Small Rural Hospital Transitions (SRHT) Project. Rural Relevant Measures: Next Steps for the Future

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1 Small Rural Hospital Transitions (SRHT) Project Rural Relevant Measures: Next Steps for the Future Paul Moore, DPh Senior Health Policy Advisor Federal Office of Rural Health Policy, Health Resources & Services Administration U.S. Department of Health & Human Services DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Discussion Areas Why Measure and Report Quality? National Strategies and Key Rural Issues Proving Value in a Challenging Environment Principles for Rural-Relevant Measures Current Initiatives Underway

3 Why Measure and Report? Every Patient Matters! Basic human nature Regulatory constraints Owning our own quality story and Financial considerations

4 National Quality Strategy Reducing harm to patients; Facilitating communication and care coordination; Empowering patient and family involvement in their care; Implementing evidence-based prevention and treatment; Promoting healthy behaviors and environments; Implementing new delivery models that reduce cost and improve quality;

5 Delivery System Reform (DSR) Initiative Improving the way providers are paid, the way care is delivered, and the way information is distributed will get us to better care, smarter spending, and healthier people system-wide. Focus Areas Incentives Description Promote value-based payment systems Test new alternative payment models Increase linkage of Medicaid, Medicare FFS, and other payments to value Bring proven payment models to scale Care Delivery Encourage the integration and coordination of clinical care services Improve population health Promote patient engagement through shared decision making Information Create transparency on cost and quality information Bring electronic health information to the point of care for meaningful use

6 Focus Areas 2016 Goal 2018 Goal Incentives Goals Promote value-based payment systems Test new alternative payment models Increase linkage of Medicaid, Medicare fee-for-service, and other payments to value Care Delivery 30%* of Medicare payments in alternative payment models 85% of remaining FFS Medicare payments linked to quality/value 50% 90% Integrate and coordinate care Improve population health Promote patient engagement in decisions 30% of patients in primary care medical homes or physician groups accountable for both cost and quality 50% 15 states implement comprehensive reform 25 states 80% of patients participate in shared-decision making 85% Information Create transparency on cost and quality information Bring electronic health information to the point of care for meaningful use Establish websites for all FFS settings and health plan programs with quality info. and star ratings for consumers Establish metrics on consumer access to out-of-pocket costs data 85% of providers adopt certified EHR 90% 30% of clinical visits have electronic health info. available when and where needed** Measure use Measure use 50%

7 Alternative Payment Models Accountable Care Organizations (ACOs) Medicare Shared Savings Program (MSSP) ACO Investment Model (AIM) Pioneer ACO Next Generation ACO Examples of Other Alternative Payment Models Patient Centered Medical Home Model Comprehensive Primary Care (CPC) Initiative Medicare-Medicaid Financial Initiative FFS Model

8 Linking Medicare FFS Payments to Value Hospitals Hospital Value-Based Purchasing (HVBP) Hospital Readmissions Reduction Program Hospital-Acquired Condition (HAC) Reduction Program Physicians Physician Value-Based Modifier

9 Challenging Environment Moving Beyond Fee for Service Reimbursement & the Increasing Link to Quality Outcomes Value-Based Purchasing Patient-Centered Medical Homes Accountable Care Organizations And Changing Payer Mix Post ACA Newly Insured DSH Reductions Fitting into the Many New Networks Role in Ongoing Outreach and Enrollment Helping Educate about Insurance Basics Changing Dynamics of Workforce Team-Based Care Community-Based Training Emergence of New Training Models Disconnect with Existing Training Models Scope of Practice Transitional and Volatile Environment Mergers & Acquisitions Moving to Employed Clinician Model Market Segmentation Changes and Variability in Federal and State Policy Arenas Role of Health IT EHR Implementation Reaching Meaningful Use Role of Telehealth What might this mean for Rural Providers and the people they serve?

10 Challenging Environment Rural hospitals paid under PPS, and Critical Access Hospitals, generally had the lowest profitability in comparison to hospitals with other payment classifications.

11 Challenging Environment

12 Key Rural Issues Restricted Resources; Financial Workforce Low volume, small practice size; Limited scope of services; Patient population;

13 Guiding Principles for Rural-relevant measures Broad applicability for rural providers; Reflects services provided; Addresses low-volume challenges Population case-mix adjusted; (social determinants) Supports local access; (ex: tele-health measures) Evidence-based; Actionable - opportunity for improvement;

14 Guiding Principles for Rural-relevant measures Readily available data collection and reporting process; Suitable for internal QI efforts; Meaningful for consumers and payers; Includes patient satisfaction; Aligned with other reporting requirements;

15 NQF Rural Health Project To provide multistakeholder information and guidance on performance measurement issues for rural providers, including: Critical Access Hospitals (CAHs) Rural Health Clinics (RHCs) Community Health Centers (CHCs) Small rural hospitals Small rural clinician practices Clinicians who serve in these settings

16 Project Description Project includes: Environmental scan of measures and measurement programs Multistakeholder input on measurement efforts and challenges for rural providers Written report of Committee recommendations regarding performance measurement for rural providers in the context of Federal payment incentive programs View the website to see the environmental scan

17 NQF Upcoming Events June 1-30, 2015: Draft report will be available for public comment July 29, 2015: Committee web meeting to review and respond to public comments (All NQF meetings are open to the public) September 14, 2015: Final report due to HHS

18 For More Information on the project See NQF project page Sign up for project alert s to receive notifications of the upcoming meetings and activities Contact the project team at

19 Rural Health Quality and Value Special Projects in Critical Access Hospitals and Rural Health Clinics Quality Measurement Quality Improvement Improved Patient Outcomes Performance Improvement Cornerstones of the Flex & SHIP Programs

20 MBQIP Priorities for FY15 Aligning with national measures and priorities Rural relevant measures in 4 areas: Patient Safety (Adverse Drug Events & Hospital Acquired Infections, Falls) Patient Engagement Care Transitions Outpatient

21 FORHP Rural Quality Goal AHRQ and CDC Tools NQF Rural / Low-volume Providers Project Natl. Action Plan For Healthcare Assoc. Infections SHIP Funding Flex Funding MBQIP QIO Special Project on Transfers Natl. Action Plan for Adverse Drug Events Small Provider Quality Improvement Program RHC Specific Measure Set OAT Evidence-based Tele-emergency grant program Transforming Primary Care Initiative Improved Population Health Partnership for Patients - Rural Affinity Group Delivery System Reform

22 A few final thoughts The Rural Healthcare System of the future is essential to the entire healthcare system! can provide integrated access to better care, better health and lower cost; will report on quality as one way to prove value to patients and purchasers. will find sustainability through value.

23 Our Goal Helping Rural Communities Make the Transition Our Goal Helping Rural Communities Make the Transition Grants Supporting rural hospitals Addressing community health needs Addressing community workforce needs Assisting state rural health efforts Increasing access through telehealth Technical Assistance Rural health information resource website Information for new and existing telehealth networks Resources for Rural Health Clinics Policy & Research Regulation Review White House Rural Council National Advisory Committee on Rural Health and Human Services Collaboration with key rural partners Monitoring Access/Rural Safety Net

24 THANK YOU Contact Information