on to collect and submit data Click HHCAHPS to edit Survey Master title style 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 29 Click Experience to edit of Master Care title Measures style CMS released the first HH Patient Experience of Care STAR Ratings on January 28, 2016 to evaluate patients experience with Home Health agencies. HHA must have at least 40 completed HHCAHPS Surveys over the publically reported 4-quarter period in order to receive HHCAHPS STAR Ratings Agencies with less than 40 completed surveys will still have their HHCAHPS measure scores reported on HHC as long as they are eligible to be reported for that period ( 12 months of data) 30 10

11 Click Experience to edit of Master Care title Measures style The 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) January 2016 reporting was based on patients who received care between July 1, 2014 & June 30, Click Future to Considerations edit Master title style The National Quality Forum is undertaking a demonstration project with CMS to look at incorporating socio-demographic variables in risk models which may be applied for the ACH measure in the future The CMS Independence at Home Demonstration provides chronically ill patients with a complete range of primary care services in the home setting. Originally authorized by the ACA in 2012 for three years, it was extended through September 30, 2017 Physicians & APRN s provide primary care home visits tailored to the needs of beneficiaries with multiple chronic conditions and functional limitations VPA Flint, VPA Lansing, VPA Milwaukee are among the 15 participating practices and both Lansing & Milwaukee were among the aggregate that saved an average of $746 per beneficiary per year based upon a PMPM Home Health Agency collaboration in programs like this will be integral to optimizing patient quality and satisfaction 32 Click Future to Measures edit Master title style TEP Summary report for the refinement of percent of residents or patients with pressure ulcers that are new or worsened, is available. Cross-setting approach to data collection for pressure ulcers in post-acute settings IMPACT ACT CMS has contracted with Abt Associates to develop cross-setting post acute care measures for the quality measures: Discharge to Community (DTC) Potentially Preventable Re-hospitalizations TEP held for cross-setting quality measure: Functional status, cognitive status, and changes in function & cognitive function Instruments/MMS/TechnicalExpertPanels.html 33 11

12 4. Calculation & Reporting of Ratings omethodology of Calculation Process oprovider Preview Process oreporting Schedule 34 Click Calculation to edit Master of STAR title Ratings style Quality of Care STAR ratings are based upon 9 of the 27 process and outcome quality measures tracked and reported in 2016 by HHA 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 STAR ratings, i.e, for hotels, which compare a provider to pre-determined quality standards 35 Click Calculation to edit Master of STAR title Ratings style 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 36 12

13 Click Calculation to edit Master Methodology title style 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 37 Click Steps to in edit Calculation Master title of STAR styleratings 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 38 Click Reported to edit STAR Master Rating title style Overall score after averaging across QMs & rounding to nearest half STAR Reported Quality of Patient STAR Rating 4.5 &

14 Click Provider to edit Review Master Process title style & 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. ( Assesment- Instruments/Homehealthqualityinits/HHQIHomeHealthSTARRatings.html ) STAR ratings are updated on a quarterly basis, January, April, July and October Improving Your STAR Measures ovalue Based Payment Models ooperational Considerations 41 Click Operational to edit Master Considerations title style Use dashboards/scorecards to identify trends and opportunities for drill down by location/branch Focus on OASIS and Primary & Secondary Diagnosis Accuracy and Sequencing Need real-time data to monitor whether your improvement plans are effective Continuous monitoring with and reporting to staff, physician and patient levels Start training your board to play a key role in compliance 42 14

15 Click Operational to edit Master Considerations-Staff title style Focus on recruitment & retention of clinical and support staff Optimize orientation to ensure competency Provide scheduled and continuous opportunities for education Don t skimp on Clinical Supervisory staffing Real-time OASIS, POC & documentation review & improvement Interdisciplinary, collaborative team model to ensure consistency in functional assessments, care planning and visit frequency management Foster a culture of accountability 43 Click Operational to edit Master Considerations title style Problem Solving Put out the fires Always consider Does it improve quality of service? Process Improvement Service is made up of multiple processes Only way to improve service/quality is to improve & maintain individual performance & accountability Patient Engagement Create simple tools to foster patient engagement & selfmonitoring o Disease specific evidence-based Share & celebrate your successes! 44 Click Average to edit to 5 Master STAR title style Risk assessment for the most appropriate setting of care No primary care physician Lives alone/no capable caregiver Multiple chronic disease diagnoses and medications Psychiatric diagnosis Frequent re-hospitalizations Falls into Palliative/Hospice eligibility but not ready Cognitive decline Functional capacity 45 15

16 Click Average to edit to 5-STAR Master title style Evidence based care guidelines Rescue action planning for COPD, CHF Optimize value of Social Work Consider social determinants Link to community resources Resources for Prescriptions/Medication adherence Facilitate appropriate progression to Hospice/Palliative care Early SW contact to reduce barriers to improved outcomes 46 Click Average to edit to 5-STAR Master title style STARs Agency 1 Agency Michigan National October 1, 2015-September (2005) (1994) Average Average 30, 2016 Quality Results *** ***** ***1/2 ***1/2 Patient Survey Results *** (N=61) **** N=360) Measures Agency 1 Agency 2 Quality Results Patient Survey Results in better walking or moving, bathing, breathing, HH taught about drugs; wounds healed, timely SOC, pts better at taking drugs; worst than expected on ED care for recent IP s Exceeded team communicated w pts; remaining Exceeded MI & National scores; prevent unplanned IP care 1% Met or exceeded MI av. in all measures 47 Click A Word to on edit Value-Based Master title Payments style (VBP) VBP is a payment methodology that rewards quality of care through payment incentives and transparency Value is broadly considered to be a function of quality, efficiency, safety and cost Under VBP, providers are held accountable for the quality and cost of the services they provide through a system of rewards and consequences and are conditional upon achieving pre-specified performance measures Incentives are structured to discourage inappropriate, unnecessary and costly care 48 16

17 Click VBP: The to edit CMS Master Strategic title style Evolution CMS has been paving a strategic path to position VBP as the basis for an evolution in healthcare reimbursement The goal is to reward providers who deliver value & care coordination rather than volume & care duplication Department of Health & Human Services (HHS) adopted a framework that categorizes healthcare payment according to how providers receive payment to provide care: 49 Category 1: Fee-for-service (FFS) with no link of payment to quality Category 2: FFS with a link of payment to quality Category 3: Alternative payment models built on FFS architecture Category 4: Population-based payment Medicare VBP Targets 50 Click CMS: to Home edit Master Health title VBPstyle The Home Health Value Based Payment Pilot was first established as part of CMS 2016 HH PPS Update, CMS-1625-F November 5, 2015, Federal Register Initially impacts all Medicare certified agencies in nine VBP states Align payment with quality Baseline performance year of 2015 for 2016 measures Performance measurement begins January 2016 Two Measurement Groups -Smaller Volume Cohorts (exempt from HHCAHPS) -Larger-Volume Groups (participating in HHCAHPS) 51 17

18 Click Can Your to edit Software Master Support title style Strategic Goals? The ability to collect, measure, manage and share data will be essential in the VBP environment of care Utilize data to: -Identify high-risk patients -Determine individual patient care needs -Optimize patient placement/loc across continuum -Communicate across the provider continuum -Support changes in care delivery -Care management -Report quality outcomes -Utilize results in marketing and contracting -Track, trend, & optimize patient satisfaction -Real-time monitoring of outcomes at a staff level to facilitate trending & accountability -Educate staff, patient and community 52 TELL YOUR STORY!!! What Are Your Strategic Goals? 53 Admits 54 18

19 Discharges 55 Outcomes Management 56 HH Clinical Outcomes 57 19

20 Re-Hospitalization Toolkit 58 Click Strategic to edit Considerations Master title for style Success in VBP Post acute care is the largest driver of geographic variation in Medicare spending (Institute of Medicine) Treat patients in the most cost-effective and clinically appropriate setting -Right Care-Right Setting-Right Time Under BPCI, health systems have financial incentives to NOT refer patients to high intensity care settings that they don t need Financial responsibility for readmissions and quality outcomes diminish concerns for limits to medically necessary care Population management/risk stratification & care planning Readmission reduction Hospitals, SNF s and Physician providers want post acute partners who help them improve care transitions and care coordination 59 Click Strategic to edit Considerations Master title for style Success in VBP Align with hospitals, physicians and post acute providers to increase referral volume and improve outcomes Willingness to actively collaborate on quality improvement & care coordination with community partners Identify technology to support care coordination, data collection and regular performance reporting Develop service offerings that target areas of potential savings/lower costs Develop services that substitute for all or part of SNF stays Expansion of patient support services paid for by program savings Demonstrate ability to reduce readmissions Maximize PPS reimbursement for selected bundles 60 20

21 Click Strategic to edit Considerations Master title for style Success in VBP Home Health can provide the critical success factor in VBP -Care delivery -Care coordination for physician practices, health departments, insurers -Community care management for assisted living and independent clients Innovations in Mobile Technology/Digital Health -Partnerships or new business lines Connect with patients in more convenient and cost-effective ways - Web based coaching - Cloud based self management tools - Tele-Health programs for chronic disease monitoring, management & realtime interventions - Medication reminders Enhanced patient engagement, patient & care-giver experience 61 Click Strategic to edit Considerations Master title for style Success in VBP Home Health must be prepared to substitute for some or all of the post acute services traditionally delivered in an inpatient setting Ability to care for patients with complex needs -Bilateral knees -Lack of caregiver support in home -Co-morbid conditions Front load visits during the most stressful time for patients - upon hospital discharge day when needed 7-day therapy Daily coordinated visits for first 7-14 days Enhanced Interdisciplinary Teams: Community Pharmacists, APRN s Palliative Care/Hospice partnerships Ability to provide high-quality care efficiently Willingness to collaborate in care coordination 62 Thank You Q&A 63 21

22 Contact Us Joanne Erickson, RN, MSN Director of Advisory & Continuum Services Robbin Boyatt, MPH Vice President of Revenue Management Services OASIS Items at SOC/ROC/Recertification 65 OASIS Items at SOC/ROC/Recertification 66 22

23 OASIS Items at SOC/ROC/Recertification 67 OASIS Items at SOC/ROC/Recertification 68 OASIS Items at SOC/ROC/Recertification 69 23