Overview of DataGen nalyses Wyoming Hospital ssociation Bill Shyne, anager September 20, 2017
genda Who is DataGen and why partnership exists Data sources utilized Overview of analyses available to WH Regulatory, legislative, quality/finance, and operational/comparative analyses Use of analyses
HNYS/DataGen Relationship with Wyoming Hospital ssociation DataGen is a subsidiary of HNYS Relationships with: 47 hospital/health care associations 7 multi-state systems Consulting firms Individual hospitals and health systems Leverage federal/state/proprietary health care data for analysis of: Current payment systems New payment/care models Quality performance Financial performance
Why Partnership Exists edicare analytics that: Educate Support operations and finance Enhance quality initiatives Support advocacy
Data Sources Utilized Data sources utilized: edicare cost report edicare Standard nalytic File (edicare claims for all settings) edpr (IPPS and LTCH claims) Quality data from Hospital Compare website Impact Files (claims and/or cost report data consolidated by CS) Proprietary data provided by hospitals/states/others
Regulatory nalyses and Summaries Category: Regulatory nalyses for Reimbursement/Education Purpose: How edicare fee-forservice payments will change from year to year Uses: Budgeting, advocacy, board/internal meetings
FFY 2018 IPPS Final Rule Final FFY 2017 Final FFY 2018 Percent Change Federal Operating Rate $5,516.14 $5,574.11 +1.05% Federal Operating Rate C-djusted Update (2.70% B minus 0.6% productivity adj. minus 0.75% pre-determined adj.) 21 st Century Cures ct-andated Retrospective Coding djustment Reduction -1.35% +0.4588% 2-idnight Rule Temporary Retrospective djustment Removal -0.6% Net Rate Change (EXCLUDING BUDGET NEUTRLITY) Net Rate Change (INCLUDING BUDGET NEUTRLITY DUSTENTS) +1.21% +1.05%
FFY 2018 IPPS Final Rule: ain Points Updated baseline for marketbasket and labor share (2010 -> 2014 cost reports) Imputed Rural Floor extended S-10 inclusion adopted for FFY 2018, no concrete plans for calculation in future years DH and Expanded LV provisions expire PSI-90 removed from VBP for FFY 2019+ FFY 2019 implementation of SDS-adjusted RRP program
FFY 2018 IPPS Final Rule Impacts Wyoming
Final 2017 vs Final 2018 UCC Revenue
Estimated Impact Due to Changes in DSH Payment ethodology
CY 2018 OPPS Proposed Rule nalysis Final CY 2017 Proposed CY 2018 Percent Change OPPS Conversion Factor $75.001 $76.483 +1.98% Proposed CY 2018 Update Factor Component Value arketbasket (B) Update +2.9% ffordable Care ct (C)-andated Productivity B Reduction -0.4 percentage points (PPT) C-andated Pre-Determined B Reduction -0.75 PPT Wage Index BN djustment -0.01% Pass-through Spending BN djustment +0.22% Outlier BN djustment -0.04% Cancer Hospital BN djustment +0.03% Other djustments +0.02% Overall Proposed Rate Update +1.98% RFI for more efficient healthcare delivery system. Proposed 340B reductions non-pass through drugs reimbursed from SP +6% to SP 22.5% Proposed 2 yr moratorium on direct supervision requirement for Rurals and CHs Proposed pkging of low-cost drug administration Lab date of service revision Quality propose to remove 6 measures and delay mandatory OS CHPS for 2018 Proposed PFS has proposal to reimburse hospitals @ 25% (vs current 50%) of the OPPS rate for non-excepted services in off-campus PBDs that began OPPS billing on or after 11/2/15.
Wage Index nalyses Wage Data Comparison Wage Index Reclassification nalyses
Bundled Payments On ugust 15, CS proposed to halt implementation of the new bundled payment model for heart attack and cardiac bypass surgery and a new cardiac rehab payment model CS also proposed to reduce the scope of CR beginning 1/1/18 by reducing geographic areas required to participate from 67 to 34 areas; CS would allow voluntary CR program participation in the other 33 areas (Wyoming had no mandatory Ss) CS plans to maintain edicare payment bundling opportunities for providers on a voluntary basis by building on the Bundled Payments for Care Improvement initiative
Quality/Finance nalyses Category: Quality/Reimbursement/ and Education Purpose: Preview quality-based payment reforms authorized by the C Comparative review of the quality data collected by CS and published on the Hospital Compare website Uses: Enhance quality initiatives/performance, board/internal meetings
edicare Quality Program nalyses
Value Based Purchasing
Wyoming s VBP Performance 2013 2014 2015 2016 2017 Payout Percentage 94.0% 79.5% 93.0% 96.6% 86.7% Total Impact ($59,700) ($235,500) ($112,300) ($63,700) ($291,000) Eligible Hospitals 9 7 10 10 10 Number of Winners 4 1 5 5 7 Number of Losers 5 6 5 5 3
Wyoming s VBP Performance Trends Domain Ranking 2013 2014 2015 2016 2017 Process of Care 32 of 50 21 of 50 43 of 50 37 of 50 48 of 50 Patient Experience of Care 45 of 50 47 of 50 43 of 50 38 of 50 44 of 50 Outcomes of Care n/a 50 of 50-36 of 50 40 of 50 48 of 50 Efficiency n/a n/a - 9 of 50-11 of 50 11 of 50 - Safety of Care n/a n/a - n/a - n/a - 1 of 50 - Total Performance Score 41 of 50 50 of 50 44 of 50 37 of 50 41 of 50 Key Drivers of Statewide Performance: New Domains FFY 2014: Outcomes Domain FFY 2015: Efficiency Domain FFY 2017: Safety of Care Domain New/Removed easures FFY 2014: dded - SCIP-Inf-9, ortality easures FFY 2015: dded - PSI-90, HI-1, SPB; Removed - SCIP-VTE-1 FFY 2016: dded I-2, HI-2, HI_SSI (HI-3 and HI-4); Removed I-8a, HF-1, PN-3b, SCIP-Inf-1, SCIP-Inf-4 FFY 2017: dded HI-5, HI-6, PC-01; Removed PN-6, SCIP-Inf-2, SCIP-Inf-3, SCIP-Inf-9, SCIP- Card-2, SCIP-VTE-2 Changing Eligibility Update performance periods/standards Nationwide Improvement Changing Domain Weights with increased weight towards Outcomes/Efficiency
Wyoming s Top/Bottom VBP easures
VBP Efficiency easure (SPB)
Wyoming s 2015 edicare Spend Per Beneficiary* *Values are not risk-adjusted
Wyoming s 2015 SPB (con t)
Readmission Reduction Program
Wyoming s RRP Revenue by Condition
Wyoming s RRP Impact by Condition Eligible providers and their characteristics are based on the FFY 2017 IPPS Final Rule.
Wyoming s Readmission Rank Trends 4Q 2014 uly 1, 2010 - une 30, 2013 2Q 2015 uly 1, 2011 - une 30, 2014 State Rank 2Q 2016 uly 1, 2012 - une 30, 2015 2Q 2017 uly 1, 2013 - une 30, 2016 RED_30_I: cute yocardial Infarction (I) 30-Day Readmission Rate 32 of 51 17 of 51 20 of 50 35 of 51 Readmission Ranks RED_30_HF: Heart Failure (HF) 30-Day Readmission Rate RED_30_PN: Pneumonia (PN) 30-Day Readmission Rate RED_30_HIP_KNEE: Elective Total Hip/Knee Surgery (TH/TK) 30-Day Readmission Rate RED_30_COPD: Chronic Obstructive Pulmonary Disease (COPD) 30-Day Readmission Rate RED_30_CBG: Coronary rtery Bypass Graft (CBG) 30-Day Readmission Rate 17 of 51 19 of 51 26 of 50 32 of 51 19 of 51 14 of 51 13 of 50 13 of 51 42 of 51 40 of 51 40 of 50 50 of 51 17 of 51 36 of 51 33 of 50 41 of 51 No Data 48 of 51 50 of 50 41 of 51
HC Reduction Program
Wyoming s HC Reduction Program Performance Eligible providers and their characteristics are based on the FFY 2017 IPPS Final Rule.
Quality Program Reference Guide Reference Guide for complete programs detail Year over Year Program Changes (easures, Domains, Domain Weights) General Program ethodology Reference Guides will be updated after FINL Rule is adopted Quality Based Payment Reform (QBPR) Reference Guide Value Based Purchasing (VBP) Overview: FFY 2015 Program easures, Performance Standards, Evaluation Periods, and Other Program Details for the FFY 2015 VBP Program easure Description I 7a Fibrinolytic Therapy Received Within 30 inutes of Hospital rrival I 8a Primary PCI Received Within 90 inutes of Hospital rrival HF 1 Discharge Instructions National National inimum Threshold1 Benchmark2 Standards4 80.00% 100.00% Total Performance Score: Original Domain Weighting5 100% Quality Based Payment Reform (QBPR) Reference Guide 95.35% 100.00% 100.00% FFY 2016 Program Value Based Purchasing94.12% (VBP) Overview: 97.78% 100.00% easures, Performance Standards, Evaluation Periods, and Other Program Details for the FFY 2016Process VBP Program of PN 3b Blood Cultures Performed in the ED Prior to Initial ntibiotic Received in Hospital PN 6 Initial ntibiotic Selection for CP in Immunocompetent Patient 95.92% 100.00% SCIP Inf 1 Prophylacticeasure ntibiotic Received Within One Hour PriorDescription to Surgical Incision ID easure 98.64% 100.00% SCIP Inf 2 Prophylactic ntibiotic Selection for Surgical Patients 98.64% 100.00% SCIP Inf 3 Fibrinolytic Therapy Received Within 30 inutes of Hospital rrival 97.49% ProphylacticI 7a ntibiotics Discontinued Within 24 Hours fter Surgery End Time 100.00% SCIP Inf 4 PN 6Patients with Controlled 6 Initial ntibiotic Selection for CP in Immunocompetent Patient95.80% Cardiac Surgery Postoperative Serum Glucose 99.77% Process of Care Process of Care easure ID SCIP Inf 9 SCIP Inf 2 90% National National Careinimum Benchmark2 20%Standards4 10 Cases 1 Threshold Total Performance Score: Original Domain Weighting5 Quality Based Payment Reform (QBPR) Reference Guide100% 100.00% 91.15% Process of Program Value Based Purchasing (VBP) Overview: FFY 2017 96.55% 100.00% 80% Care 99.07% 100.00% 94.89% 99.99% 10%Details for the FFY 2017 VBP Program easures, Performance Standards, Evaluation Periods, and Other Program Prophylactic ntibiotic Selection for Surgical Patients Postoperative Urinary Catheter Removal on Post Operative Day 1 or 2 98.09% 100.00% 10 Cases 97.06% 100.00% SCIP VTE 2 easure ID easure Description 70% 97.73% 100.00% Patient SCIP Card 2 Beta Blocker Prior to rrival That Received a Beta Blocker During the Perioperative Period Experience Removed: SCIP-VTE-1: Surgery Patients with Recommended Venous thromboembolism Prophylaxis Ordered 98.23% 100.00% of Care SCIP VTE 2 ppropriate Venous Thromboembolism Hours ofline-ssociated Surgery HI_1*Prophylaxis Within 24Central Blood Stream Infection (CLBSI) 90.61% Patients ssessed and Given Influenza Vaccination I-2 (NEW) Catheter-ssociated Urinary Tractinimum Infection (CUTI)98.88% 30% HI_2* National National SCIP Inf 3 Prophylactic ntibiotics Discontinued Within 24 Hours fter Surgery End Time 100.00% 97.18% SCIP Inf 9 Postoperative Urinary Catheter Removal on Post Operative Day 97.40% 1 or 2 ppropriate Venous Thromboembolism Prophylaxis Within 24 Hours of Surgery 100.00% Safety of Care Beta Blocker Prior to rrival That Received a Beta Blocker During the Perioperative Period SCIP Card 2 Patient Experience of Care Pooled Surgical Site Infection63.17% (SSI) easure**: 35.10% 79.06% National National National HI-3 * 43.58% Surgical - Colon 3 1 69.46% Site Infection 78.17% Floor Threshold Benchmark2 100 Surveys Surgical - bdominal Hysterectomy HI-4 * 35.48% 60.89% Site Infection 71.85% 53.99% 77.67% 86.07% easure ID easure Description Pain anagement Communication about edicines Communication with Nurses Hospital Cleanliness & Quietness 41.94% Communication with Doctors 64.07% 57.67% Responsiveness of Hospital Staff easure ID Discharge Information Overall Rating of Hospital 78.90% 57.01% 80.40% 83.54% Description 89.72% easure 38.21% I-7a Communication about edicines I-2 easure Description & Quietness Hospital Cleanliness NationalssessedNational inimum Patients and Given Influenza Vaccination 43.08%2 64.95%4 79.10% 1 Threshold Standards Elective DeliveryBenchmark Prior to 39 completed Weeks Gestation inimum 2 Standards 100% 0.0000 0.0000 0.0000 0.0000 0.5479 1 Predicted Infection Safety of Care 20% 3 Cases 0.7510 0.6980 0.0000 0.0000 95.4545% 100.0000% 95.1607% 99.7739% 10 Cases 70% Central Line-ssociated Blood Stream Infection (CLBSI) Clinical Care: Outcomes Outcomes of Care easure ID PSI-90 HI-1 * HI-2 * (NEW) cross ll Hospitals** Patient Experience of Care Pooled Surgical Site Infection (SSI) easure**: HI-3 * (NEW) Surgical Site Infection - Colon easure ID Surgical Site Infection - bdominal Hysterectomy HI-4 * (NEW) Top 10% Hospitals** 0.6680 0.7520 S O N D F 2011 easure ID S 2012 O N D F Process of Care: Baseline Period6 S O N D Outcomes of Care (ortality/psi-90): Baseline Period6 2010 FOutcomes of Care S (CLBSI easure): Baseline Period6 2013 easure Description S O N D Responsiveness of Hospital StaffThreshold N D F Efficiency of Care: Baseline Period6 S O N D F S O N F S Hospital Cleanliness & QuietnessHospitals 2013 O N D F 25 Cases Hospitals*** S O N Baseline Period6 S O N D F FFY 2015 Payment djustment 2014 2015 easure Description S O N D 87.1669% 90.3985% 90.8124% 25 Cases National20% National inimum F 2 70.28% 62.88% 73.36% 65.30% 0% 79.39% 64.09% 85.91% 91.23% 70.02% 84.60% 35.99% S O N D F Spending Per Hospital Patient With edicare Patient Experience of Care: Performance Period7 20% inimum Standards4 edian Ratio ean Ratio of cross ll Top 10% 25 Cases *** 40% 30% National 1 S O N D Threshold Benchmark2 50% Patient Experience of Care 25% 100 Surveys National 2016 60% Standards4 78.33% 41.42% 44.32% Process of Care: Performance Period7 SPP-1* 88.1794% 88.2986% 1 49.53% edian Ratio ean Ratio of Top 10% OverallProgram Rating of Hospital FFY 2016 VBP Timeframes 2012 easure ID of Care S Outcomes (CLBSI easure): Process of Care: 7 Performance BaselinePeriod Period6 D Clinical Care: Outcomes 25% inimum Standards4 Threshold Benchmark Floor Efficiency 58.14% 78.19% 86.61% of Care 63.58% 25% 80.51% 88.80% 10% 37.29% 65.05% 80.01% inimum 2015 2 D F S O N Benchmark Standards4 *** National Discharge Information F N 85.1458%30% 3 National 1O Communication about edicinescross ll (ortality & PSI-90): Efficiency and Cost Reduction 25% 10% *** Hospitals Hospitals 0% Outcomes of Care (HI easures): FFY 2017 VBP Program Timeframes FFY 2016 7 Performance Period 2012 2011 D F S O N D F Outcomes of Care (ortality & PSI-90): Performance Period7 S O N D Payment 2014 djustment 2013 F S O N D F S O N D Clinical Care - Process: Baseline Period 2015 F 2016 S O N D F 2017 S O N D F S O N D Patient Experience of Care: Performance Period Efficiency of Care: Performance Period7 Clinical Care - Outcomes: Baseline Period Clinical Care - Process: Performance Period Patient Experience of Care: Baseline Period Efficiency of Care: Baseline Period6 Notes: D Pain anagement EfficiencyofofCare: Care: Patient Experience 7 Performance Baseline Period6Period Patient Experience of Care: Performance Period7 Outcomes of Care (HI easures): 6 Baseline 2010 Period Outcomes of Care Process of Care: Performance Period7 Outcomes of Care (ortality/psi-90): Performance Period7 2011 O 0.0000 0.0000 National 2014 2014 Communication with Doctors F Spending Per Hospital Patient With edicare SPP-1* Patient Experience of Care: Baseline Period6 F Efficiency and Cost Reduction Efficiency FFY 2015 VBP Program TimeframesCommunication with Nurses 2010 1 Predicted Infection0% 25 Cases easure Description National Benchmark2 National Threshold1 25 Cases Pneumonia (PN) 30-Day ortality Rate (converted to survival rate for VBP) 88.27% 90.42% Efficiency 10% rate for VBP) National of Care to survival cute yocardialnational Infarction (I)inimum 30-Day ortality Rate (converted ORT 30 I easure Description 61.62%4 45.00% 3 Cases Patient Safety Indicator Composite 1 2 Threshold Benchmark Standards Heart Failure (HF) 30-Day ortality Rate (converted to survival20% rate for VBP) ORT 30 HF 0.4650 0.0000 Central Line-ssociated Blood Stream Infection (CLBSI) Pneumonia 30-Day Rate (converted 0.0000 to survival rate for VBP) edian Ratio (PN) ean Ratioortality of Catheter-ssociated Urinary Tract ORT 30 PN Infection (CUTI) 0.8010 Spending Per Hospital Patient With edicare SPP-1* (New) 30% 1 Predicted 84.75% 86.24% Infection easure Description 88.15% 90.03% cute yocardial Infarction (I) 30-Day ortality Rate (converted to survival rate for VBP) 0.4370 0.0000 ID to survival rate for VBP) Heart Failure (HF) 30-Day ortalityeasure Rate (converted ORT 30 HF ORT 30 PN 80% Clinical Care: Process 5% inimum Standards4 HI-1* (New) ORT 30 I 90% 1 Predicted Infection National60% National Threshold1 Benchmark2 PSI-90* (New) ORT 30 HF ORT 30 PN PC-01* (NEW) Total Performance Score: Original Domain Weighting5 4 Benchmark 3.1250%50% 0.0000% Discharge Information 61.36% 84.70% 90.39% Outcomes cute yocardial Infarction (I) 30-Day ortality Rate (converted to survival rate for VBP) 84.75% Removed easures: SCIP-Inf-2: Prophylactic 86.24% ntibiotic for Surgical Patients, Discontinued within 24 Hours of Surgery, SCIPof Care 34.95% Selection 69.32% 83.97% SCIP-Inf-3: Prophylactic ntibiotics Overall Rating of Hospital 25 Cases Heart Failure (HF) 30-Day ortality Rate (converted to survival rate for VBP) 90.03% Inf-9: Postoperative Urinary 88.15% Catheter Removal on Post Operative Day 1 or 2, SCIP-CRD-2: Beta Bloacker Prior to rrival That Received a Beta Blocker During the 40% Perioperative Period, SCIP-VTE-2: Venous Thromboembolism Prophylaxis 24 Hours Prior to Surgery; PN-6: Initial ntibiotic Selection for CP in Pneumonia (PN) 30-Day ortality Rate (converted to survival rate for VBP) 88.27%ppropriate 90.42% National National Within inimum easure ID easure Description 40% Immunocompetent Patient 1 4 Threshold Benchmark2 Standards20% Patient Safety Indicator Composite 0.6162 0.4500 3 Cases ORT 30 I F National 1 70% inimum 50% Standards4 88.56% 64.71% 79.76% 40% 67.96% 83.44% 48.96% 70.18% 78.16% Outcomes Fibrinolytic Therapy Received Within 30 inutes of Hospital ofrrival 100 Surveys Care 34.61% 62.33% 72.77% 30% 32.82% Pain anagement Clinical Care: Process Patient Experience of Care Responsiveness of Hospital Staff easure ID National90% Threshold 0.4570 Patient 0.8450 80% Experience easure Description National Floor3 1 2 4 (RS) Blood Laboratory-identified Events 0.7990 ethicillin-resistant Staphylococcus ureus Removed easures: I 8a: Primary PCI Received Within 90HI_5* inutes(new) of Hospital rrival,threshold HF-1: Discharge Insructions, PN-3b: Blood Cultures Performed in the ED Prior 60% to Benchmark Standards of Care Initial ntibiotic Received in Hospital, SCIP-Inf-1: ProphylacticHI_6* ntibiotic received Within One Hour Prior to Surgical Incision, SCIP-Inf-4: Cardiac Surgery Patients with (NEW) Clostridium difficile (C.diff.) 47.77% 76.56% 85.70% Communication with Nurses 25% 0.7500 Controlled 6 Postoperative Serum Glucose 0.7779 PSI-90* 55.62% Patient Communication with Doctors 79.88%Safety Indicator 88.79%Composite easure ID Outcomes of Care Efficiency Clinical Care - Outcomes: Performance Period FFY 2017 Payment djustment Safety of Care (PSI-90): Performance Period Safety of Care (PSI-90): Baseline Period Safety of Care (ll other): Baseline Period Safety of Care (ll other): Performance Period Efficiency and Cost Reduction: Baseline Period Efficiency and Cost Reduction: Performance Period
Operational and Comparative nalyses Category: Operational/Comparative nalyses for Reimbursement/Education Purpose: nalyses that address past, present, and future policy, utilization, and reimbursement issues Uses: Profitability Indicators: Liquidity Indicators: Capital Structure Indicators: Total argin Current Ratio verage ge of Plant Operating argin verage Payment Period Capital Expenditures as a % of Depreciation Earnings before interest, tax, depreciation and amortization (EBITD) argin Days Cash on Hand ll Sources Debt to Capitalization Operating Cash Flow argin Net Days Revenue in /R Debt Service Coverage Budgeting and Strategic Planning
Critical ccess Hospital DataBook lso includes inpatient utilization, financial indicators, and quality performance data
Legislative nalyses and Tools Category: Legislative nalyses for dvocacy & Education Purpose: How various payment policy changes authorized by the C/other legislation will impact your edicare fee-for-service reimbursement Uses: dvocacy/budgeting and board/internal meetings
Legislative nalyses and Tools: Risk to CH Payments
Legislative nalyses and Tools: edicare Cuts nalysis
Legislative nalyses and Tools: edicare Cuts nalysis (cont.)
Legislative nalyses and Tools: Proposed edicare Cuts nalysis
Use of nalyses Enhance federal policy / advocacy agenda Committee work with members Board discussions/positions Coalition building
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