Value Based Purchasing

Transcription

1 Value Based Purchasing Baylor Health Care System Leadership Summit October 26, 2011 Sheri Winsper, RN, MSN, MSHA Vice President for Performance Measurement & Reporting Institute for Health Care Research & Improvement Baylor Health Care System

2 Pay for Performance Methods Hospital Inpatient Quality Reporting Program 2% payment penalty Hospital Value-Based Purchasing Program (VBP) 1-2% payment penalty Hospital Readmission Reduction Program 1-3% payment penalty Hospital Acquired Condition Reduction Program Non-Payment unless POA & 1% penalty for Lower Quartile Hospitals 2

3 Paying for Value 3

4 Hospital Value-Based Purchasing (VBP) Program A paradigm shift in Medicare reimbursement strategy, linking a portion of hospital s payment to performance. Transforming CMS from a passive payer of claims to an active purchaser of quality care Encourage hospitals to continually improve quality of care. 4

5 Value-Based Purchasing (VBP) Program Background Part of the Patient Protection & Affordable Care Act (2010) Incentive program linking Medicare reimbursement to performance on quality measures Initially funded by a 1% withhold of Medicare discharge payments For BHCS, approximately $4 million at risk in 1 st year By 2017, approximately $8 million at risk Possible to earn more than 1% back

6 Performance-Based Incentive Payments: Funding Incentive payments funded by phased-in reduction risk to base operating DRG payments. 6

7 VBP: Structure of Scoring Total Performance Score (TPS) Domains Clinical Process Patient Experience Outcomes (FFY 2014) Efficiency (FFY 2014) Measures/ Dimensions 12 AMI, HF, PN, SCIP 8 HCAHPS 13 HAC, Mort30d, AHRQ PSI/IQI Composites 1 Medicare Spending per Beneficiary 7

8 VBP Updates: Performance Periods FFY 2013 & FFY 2014 CY2009 CY2010 CY2011 CY2012 CY2013 CY2014 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 FFY 2013 Baseline (CM s & HCAHPS) Jul 1 Mar 31 Baseline (Mortality 30d) Jul 1 June 30 **FFY 2014 CM s, HCAHPS, HAC/AHRQ s Baseline/ & Performance Periods ONLY PROPOSED at this time Baseline (CM s & HCAHPS) Apr 1 Dec 31 Baseline (HAC, AHRQ) Mar 3 Sep 30 Baseline (Medicare Spending/ Beneficiary) May 15 Feb 14 Performance (CM s & HCAHPS) Jul 1 Mar 31 FFY 2014 Performance (Mortality 30d) Jul 1 June 30 Performance (CM s & HCAHPS) Apr 1 Dec 31 Performance (HAC, AHRQ) Mar 3 Sep 30 Performance (Medicare Spending/ Beneficiary) May 15 Feb 14 Payment Determination Oct 1 Sep 30 Payment Determination Oct 1 Sep 30 8

9 FFY 2013 Clinical Process Measures AMI HF PN 1.Fibrinolytic therapy w/in 30m arrival 2. Primary PCI w/in 90m arrival 3. Discharge instructions Received 4. Blood culture performed in ED prior to first Antibiotic Received 5. Initial abx selection for CAP in immunocompetent patients SCIP HAIs SCIP 6. Prophylaxis 1 hr prior to incision 7. Prophylatic Abx Selection surg pts 8. Prophylactic abx stopped w/in 24 hrs after surgery end time 9. Cardiac surgery pts w/ controlled 6am post-op serum glucose 10. Beta-blockers in peri-op period 11. VTE prophylaxis ordered 12. VTE prophylaxis received w/in 24 Hrs prior to or after surgery HAI *Postop Urinary Cath Removal POD 1&2 (Proposed FFY2014 addition) 9

10 FFY 2013 Patient Experience (HCAHPS) Dimensions 1. Nurse communication 5. Responsiveness of hospital staff 2. Doctor communication 6. Communication about medications 3. Pain management 7. Cleanliness and quietness 4. Discharge instructions 8. Overall rating 10

11 FFY 2014 Outcomes Measures 1. Foreign object retained after surgery 9. AMI 30-day mortality 2. Air embolism Mort 10. HF 30-day mortality 3. Blood incompatibility 11. PN 30-day mortality HAC 4. Pressure ulcer stages III and IV 5. Falls and trauma 6. Vascular catheter-assoc infections 7. Catheter-Associated UTI 8. Manifestations poor glycemic control AHRQ Cost Effic 12. Mortality selected medical conditions (Composite) 13. Complications/patient safety for selected indicators (Composite) 14. Medicare spending per beneficiary ratio *Additional FFY 2014 Measures will be finalized in the CY2012 OPPS Final Rule expected in November

12 FFY 2014 Efficiency Measure Medicare Spending per Beneficiary Ratio 12

13 Total Performance Score (TPS) Methodology FFY2013 Process of Care (70% of TPS) 12 Core Measure Scores (each worth up to 10 points) For each measure, opportunity to earn the higher of achievement OR improvement score Patient Experience of Care (30% of TPS) 8 HCAHPS Dimension Scores (80 points total) For each measure, opportunity to earn the higher of achievement OR improvement score Consistency (up to 20 points possible) 13

14 Threshold, Benchmark & Baseline Calculations Process, Patient Experience, & Outcome Efficiency Process, Patient Experience, & Outcome Efficiency Achievement Scores Threshold 50 th percentile during baseline period. 50 th percentile during performance period Improvement Scores Threshold Hospital s score during baseline period. Hospital s ratio during baseline period. Benchmark Mean of top 10% of nation during baseline. Mean of lowest 10% of nation during performance period. Benchmark Mean of top 10% of nation during baseline. Mean of lowest 10% of nation during performance period. 14

15 Example: Surgery Patients Who Received Beta Blocker Prior to Surgery September 2010 May 2011 Achievement About 70% of the distance => 7 achievement points Improvement About 40% of the distance => 4 improvement points Measure score = maximum of achievement or improvement = 7 15

16 Calculating Process Domain Performance Score Clinical Process Performance Score (0-100 scale) = (Earned Points TOTAL / Possible Points TOTAL ) *

17 HCAHPS Domain Scoring Component Description Maximum Points Achievement* and Improvement Evaluates each dimension based on achievement & improvement scores, similar to scoring methodology for clinical process measures. Dimensions Nurse communication 10 Doctor communication 10 Clean, quiet 10 Responsiveness 10 Pain management 10 Comm. about meds 10 Discharge info 10 Overall rating 10 Consistency Evaluates consistency across dimensions 20 Total Combines components to provide an overall HCAHPS score

18 Example: Nurse Communications September 2010 May 2011 Achievement About 40% of the distance => 4 achievement points Improvement About 0% of the distance = 0 improvement points Measure score = maximum of achievement or improvement = 4 18

19 HCAHPS Scoring: Consistency To incentivize improvement across all HCAHPS dimensions to > 50 th percentile Lowest scored dimension determines points Score determined according to the # of percentiles the lowest dimension score is between the 0 th - 50 th percentile of hospital performance during the baseline period. Hospital Consistency Score: Points 0 th percentile > [lowest performing dimension] < 50 th percentile 0-19 [all 8 HCAHPS dimensions] > 50 th percentile 20 19

20 Calculating Patient Experience (HCAHPS) Performance Score HCAHPS Performance Score (0-100 scale) = Earned Points TOTAL + Consistency Points 20

21 Payment Percentage Texas Hospital Association VBP Payment Impact: Example Hospital 300% 280% 260% 240% 220% 200% 180% 160% 140% 120% 100% 80% 60% 40% 20% Estimated Medicare IPPS Dollars Contributed to VBP (1.0% Carve-Out) $505,000 Current Estimated Payment $691,400 Net VBP Gain $186,400 Conservative Estimated Payment $472,100 Net VBP Loss ($32,900) Payment Conversion Line As more current data for the performance period become available, VBP scores are expected to improve nationwide. As scores improve, the slope of the payment conversion line will move towards the conservative estimate line. 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Score Payment Conversion Line - Current Estimate Using National Data Payment Conversion Line - Conservative Estimate 21

22 VBP Domain Weighting Proposed 20% 30% 30% 20% 22

23 BHCS VBP Measurement and Reporting TPS score can only be maximized by exceeding achievement benchmark values Benchmark and threshold values will be fixed using the baseline period, July 2009 March 2010 Both core measures and HCAHPS domain scoring will be based on the most recent 9 months of data 23

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26 Summary BHCS Board Resolution of 2000 & 2010 vital to current & future performance Current performance high Expect Minimal Payment Penalties 2013 Remember the dollars at risk if we fail to continually improve Robust measurement & feedback of data are important Set goals so that quality metrics remain part of our core business strategy Hold the Gains while continuing to invest in quality, patient safety, & patientcentered care 26