Winning at QI and Safety Through GME: Show Your Value!

Winning at QI and Safety Through GME: Show Your Value! Steven Minnick MD MBA ACGME Designated Institutional Director St. John Hospital and Medical Center Detroit, Michigan

Why this talk? Clinical Learning Environment Review Intense emphasis on Quality metrics our Hospitals are facing. GME has the ability to provide more than ever a strategic advantage!

Coordination with Institutional quality and safety goals was a very evident component of our CLER Review!

CLER: Health Care Quality Pathway HQ Pathway 2: Resident/fellow engagement in quality improvement activities Experiential learning is essential to developing the ability to identify and institute sustainable systems-based changes to improve patient care. Properties include: Residents/fellows are actively involved in the quality improvement activities at the clinical site. The focus will be on the proportion of residents/fellows that are: actively involved in a quality improvement project at the site; involved in inter-professional teams, focused on measures of resource use, aligned and integrated with the clinical site s priorities; and involved in site-wide initiatives with active oversight by the clinical site s quality improvement leadership.

What are those priorities and site-wide opportunities?

You re the CEO. How would you choose the quality metrics to target? How could GME help?

The Hospital Acquired Conditions (HAC) Value Based Purchasing (VBP) Health Engagement Networks (HEN 2.O)

Hospital-Acquired Conditions (HAC) Reduction Program

Hospital-Acquired Conditions (HAC) Reduction Program All Hospitals 25% PENALTY APPLIED Medicare will reduce payments to hospitals with HAC scores in the worst quartile by 1% How will they determine this?

HAC Scoring Methodology 1. AHRQ* Patient Safety Indicator (PSI) 90 Composite Measure. Pressure Ulcer Stage 3 or 4 Iatrogenic Pneumothorax Post-op Hip Fracture Post-op Pulmonary Embolism or Deep Vein Thrombosis Post-op Sepsis Post-op Wound Dehiscence Accidental Puncture or Laceration 2. CAUTI (Catheter Associated Urinary Tract Infection) 3. CLABSI (Central Line Associated Blood Stream Infection) *Agency for Healthcare Research and Quality (AHRQ)

HAC Scoring Methodology weights the different components Total HAC Score Domain 1 Domain 2 Performance On PSI 90 Pressure Ulcer Stage 3 or 4 35% Domain 1 65% Domain 2 CLABSI 50% CAUTI 50% Iatrogenic Pneumothorax Post-op Hip Fracture Post-op Pulmonary Embolism or Deep Vein Thrombosis Post-op Sepsis Post-op Wound Dehiscence Accidental Puncture or Laceration

FFY16: How Can Our GME Programs Help? FFY16 Domain 1 Total HAC Score FFY16* Domain 2 Note: Possible weighting Performance On PSI 90 25% Domain 1 75% Domain 2 CLABSI SSI CLABSI * FFY16 will add Surgical Site Infections (SSI) for Colon and Hysterectomies and FFY17 will add MRSA and Clostridium Difficile Infections

Value Based Purchasing How does hospital value based purchasing work? CMS rewards hospitals based on the quality of care provided to Medicare patients, how closely best clinical practices are followed, and how well hospitals and enhance patient s experiences of care during hospital stays. Hospitals are no longer paid solely used on the quantity of services they provide.

Source: MLN Connects CMS Acute Care and Quality Reporting Systems May 2015

Source: MLN Connects CMS Acute Care and Quality Reporting Systems May 2015

How can GME help? Domains And Weights VBP Measurement Periods Points Assignment The goal is familiarity with the components of the VBP Program

The Role of the Total Performance Score (TPS) Source: MLN Connects CMS Acute Care and Quality Reporting Systems May 2015

Please turn to your handout. CMS bases hospital total performance scores on an approved set of Measures and Dimensions, grouped into specific Domains. Domains currently are as follows: Clinical Processes Clinical Outcomes Patient Experience of Care Efficiency Safety (see FY17)

Assigning Points: Thresholds, Benchmarks, and In-between.

Benchmark equals the mean of the top decile. 10 Points Above the threshold but below the benchmark. 1 9 Points Threshold = 50 th percentile Below the threshold Below the threshold O points CMS assesses each hospitals total performance by comparing its Achievement and Improvement scores for each applicable hospital VBP measure. CMS uses a threshold (50 percentile) and Benchmark (mean of the top decile) to determine how many points are awarded for the Achievement and Improvement scores. CMS compares the Achievement and Improvement scores and only uses whichever is greater.

Assigning Points

Please turn to your handout. Concept: Calculation of the Total Performance Score (TPS) is calculated by using the Domain scores multiplied by their weights and then added together

Patient Experience of Care Domain The dimensions of the Patient Experience of Care Domain are: 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 rating of care Please see your handout HCAHPS HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS SURVEY

Source: MLN Connects CMS Acute Care and Quality Reporting Systems May 2015

Concept: Timing of the Baseline Periods and the Performance Periods Question: When do you think the Baseline Period and the Performance Period for FY 2017 begin and end?

With so much at stake how can our GME programs help? Source: MLN Connects CMS Acute Care and Quality Reporting Systems May 2015

Hospital Engagement Networks (HEN) Leading Edge Advance Practice Topic (LEAPT) Organizations And CMS Support

Centers for Medicaid and Medicare Systems (CMS) selected the organizations which make up the HENs and the LEAPTs

Centers for Medicare & Medicaid Services Partnership for Patients A public-private partnership working to improve the quality, safety and affordability of health care for all Americans Please see your handout The Hospital Engagement Networks (HEN) Leading Edge Advanced Practice Topic (LEAPT) Source: http://partnershipforpatients.cms.gov/about-thepartnership/aboutthepartnershipforpatients.html

HEN s Health Topics 1. Adverse Drug Events 2. Catheter-Associated Urinary Tract Infections 3. Central Line Associated Blood Stream Infections 4. Injuries from Falls and Immobility 5. Obstetrical Adverse Events 6. Pressure Ulcers 7. Surgical Site Infections 8. Venous Thromboembolism 9. Ventilator-Associated Pneumonia 10. Readmissions Source: http://partnershipforpatients.cms.gov/about-the-partnership/what-is-the-partnershipabout/lpwhat-the-partnership-is-about.html

LEAPT s Health Topics 1. Severe Sepsis and Septic Shock (mandatory) 2. Clostridium Difficile (c-diff) 3. Hospital Acquired Acute Renal Failure 4. Airway Safety 5. Iatrogenic Delirium 6. Procedural Harm 7. Undue Exposure to Radiation 8. Failure to Rescue 9. Results beyond 40/20 AIMs 10. Hospital Culture of Safety 11. Cost Savings Calculations for Hospital Acquired Conditions Source: http://partnershipforpatients.cms.gov/about-the-partnership/hospital-engagementnetworks/thehospitalengagementnetworks.html

In conclusion

Questions? Thank you.