Hospital Value-Based Purchasing (At a Glance) Healthcare Financial Management Association South Carolina Chapter March 20, 2012 Presenters: Linda Moore, RN, Manager of Federal Programs and Services, CCME Collins Gibson, MS, Research Analyst, CCME www.ccmemedicare.org
Introduction Established in the Affordable Care Act and further defined in Section 1886(o) of the Social Security Act Quality incentive program based on the Hospital Inpatient Quality Reporting (IQR) measure reporting structure Next step in promoting higher quality care for Medicare beneficiaries
Funding and Eligibility Funded by a 1% withhold from participating hospitals Diagnosis-Related Group (DRG) payments Subsection (d) hospitals are eligible Statutory definition of subsection (d) hospitals is in Section 1886(o)(1)(C)(i) of the Affordable Care Act
Reasons for Exclusion Hospitals subject to payment reduction under the hospital IQR program Hospitals excluded from the Inpatient Prospective Payment System (IPPS) Psychiatric hospitals Rehabilitation hospitals Long-term care hospitals Critical access hospitals, etc.
Reasons for Exclusion 2 Hospitals paid under Section 1814(b)(3) but have received an exemption from DHHS Hospitals reporting fewer than 100 HCAHPS surveys Hospitals without the minimum number of cases and measures Hospitals cited for deficiencies during the Performance Period that pose immediate jeopardy to the health or safety of patients
To Receive Scores Must Have Both Hospitals receive a Clinical Process of Care domain score if they have at least 10 cases for each of at least four applicable measures Patient Experience of Care domain score if they have at least 100 completed HCAHPS surveys during the Performance Period
Critical Dates FY 2013 VBP Program Baseline Period for both domains July 1, 2009 March 31, 2010 Performance Period for both domains July 1, 2011 March 31, 2012 Hospitals should receive notification of the exact amount of their FY 2013 value-based incentive payment in November 2012
Domains 12 Clinical Process of Care Measures 1. AMI-7a: Fibrinolytic Therapy in 30 Minutes 2. AMI-8: Primary PCI in 90 Minutes 3. HF-1: Discharge Instructions 4. PN-3b: Blood Cultures in ED Prior to Antibiotic 5. PN-6: Antibiotic Selection 6. SCIP-Inf-1: Antibiotic Received Within 1 Hour Prior to Incision 7. SCIP-Inf-2: Antibiotic Selection 8. SCIP-Inf-3: Antibiotic Discontinued in 24 Hours 9. SCIP-Inf-4: Cardiac Patients with Controlled Serum Glucose 10. SCIP-CARD-2: Beta Blocker Prior That Received Beta Blocker 11. SCIP-VTE-1: Recommended VTE Ordered 12. SCIP-VTE-2: VTE Received Within 24 Hours 8 Patient Experience of Care Dimensions 1. Nurse Communication 2. Doctor Communication 3. Hospital Staff Responsiveness 4. Pain Management 5. Medicine Communication 6. Hospital Cleanliness and Quietness 7. Discharge Information 8. Overall Hospital Rating
Total Process Score 70% - based on Clinical Process of Care measures 30% - based on Patient Experience of Care dimensions
Achievement Points Awarded by comparing a hospital s rates during the Performance Period with all hospitals rates during the Baseline Period How Many Points 10 points: rate at or above the Benchmark 0 points: rate less than Achievement Threshold 1-9 points: rate in between Threshold and Benchmark
Improvement Points Awarded by comparing a hospital s rates during the Performance Period that hospital s rate during the Baseline Period How Many Points 9 points: rate at or above the Benchmark 0 points: rate less or equal to Baseline Rate 0-9 points: rate in between Baseline and Benchmark
FY 2013 Total Performance Score Clinical Process Domain Score 70% + Patient Experience Domain Score 30% = Total Performance Score
How We Can Help We can assist you with 1. Making sure the right data is in the right place at the right time 2. Improving your Clinical Measures 3. Improving your HCAHPS Scores 4. Keeping VBP at the forefront
How is this accomplished Dedicated staff to assist with Quality Data Reporting activities Data submission reminders TAFFY The Abstraction Forum For You Partnership with the SCHA
Resources Hospital Compare: www.hospitalcompare.hhs.gov VBP Final Rule: www.gpo.gov/fdsys/pkg/fr- 2011-05-06/pdf/2011-10568.pdf Detailed information: www.cms.giv/hospital- Value-Based-Purchasing/
Questions???
Thank You!!! Linda Moore, RN Collins Gibson, MS The Carolinas Center for Medical Excellence 246 Stoneridge Drive, Suite 200 Columbia, SC 29210 803-212-7500 This material was prepared by The Carolinas Center for Medical Excellence, the Medicare Quality Improvement Organization for South Carolina, 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. 10SOW-SC-C6-12-3