How Your Hospital s Total Performance Score (TPS) Will Impact Your Medicare Payments

As a follow-up to the white paper titled What Value are we Gaining from VBP?, the authors have taken a deeper dive to identify the impact of the weighted measures on the total performance score (TPS). The purpose is to pinpoint if there is one or more measures that affect the TPS more adversely when a hospital isn t performing well. This is an important area of focus, as non-performing hospitals stand to lose money, have a more difficult time breaking even when the benchmark continually rises, and experience issues attaining the ability to pursue needed efficiency initiatives. The TPS is used as a measure to determine adjusted payment for inpatient services under the MS-DRG system. The TPS is calculated based on the sum of four domains that include measures of efficiency, clinical process of care, patient experience of care, and outcomes. The domains are measured based on a composite score from individual performance measures. Figure 1 displays how the TPS is broken down into the four distinct domains and the respective measures that make up those domains. Figure 1: https://www.cms.gov/outreach-and-education/outreach/npc/downloads/hospvbp_ FY15_NPC_Final_03052013_508.pdf Copyright 2015 Panacea Healthcare Solutions, Inc. All Rights Reserved page 2

Interestingly, the impact that each individual performance measure has on the TPS has never been formally investigated. This information may be beneficial for hospitals, allowing targeted interventions to be made to those areas that have the largest impact on TPS. The value-based performance (VBP) performance measures for each hospital are published publically on the Hospital Compare website. Using this data, an analysis was conducted to investigate which individual performance measures are most correlated with the TPS. A series of linear regressions were used to calculate the strength of the relationship between each performance measure using correlation coefficients. Table 1 displays the strength of the relationship of each individual performance measure to the TPS. As shown, the nurse communication measure has the strongest positive association with TPS. As nurse communication scores increase, the TPS increases. MSPB-1 has the strongest negative association with TPS. As MSPB-1 scores increase, the TPS decreases. Table 1. The correlation coefficient (r) for each performance score relative to the TPS: Domain Performance Score Correlation Coefficient with TPS Clinical Process of Care AMI-7a NA Clinical Process of Care SCIP-Inf-9 0.231 Clinical Process of Care AMI-8a 0.179 Clinical Process of Care SCIP-Inf-4 0.174 Clinical Process of Care SCIP-Card-2 0.169 Clinical Process of Care SCIP-Inf-3 0.152 Clinical Process of Care HF-1 0.150 Clinical Process of Care SCIP-VTE-2 0.111 Clinical Process of Care PN-3b 0.093 Clinical Process of Care SCIP-Inf-2 0.083 Clinical Process of Care SCIP-Inf-1 0.072 Clinical Process of Care PN-6 0.066 Efficiency MSPB-1-0.421 Outcome MORT-30-PN 0.221 Outcome MORT-30-AMI 0.152 Outcome MORT-30-HF 0.108 Outcome PSI-90-0.221 Outcome CLABSI -0.267 Patient Experience Nurse Communication 0.618 Copyright 2015 Panacea Healthcare Solutions, Inc. All Rights Reserved page 3

Patient Experience Hospital Staff Responsiveness 0.615 Patient Experience Medicine Communication 0.609 Patient Experience Overall Hospital Rating 0.585 Patient Experience Pain Management 0.568 Patient Experience Hospital Cleanliness & Quietness 0.554 Patient Experience Doctor Communication 0.540 Patient Experience Discharge Information 0.469 Additionally, an analysis was conducted to see how each of the performance measures correlate to one another. Again, correlation coefficients were calculated using simple linear regressions to determine the strength of the relationship between each performance measure, which is shown in Figure 2. Figure 2. Strength of the relationship between each Performance Measure: Copyright 2015 Panacea Healthcare Solutions, Inc. All Rights Reserved page 4

The blue color demonstrates a positive relationship whereas a red color depicts a negative relationship. The larger the circle and the darker the color, the stronger the relationship is between the two variables. The strongest associations exist with the patient experience of care domain measures. Therefore, when a hospital has a low score on one of the patient experience of care domain measures, it is likely that the hospital will score low on the other patient experience of care domain measures. The Journal of Nursing Administration published an article supporting the findings reached by the authors. The results of the study outlined in this article were identified through a logistical regression analysis of patient-level satisfaction domain scores and HCAHPS top-box scores (Wolosin, 2012). Findings included that with each 1-point increase of the nursing domain score, the odds of achieving an HCAPHPS top-box score increased by 4.9 percent (Wolosin, 2012). Although the results also found other domain scores affected top-box odds, they did so to a much smaller extent. According to Price et. al. (2014), national survey data indicates that 1 in 6 Americans consulted online rankings or reviews of providers in the prior year. This phenomenon has led to increased interest in understanding the association of patient experience and measures of structure, process, and outcomes (Price, 2014). The study cited in this article was conducted via literature reviews on the association between patient experience measures and other indicators of healthcare quality. The findings support a positive correlation between higher patient experience satisfaction and better adherence to provider advice, particularly in relation to provider-patient communication (Price, 2014). In terms of clinical outcomes, this study also identified that higher patient ratings of hospitals clinical performance were associated with lower hospital inpatient mortality rates among AMI patients (Price, 2014). Although this study did not investigate the mechanism by which patient experiences have influence on clinical outcomes, there exists potential in seeking other factors that may account for patients having both better care experiences and better clinical outcomes (Price, 2014). It has become clear in the shift from volume to value that patient experiences are an appropriate measurement for VBP that compliment outcome measures. The CAHPS website gives users quality improvement strategies to help reach this end goal. Given the scope of current VPB programs, it is crucial to monitor and evaluate the effects of these identified correlations and make the appropriate adjustments before CMS expands the domains of VBP with safety, care coordination, and population or community health. This will fully advance CMS s National Quality Strategy with the intended six domains of quality measurement (safety; patient, and caregiver-centered experiences and outcomes; care coordination; clinical care; population or community health; and efficiency and cost reduction measures). Copyright 2015 Panacea Healthcare Solutions, Inc. All Rights Reserved page 5

Watch for the next white paper in this series on VBP! The authors next will analyze perspectives of the currently identified TPS weights from the provider perspective. CMS PDF: https://www.cms.gov/outreach-and-education/outreach/npc/downloads/hospvbp_ FY15_NPC_Final_03052013_508.pdf Nursing Care, Inpatient Satisfaction, and Value-Based Purchasing: Vital Connections Wolosin, Robert PhD; Ayala, Louis PhD; Fulton, Bradley R. PhD Journal of Nursing Administration: June 2012 - Volume 42 - Issue 6 - p 321 325 doi: 10.1097/NNA.0b013e318257392b Articles: Examining the Role of Patient Experience Surveys in Measuring Health Care Quality Medical Care Research and Review 2014, Vol. 71(5) 522 554 The Author(s) 2014 Reprints and permissions: sagepub.com/journalspermissions.nav DOI: 10.1177/1077558714541480 mcr.sagepub.com Rebecca Anhang Price, Marc N. Elliott, Alan M. Zaslavsky, Ron D. Hays, William G. Lehrman, Lise Rybowski, Susan Edgman-Levitan, and Paul D. Cleary Copyright 2015 Panacea Healthcare Solutions, Inc. All Rights Reserved page 6

About the Authors Brooke Palkie, EdD, RHIA College of St. Scholastica Brooke Palkie is an Associate Professor in the Health Informatics and Information Management Department at The College of St. Scholastica. Brooke earned her doctoral degree in educational leadership and management and holds the credential of Registered Health Information Administrator. David Marc, MBA, CHDA College of St. Scholastica David Marc is an assistant professor and the health informatics graduate program director at the College of St. Scholastica. He holds a certification as a health data analyst (CHDA), earned his master s degree in biological sciences from the University of Minnesota, and is nearly complete with his PhD in health informatics also from the University of Minnesota. Copyright 2015 Panacea Healthcare Solutions, Inc. All Rights Reserved page 7

About Panacea Healthcare Solutions, Inc. Panacea Healthcare Solutions provides coding, compliance, reimbursement and revenue solutions through consulting, software, publications and webcasts. Panacea operates RACmonitor, ICD10monitor and now VBPmonitor, an online news and information service that monitors the transition of healthcare providers from the current Fee For Services (FFS) payment system to the value-based purchasing model authorized by Congress in Section 3001(a) of the Patient Protection and Affordable Care Act. The program uses the hospital quality datareporting infrastructure developed for the Hospital Inpatient Quality Reporting (IQR) Program, which was authorized by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. VBPmonitor.com is not affiliated with any governmental agency but is a reliable source for healthcare providers in all settings. For more information about Panacea, visit www.panaceainc.com or call 800.252.1578. Copyright 2015 Panacea Healthcare Solutions, Inc. All Rights Reserved page 8