Quality Incentive Programs. By: Amy Yearwood RN, BSN Physicians Network Quality Manager Huntsville Hospital

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1 Quality Incentive Programs By: Amy Yearwood RN, BSN Physicians Network Quality Manager Huntsville Hospital

2 Housekeeping 1. Using the control panel - Use the control panel on the right side of your screen to minimize and expand this panel by clicking on the arrow in the upper right corner. 2. Ask Questions - You can submit questions using the Question section located near the bottom of the control panel. We will take time to answer as many questions as we can during Q&A at the end of the presentation. If your question was not answered, we will respond to you individually after the event. 3. After the webinar - We want your feedback! Please take the short survey at the completion of the webinar. Also, all registrants will receive a copy of the presentation, and the recording for on-demand replay.

3 Objectives Huntsville Hospital s merit-based incentive contracts Learn the performance categories Huntsville Hospital uses in their incentive contracts Learn which specialties have merit-based incentive contracts

4 Who is Huntsville Hospital? 941 bed community-based not-for-profit hospital in North Central Alabama State s second largest hospital 24-Physicians Network-owned practices with 76+ providers

5 What Specialties do we have? HH Physicians Care Hampton Cove HH Physicians Care Lowell Drive HH Maternal Fetal Medicine Huntsville Surgical Associates (Trauma) HH Endocrinology & Diabetes Clinic TN Valley Pediatric Surgery HH Surgical Associates - Huntsville HH Pediatric Intensivists Hazel Green Pediatrics TN Valley Gynecological Oncology Associates HH Walk in Clinic at Airport Road OB/ED Hospitalist HH Physicians Care Madison HH Physicians Care Bailey Cove HH Physicians Care Gurley HH Lung Center HH Neurology Associates HH Surgical Associates of Madison HH Pediatric Neurology North Alabama Hospitalists HH Pediatric Hospitalists St. Jude s Clinic at Huntsville Hospital HH Digestive Disease Center Huntsville Hospital Spine and Neuro

6 Core Protocol for Incentives Specialty Quality Service Financial

7 HH Surgical Associates Quality-Principal Weight = 50% Surgical site infections rate less than the comparative general surgeons on staff. Compliance with hospital approved and suggested Operation Room Policies and Procedures: Including but not limited to: Service- Principal Weight=25% In the last 12 months, when you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed? Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider? In the last 12 months, how often did you see this provider within 15 minutes of your appointment time? Financial Performance - Principal Weight=25% Meet budgeted expenses Achieve coding accuracy Submit charge data within 7 days

8 Pediatric- Neurology Quality- Principal Weight Achieve 60% CPOE MU 2 Goal is 60% Achieve 50% eprescribing MU 2 Goal is 50% Provide patient-specific educational material MU 2 Goal is 10% Provide a summary of care for transition out MU 2 Goal is 10% Service- Principal Weight Achieve overall patient satisfaction Financial Performance- Principal Weight Achieve coding accuracy

9 Hospitalists Quality-Principal Weight=50% 30 day Readmission rate: Readmission as an admission to a hospital within 30 days of a discharge from the same or another hospital. Risk adjusted mortality index (compared to large hospitals) VTE Prophylaxis (ICARE) LOS average observed vs. expected (compared to large hospitals) Participate in the High Value Care Team Initiatives 30 day Readmission rate for COPD Service-Principal Weight=25% How well the hospitalist kept the patient informed about the care and treatment How well the hospitalist coordinated care How well the hospitalist program was explained Financial Performance -Principal Weight=15% Meet the wrvus for the National Region of MGMA ( 2014 Report) 4,141 Achieve coding accuracy Reduce cost per case as compared to other Internal Medicine physicians at HH Manage the program within national benchmarks for provider subsidy ($156, SHM) Attend the quarterly meetings (each meeting is worth 25% of the payout) Complete the ProAssurance Seminar

10 HH Neurological Associates Quality-Principal Weight Achieve 60% CPOE Achieve 50% eprescribing All prescriptions written must include the medication name, dosage, route, directions and PRN indication if necessary Provide patient-specific educational material Service-Principal Weight In the last 12 months, how often did the provider explain things in a way that was easy to understand? (Clear Communication by provider) In the last 12 months, how often did the provider listen carefully to you? (Provider listened carefully to you) Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider? (Provider overall rating) Financial Performance -Principal Weight Achieve coding accuracy

11 Hazel Green- Pediatrics Quality & Efficiency Outcome Scorecard Principal Weight=50% Provide HPV vaccine for children that meet the recommended guidelines within 9 months after the start of the series Provide reminders for the 11 and 12 year olds of their preventative visit Receive PKU results within 4 weeks Service-Principal Weight=25% In the last 12 months, when you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed? Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider? In the last 12 months, how often did you see this provider within 15 minutes of your appointment time? Financial Performance -Principal Weight=25% Meet budgeted expenses Achieve coding accuracy Submit charge data within 7 days

12 Digestive Disease Center Quality & Efficiency Outcome Scorecard Principal Weight=50% Body Mass Index ("BMI)" documentation completed and education of patients proper BMI completed 95% of the time Achieve adenoma detection rate of 15% for colon cancer screening patients Achieve colonoscopy withdrawal time of at least 6 minutes in 90% of patients undergoing screening colonoscopies Colon cancer screening documentation completed at least 90% of the time Completion of medical records in the office and hospital accordance with medical staff bylaws Routine continuing education provided for clinical staff in the endoscopy labs located at HH, Madison Hospital, Madison Office, Huntsville office Service-Principal Weight=25% Started as Employed Practice 1/1/2015 Financial Performance -Principal Weight=25% Meet budgeted expenses Achieve coding accuracy Submit charge data within 7 days

13 Primary Care Quality & Efficiency Outcome Scorecard Principal Weight=50% Diabetic Foot Exam completion Physician Composite Star Rating for Blue Advantage, Humana and HealthSpring- 3 stars BP Control- Increase the percentage of individuals years of age with a diagnosis of hypertension whose BP was adequately controlled (<140/90) during the previous 12 months. 65 or older BP was adequately controlled ( 150/90) Breast Cancer Screening-members who are female between years of age who had a mammogram to screen for breast cancer during the measurement year or the prior year. Colorectal Cancer Screening-members who are between years of age who had appropriate screening for colorectal cancer. A1c Control- Diabetes, provider must ensure that eligible patients most recent A1c is no greater than 8. Red, White & Blue Medicare Wellness visits Reduce COPD Readmissions less than or equal to 6% Provider must exceed the performance standard for their assigned member population. The readmission rate = (# of readmissions) / (# of admissions). This includes inpatient admissions to any facility exclusive of psychiatry, maternity, SNF and rehabilitation visits Completion of Medicare & Medicare Advantage Forms Service-Principal Weight=25% In the last 12 months, when you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed? Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider? In the last 12months, how often did this provider spend enough time with you? Financial Performance -Principal Weight=25% Meet budgeted expenses Achieve coding accuracy Medical Records completed within 7 days

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16 How HH meets the challenges of measuring and reporting quality Currently participate in Meaningful Use. HH monitors each provider s quality based on specialty. Quality incentive contracts are in place with most of the employed providers and renewed each year. Reviewing new EMRs for better workflow, documentation and reporting capabilities. Collect patient satisfaction results to drive practice improvements. In the process of applying for National Committee for Quality Assurance (NCQA) recognition for Patient Centered Medical Home (PCMH). Reviews are coordinated with payers to see each provider s quality outcomes to make necessary adjustments for the future.

17 How are you aligned with an incentive payment system? WHAT WILL DETERMINE YOUR FUTURE WITH THE MEDICARE ACCESS & CHILDREN S HEALTH INSURANCE PROGRAM (CHIP) REAUTHORIZATION ACT OF 2015 (MACRA) APMs/MACRA-MIPS-and-APMs.html

18 Additional Resources

19 Questions?