Transforming to Value-Based Purchasing (VBP) QI tools can drive your value proposition Paul Mulhausen, MD, AGSF, FACP Medical Director Telligen Quality Improvement Network Quality Improvement Organization This material was prepared by Telligen, Medicare Quality Innovation Network Quality Improvement Organization, 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. 11SOW-QIN-D1-9/2015-11215 Presentation Objectives You will use the CMS QAPI Tools to support the development of your QAPI program. You will be familiar with sources of tools to support the implementation of QAPI and use them to initiate and develop your process improvement projects. You will be able to develop a priority focus to start your initial set of process improvement projects. You will recognize the value of Learning and Action Networks and join a quality improvement collaborative. 2 1
Payment Taxonomy and Alternative Payment Models Fee for Service No Link to Quality Payments based on volume and not linked to quality or efficiency Limited in Medicare fee-forservice Majority of Medicare payments are now linked to quality 3 Fee for Service Link to Quality A portion of payments vary based on the quality or efficiency of care delivery Hospital Value Based Purchasing Physician Value Based Modifier Readmissions/Ho spital Acquired Conditions Alternative payment built on fee-for service Some payment is linked to the effective management of a population or an episode of care ACOs Medical Homes Bundled Payment CPCI Comprehensive ESRD Population Based Payment Payment is not directly triggered by service delivery. Eligible Pioneer ACO in years 3-5 Quality Program and CMS Proposed Rules for 2016 4 IMPACT Act SNF Quality Reporting Program Skin Integrity Falls Function SNF Value Based Purchasing Program Hospital Readmissions QAPI Develop, implement, and maintain an effective, comprehensive, data-driven QAPI program that focuses on systems of care, outcomes of care and quality of life. 2
Tools for Your Transformation Building the foundation and infrastructure Prioritizing your initial focus Start improving Measuring your success and challenges Understanding and overcoming challenges 5 Build the Foundation - QAPI Build the Foundation: QAPI QAPI cuts across all areas of quality focus. Elements of QAPI Design and Scope Governance and Leadership Feedback, Data Systems and Monitoring Performance Improvement Projects Systematic Analysis and Systematic Action CMS QAPI framework and tools 6 https://www.cms.gov/medicare/provider-enrollmentand-certification/qapi/qapitools.html 3
Take the Next Step Prioritize and Develop Focus Areas of national focus: 7 Avoidable Readmissions Dementia Care Staff Stability IMPACT Act Function, Skin Integrity, Falls 5-Star Rating Infections and infection control QAPI governing body Resident and family needs and expectations Advanced Payment Model partnerships Finding Resources to Prioritize and Develop Focus Leading Age The Medicare QIN-QIO The National Nursing Home Quality Care Collaborative Advancing Excellence 9 Potential Goals CDC Nursing Homes and Assisted Living web site Gaps in care identified during recent state surveys 8 4
Resources to Prioritize and Develop Focus Star rating system 11% 1 star 20% 5 stars Quality measures 13 item composite score (<6.0) Decrease use of antipsychotics 9 Resources to Help Prioritize and Develop Focus 10 5
Start Improving Pilot the Intervention(s) Best practices learned from Learning and Action Networks, colleagues, professional journals, and industry consultants CMS QAPI Website: https://www.cms.gov/medicare/provider-enrollmentand-certification/qapi/nhqapi.html Advancing Excellence State QIN-QIO (Telligen) Medical Directors 11 Start Improving INTERACT A quality improvement approach to reduce acute care transfers Focuses on change in condition management Three basic types of tools Communication Tools Care Paths or Clinical Tools Advance Care Planning Facilities Reduction in All Cause Hospitalization Engaged 24% All 17% 12 6
Start Improving - IAADAPT Web-based Training https://www.healthcare.uiowa.edu/igec/iaadapt/ Toolkit Clinical Decision Aids Integrates well with Advancing Excellence Tools 13 Start Improving Advancing Excellence Mobility One of nine areas of focus for Advancing Excellence Tools for use in four domains Mobility Assessment Mobility Intervention Environmental Design Communication 14 7
Measuring Success QIN-QIO Run Charts 15 Measuring Success Advancing Excellence Mobility Tracking Tool 16 8
Measuring Success INTERACT Hospitalization Tracking Tool 17 Overcoming Challenges QI Tools PDSA Model for Change Root Cause Analysis Fish Bone Diagrams 5 Why s 18 9
Where are the resources? Your industry advocates Leading Age! Your Medicare QIN-QIO Telligen! Your colleagues, co-workers, and other providers Learning and Action Networks National Nursing Home Quality Care Collaborative Advancing Excellence https://www.nhqualitycampaign.org 19 More Resources CMS QAPI Framework and Tools https://www.cms.gov/medicare/provider-enrollment-and- Certification/QAPI/qapitools.html INTERACT II https://interact2.net/ Centers for Disease Control http://www.cdc.gov/longtermcare/index.html National Action Plan to Prevent Health Care Associated Infections 20 http://health.gov/hcq/prevent-hai.asp 10
Other Resources Administration for Community Living http://www.acl.gov/ CMS Medicare Learning Network https://www.cms.gov/outreach-and- Education/Medicare-Learning-Network- MLN/MLNGenInfo/index.html 21 Join a Collaborative! National Nursing Home Quality Care Collaborative Sheryl Marshall, RN, CDP 515-273-8844 Sheryl.marshall@area-d.hcqis.org Heidi Lourens 515-440-8903 Heidi.Lourens@area-d.hcqis.org 22 11
Start Now! Value-Based and Population-Based payment implementation are driving quality as a key element of the value proposition. There are many tools and resources with which you can begin transform your QA program into a QAPI program. Organize your QAPI team and start your QAPI journey. Use the widely available tools and resources we discussed to support your process improvement, measurement, feedback, and understanding. Become a part of a Learning and Action Collaborative. 23 Questions? 24 12