Quality Forum August 17th, 2016 Richard Bubach, MSA Senior Director Of Operations This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11S0W-GPQIN-ND-GEN-27/0815
Presentation Outline Brief Demographics 5 minutes Population/Physician Office Measures 20 minutes Nursing Home Measures 5 minutes Home Health Measures 5 minutes Hospital Measures 6 minutes AHRQ Dashboard 10 minutes Q & A s - 1 minute 2
DEMOGRAPHICS
Urban/Rural Population Distribution Data Source, Medicare enrollment data, U.S. Census Bureau Total Rural Population = 320,003 (42.3%) Total Urban Population = 436,924 (57.7%) Total Rural Medicare Population = 57,352 (48.3%) Total Urban Medicare Population = 61,338 (51.7%) 4
North Dakota Medicare Beneficiary Distribution 2015 Data Source, Medicare enrollment data 77 to 500 500 to 1,000 1,000 to 2,000 2,000 to 5,000 >5,000 5
% of Medicare Beneficiary Over Age 85 2015 Data Source, Medicare enrollment data 6 to 10% 11 to 12% 13 to 14% State Avg 13.0% 15 to 16% 17 to 22% 6
Demographics 20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Medicare % of Total Population Urban Rural
Demographics 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% % of Medicare Population over 85 Urban Rural
Keillor-esque Welcome to Lake Wobegon, where all the women are strong, all the men are good-looking, and all the children are above average. - Garrison Keillor 9
Keillor-esque Welcome to Lake Wobegon, where all the women are strong, all the men are good-looking, and all the children are above average. - Garrison Keillor Welcome to North Dakota, where all the health care institutions are good, all the health care providers are proficient, and all the health care indicators are above average. 10
Population Health / Physician Office Behavioral Risk Factor Survey Data CDC Cancer Prevalence Data Claims Based Prevention and Treatment data North Dakota Physician Quality Reporting System (PQRS)-based Quality Indicator Data Physician Office E.H.R. Penetration Data 11
ND=24% Rank #1 12
Smoke Daily ND=14.4% Rank #15 13
Smoking Trends Over Time 25 20 15 10 5 0 1996 2004 2014 ND US
ND=32.2% Rank #7 15
Consumed vegetables one or more times per day ND=72.6% Rank #46
Consumed fruit one or more times per day ND=59.7% Rank #31
ND=45.3% Rank #42
ND is 5 th highest 19
ND is 19 th highest 20
According to 2014 BRFSS data North Dakota ranked 40th in CRC screening. According to 2014 BRFSS data North Dakota ranked 36 th in mammography screening. 21
North Dakota Colorectal Cancer Screening Rates Medicare Claims Data (Age 50-75): 4Q2014 through 3Q2015 Analysis provided Great Plains Quality Innovation Network April 2016
North Dakota Mammography Rates Medicare Claims Data: 1Q2014-4Q2015 (Females Age 50-74) Analysis provided by Great Plains Quality Innovation Network August 2016
North Dakota Pneumococcal Pneumonia Vaccination Rates Medicare Claims Data: 1Q2015-4Q2015 * The rates reflected in this map include only billed immunizations, and do not capture immunizations given at federally designated Rural Health Centers, the Veteran s Administration, or any other entity that does not bill Medicare using roster, electronic, or standard Medicare claim forms. Analysis provided by Great Plains Quality Innovation Network August 2016
80.0% Rural Versus Urban 70.0% 60.0% 50.0% 40.0% 30.0% Rural Urban 20.0% 10.0% 0.0% CRC Screening Mammography Pneumococcal
North Dakota Hypertension Rates Medicare Beneficiaries with Hypertension Diagnosis on Medicare Part A and B Claims 10/01/14-09/30/15 Analysis provided Great Plains Quality Innovation Network June 2016
North Dakota Diabetes Prevalence 2015 Analysis provided Great Plains Quality Innovation Network June 2016
Chronic Disease 60 % of Benes with Hypertension/Diabetes by place of residence 50 40 30 20 Urban Rural 10 0 Hypertension Diabetes
North Dakota Diabetes Screening Rates Hemoglobin A1C Medicare Claims Data: 4Q2014 through 3Q2015 Analysis provided by Great Plains Quality Innovation Network May 2016
North Dakota Diabetes Screening Rates Annual Eye Exam Medicare Claims Data: 4Q2014 through 3Q2015 Analysis provided by Great Plains Quality Innovation Network May 2016
North Dakota Diabetes Screening Rates Lipids Medicare Claims Data: 4Q2014 through 3Q2015 Analysis provided by Great Plains Quality Innovation Network May 2016
Diabetes Care 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Rural versus Urban Eye Exam A1c Screening Lipid Rural Urban
Physician Quality Reporting System (PQRS) 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% (> 9.0) Diabetes Measures/Indicators (<100 mg/dl) A1c uncontrolled LDL controlled Eye Exam Foot Exam
Physician Quality Reporting System (PQRS) 60.0% Screening/Prevention Measures 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Ages > 6 months Influenza Immunization Ages >65 Pneumococcal Immunization Ages 50 through 74 Breast Cancer Screening Ages 50 through 75 CRC Screening
Physician Quality Reporting System (PQRS) Cardiac Related 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% < 140/90 10.0% 0.0% Controlling High BP Smoking Screening/Intervention IVD Aspirin Use
SD MN UT NC AL ND WI VT IA WY AR OR WA IL MT SC GA MO IN MA NE OK AZ VA KS MD CO ID NH KY ME MI MS OH PA TX CA NM NV NY NJ WV TN DE AK CT HI FL LA RI Percent of Physicians that Adopted Any EHRs (2014) % 100 90 80 70 60 50 40 30 20 10 0 Data Source Office of the National Coordinator 36
MN SD NC VT OR WI IA MT UT ND SC AZ AL IL AR WY MA NE MD PA NY WV GA IN NM ID WA NH OH TX MO KS CA NV NJ VA MS MI LA OK CO ME TN DE CT HI KY DC FL RI AK Percent of Physicians that Adopted Certified EHRs (2014) % 100 90 80 70 60 50 40 30 20 10 0 Data Source Office of the National Coordinator 37
Nursing Homes Quality Indicators Nursing Home Quality Composite Measure Use Antipsychotic Medications in Residents 39
Composite Summary by Quality Measure (Sept 2015 Feb 2016) Measure National Weighted Avg ND Weighted Avg Variance Composite Score 8.31 8.24-0.07 Falls w/major injury 3.34 5.21 +1.87 UTI 4.22 4.47 +0.25 Pain 8.20 12.00 +3.80 Pressure Ulcer 6.45 4.24-2.21 Incontinence 46.64 47.94 +1.30 Catheter 3.43 2.90-0.53 Physical Restraints 0.69 0.23-0.46 ADL 16.12 16.58 +0.46 Weight Loss 7.74 7.80 +0.06 Depression 6.0 5.19-0.71 Antipsychotic Meds 16.18 16.68 +0.50 Influenza Vaccine 5.68 2.11-3.57 Pneumococcal Vaccine 6.96 3.28-3.68
10 Nursing Home Composite Scores 9.5 9 8.5 8 7.5 7 6.5 ND National Goal Collab. NHs 6 5.5 5 6-months ending 41
Percent of Long-Term Residents Who Received an Antipsychotic by Quarter 25 22 19 16 13 Rank 37 Rank 24 Rank 13 Rank 9 US ND MN MT SD 10 13 Q3 13 Q4 14 Q1 14 Q2 14 Q3 14 Q4 15 Q1 15 Q2 15 Q3 15 Q4
North Dakota Percent of Long-Term Residents Who Received an Antipsychotic (2015 Q4) by Nursing home % 50.0 45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 43
Home Health Quality Indicators Process of Care Measures Experience of Care Measures 44
HOME HEALTH QUALITY INDICATORS DASHBOARD Measure National North Dakota Variance Rank How often patients got better at walking or moving around 66.4 68.5 +2.1 9 How often patients got better at getting in and out of bed 62.3 66.4 +4.1 4 How often patients got better at bathing 70.6 74.5 +3.9 7 How often the home health team checked patients for pain 98.9 99.6 +0.7 2 How often the home health team treated their patients pain 98.9 99.3 +0.4 4 How often patients had less pain when moving around 70.2 69.3-0.9 27 How often the home health team treated heart failure patients symptoms 98.1 99.4 +1.3 1 How often patients breathing improved 69.2 70.3 +1.1 22 How often patients wounds improved or healed after an operation How often the home health team checked patients for the risk of developing pressure ulcers How often the home health team included treatments to prevent pressure ulcers in the plan of care How often the home health team took doctor-ordered action to prevent pressure ulcers 89.8 91.2 +1.4 12 98.8 99.5 +0.7 4 98.3 96.8-1.5 45 97.6 97.4-0.2 35
Home Health Quality Measures 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0%. How often patients got better at walking or moving around
Home Health Quality Measures How often the home health team included treatments to prevent pressure ulcers in the plan of care 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0%.
Home Health Quality Indicators Measure How often the home health team began their patients care in a timely manner How often the home health team taught patients (or their family caregivers) about their drugs National North Dakota Variance Rank 92.3 95.8 +3.5 1 95.8 98.6 +2.8 1 How often patients got better at taking drugs correctly by mouth 56.1 56.6 +0.5 23 How often the home health team checked patients risk of falling 99.1 99.5 +0.4 4 How often the home health team checked patients for depression 97.9 99.2 +1.3 1 How often the home health team made sure that their patients have received a flu shot for the current flu season How often the home health team made sure that their patients have received a pneumococcal vaccine (pneumonia shot) For diabetic patients, how often the home health team got doctor s orders, gave foot care, taught patients about foot care 69.4 80.1 +10.7 2 72.8 88.7 +15.9 1 96.0 97.3 +1.3 2 How often home health patients had a hospital admission 16.0 16.8 0.8 39 How often patients receiving home health care needed any urgent, unplanned care in the hospital emergency room - without being admitted to the hospital 12.4 11.9-0.5 6
Home Health Quality Measures 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0% How often the home health team made sure that their patients have received a pneumococcal vaccine 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Home Health Quality Indicators (HCAHPS) Measure Would patients recommend the home health agency to friends and family Did the home health team discuss medicines, pain, and home safety with patients National North Dakota Variance Rank 78 82 +4 T 13 83 87 +4 T 3 How often the home health team gave care in a professional way 88 90 +2 T 7 How well did the home health team communicate with patients 85 88 +3 T 5 How do patients rate the overall care from the home health agency 84 87 +3 T 6
Home Health (HCAHPS) 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0%. Would patients recommend the home health agency to friends and family
Hospital Reporting Growth In 2003 there were 12 publicly reported hospital measures In 2016 there are more than 110 52
Hospital Value-Based Purchasing Components Clinical Process Measures Patient Experience Measures Outcome Measures Efficiency Measures 53
Hospital Value Based Purchasing Total Performance Score 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00 St. A's Sanford Bismarck Altru Trinity Essentia Sanford Fargo
Hospital Value Based Purchasing Clinical Process Measures 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00 Essentia Sanford Fargo St. A's Trinity Altru Sanford Bismarck
Hospital Value Based Purchasing HCAHPS Measures 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00 Altru Essentia St. A's Trinity Sanford Bismarck Sanford Fargo
Hospital Value Based Purchasing Outcome Measures 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00 St. A's Sanford Bismarck Trinity Altru Essentia Sanford Fargo
Hospital Value Based Purchasing 120.00 Efficiency Measure Medicare Spending Per Beneficiary 100.00 80.00 60.00 40.00 20.00 0.00 St. A's Sanford Bismarck Trinity Altru Essentia Sanford Fargo Total Part A and Part B spending within 3 days prior to admission, the admission period, and 30 days post admission LOWER is BETTER
Critical Access Hospitals (ND vs US) 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% IMM-2 Process of Care Measures PN-6 ND National
Critical Access Hospitals (ND vs US) 100.0% HCAHPS 90.0% 80.0% 70.0% 60.0% 50.0% ND 40.0% 30.0% National 20.0% 10.0% 0.0% Recommend Hospital Hospital Rate 9-10 Nursing Communication Physician Communication Pain Control
ND Critical Access Hospitals 100 90 80 70 60 50 40 30 20 10 0 HCAHPS - Rate Hospital as a 9 or 10
Care Transitions Admission Rates per 1000 beneficiaries Readmission Rates per 1000 beneficiaries Hospice Care 62
AK WY NY VT ND SD HI KY CA NH WA MD NV MA ME MN TN MT NM IL CT NJ CO NC AK OR IN NE DE ID PA KS RI WI MO MS MI LA AZ OK AL TX SC IA GA OH FL UT Percent of Medicare Beneficiaries accessing Hospice Care (2013) % 4 3 2 1 0 Data Source www.healthindicators.gov 67
AHRQ State Dashboard Overall Ranking NQS Priority Bundle Access to Care Diseases and Conditions Setting of Care 68
All STATE-BASED AHRQ MEASURES SUMMARY 9th 69
70
Care Coordination Bundle 6th 71
Care Coordination Bundle 72
Care Coordination Bundle 73
Care Coordination Bundle 74
75
Patient Centeredness Bundle T 25th 76
77
Mental Health and Substance Abuse Bundle T 48th 78
Mental Health and Substance Abuse Bundle 79
80
Nursing Home Bundle T 18th 81
WANT MORE??? Google AHRQ State Snap Shot Scroll all the way down Click on link Link: http://hqrnet.ahrq.gov/inhqrdr/state/select
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