V a l u e B a s e d P u r c h a s i n g S e r i e s The first performance period has ended what now? Presented by: Craig Deao, MHA

V a l u e B a s e d P u r c h a s i n g S e r i e s The first performance period has ended what now? Presented by: Craig Deao, MHA

Objectives At the conclusion of this video you will be able to: Discuss where we stand within the Value-Based Purchasing timeline Describe the key changes taking effect for the performance period

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Implementation Timeline CY 2009 CY 2010 CY 2011 CY 2012 CY 2013 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q Baseline Period (Jul 2009 Mar 2010 ) Performance Period (Jul 2011 Mar 2012 ) Payments Affected (Oct 2012 Sept 2013 ) We Are Here Incentive Payments Announced

Implementation Timeline CY 2009 CY 2010 CY 2011 CY 2012 CY 2013 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q Baseline Period (Jul 2009 Mar 2010 ) Performance Period (Jul 2011 Mar 2012 ) Payments Affected (Oct 2012 Sept 2013 ) We Are Here Incentive Payments Announced

Value Based Purchasing FY 2013 1% Base operating DRG payments 12 Process of Care Measures (* 70% Weight) HCAHPS (* 30% Weight) Performance attainment and improvement will determine total hospital reimbursement Implementation FY 2013 (October 2012) Source: Value Based Purchasing Program final rule 4.29.11

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Value Based Purchasing FY New update 1.25% Base operating DRG payments Note: Implementation FY Source: OPPS VBP Final rule 11.1.11 Process of Care Measures (45% Weight) HCAHPS Composites (30% Weight) Outcomes (25% Weight) Performance attainment and improvement will determine total hospital reimbursement

VBP Reimbursement Periods New update CY 2009 CY 2010 CY 2011 CY 2012 CY 2013 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q Process of Care & HCAHPS Baseline Period (Apr-Dec 2010) Process of Care & HCAHPS Performance Period (Apr-Dec 2012) CY 2009 CY 2010 CY 2011 CY 2012 CY 2013 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q Outcomes Baseline Period (Jul 2009 Jun 2010) Outcomes Performance Period (Jul 2011 Jun 2012)

Proposed vs. Final Rule New update Eliminated the Efficiency Domain Finalized the Outcomes Domain and associated measures Eliminated the composite scores for Hospital Acquired Conditions (HACs) and AHRQ Measures (initially part of Outcomes Domain) Addition of Core Process Measure: Postoperative Urinary Catheter Removal on Postoperative Day 1 or 2 (SCIP-Inf-9) Finalized domain weighting Released new floor, threshold and benchmark numbers for the performance periods Note: Implementation FY Source: OPPS VBP Final rule 11.1.11

Patient Experience of Care Domain (HCAHPS) New update Green = increased threshold from 2013 Red = decreased threshold from 2013 Floor 2013 National Threshold National Threshold 2013 National Benchmark National Benchmark Communication with Nurses 42.84% 75.18% 75.79% 84.70% 84.99% Communication with Doctors 55.49% 79.42% 79.57% 88.95% 88.45% Responsiveness of Hospital Staff 32.15% 61.82% 62.21% 77.69% 78.08% Pain Management 40.79% 68.75% 68.99% 77.90% 77.92% Communication about Medicines 36.01% 59.28% 59.85% 70.42% 71.54% Hospital Cleanliness & Quietness 38.52% 62.80% 63.54% 77.64% 78.10% Discharge Information 54.73% 81.93% 82.72% 89.09% 89.24% Overall Rating of Hospital 30.91% 66.02% 67.33% 82.52% 82.55% Note: Implementation FY Source: OPPS VBP Final rule 11.1.11

Achievement Improvement Consistency HCAHPS Scoring New update Achievement Improvement Consistency Note: Implementation FY Source: OPPS VBP Final rule 11.1.11 The greater of the two scores will be used for each composite Based on achievement performance in ALL composites or lowest index composite will be used

Final Rule Process of Care Measures New update Measure ID Measure Green = increased threshold from 2013 Red = decreased threshold from 2013 2013 National Threshold National Threshold 2013 National Benchmark National Benchmark AMI 7a AMI 8a Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival Primary PCI Received Within 90 Minutes of Hospital Arrival 0.6548 0.8066 0.9191 0.9630 0.9186 0.9344 1.0000 1.0000 HF 1 Discharge Instructions 0.9077 0.9266 1.0000 1.0000 PN 3b PN 6 Blood Cultures Performed in the Emergency Department Prior to Initial Anti-biotic Received in Hospital Initial Antibiotic Selection for CAP in Immunocompetent Patient 0.9643 0.9730 1.0000 1.0000 0.9277 0.9446 0.9958 1.0000 Note: Implementation FY Source: OPPS VBP Final rule 11.1.11

Final Rule Process of Care Measures New update Measure ID Measure Green = increased threshold from 2013 Red = decreased threshold from 2013 2013 National Threshold National Threshold 2013 National Benchmark National Benchmark SCIP Inf 1 SCIP Inf 2 SCIP Inf 3 SCIP Inf 4 NEW SCIP Inf 9 Note: Implementation FY Source: OPPS VBP Final rule 11.1.11 Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision Prophylactic Antibiotic Selection for Surgical Patients Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose Postoperative Urinary Catheter Removal on Post Operative Day 1 or 2 0.9735 0.9807 0.9998 1.0000 0.9766 0.9813 1.0000 1.0000 0.9507 0.9663 0.9968 0.9996 0.9428 0.9634 0.9963 1.0000 N/A 0.9286 N/A 0.9989

Final Rule Process of Care Measures New update Measure ID Measure Green = increased threshold from 2013 Red = decreased threshold from 2013 2013 National Threshold National Threshold 2013 National Benchmark National Benchmark SCIP Card 2 SCIP VTE 1 SCIP VTE 2 Note: Implementation FY Source: OPPS VBP Final rule 11.1.11 Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the Perioperative Period Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery 0.9500 0.9565 1.0000 1.0000 0.9307 0.9462 0.9985 1.0000 0.9399 0.9492 1.0000 0.9983

Outcome Measures New update Measure ID Measure National Threshold National Benchmark MORT 30 AMI Acute Myocardial Infarction (AMI) 30- Day Mortality Rate (shown as survival rate) 0.8477 0.8673 MORT 30 HF Heart Failure (HF) 30-Day Mortality Rate (shown as survival rate) 0.8861 0.9042 MORT 30 PN Pneumonia (PN) 30-Day Mortality Rate (shown as survival rate) 0.8818 0.9021 Note: Implementation FY Source: OPPS VBP Final rule 11.1.11

HCAHPS & Mortality [W]hen we controlled for a hospital s clinical performance, higher hospital-level patient satisfaction scores were independently associated with lower hospital inpatient mortality rates. Source: Glickman SW et al, Patient Satisfaction and Its Relationship with Clinical Quality and Inpatient Mortality in Acute Myocardial Infarction, Circ Cardiovasc Qual Outcomes 2010;3:188-195.

Achievement Improvement Process of Care & Outcomes Scoring New update Achievement Improvement The greater of the two scores will be used for each Core Measure Note: Implementation FY Source: OPPS VBP Final rule 11.1.11

More in Store 1% 1.25% 1. 5% 1. 75% 2% 1% 2% 3% 3% 3%

HCAHPS & Readmissions For all three clinical areas (AMI, HF, PN),HCAHPS performance was more predictive of readmission rates than the objective clinical performance measures often used to assess the quality of hospital care. Source: Boulding W et al. Relationship between Patient Satisfaction with Inpatient Care and Hospital Readmissions Within 30 Days, Am J Manag Care. 2011; 17(1): 41-48.