Value Based Purchasing: New Tools for Hospitals

Value Based Purchasing:

New Tools for Hospitals

The Value Based Purchasing Score Estimator

& HANYS Quality Reports

Overview of CMS

Value Based Purchasing

Program

Brian Potter,

Vice-President, Finance & Operations Wisconsin Hospital Association

Introduction to the VBP

Tools on the Quality

Center website

Stephanie Sobczak, MS, MBA Manager, Quality Improvement

Today’s Agenda

1. Intro - Bringing Finance and Quality Together

2. Overview of CMS Value Based Purchasing Program

3. Overview of Hospital Reports section of the WHA

Quality Center website

4. Introduction to the Value Based Purchasing Score

Estimator Tool

Bringing Finance and Quality Together

On October 19

_{, 2010 -}

Over 100 CFO’s, CNO’s and

QI leaders from across

Wisconsin came together to

find common ground in the

new Value Based Purchasing

world.

Based on member

Purpose of the WHA VBP Reports and Tools

1. To provide reports and tools for hospital Quality & Finance

leaders as the VBP implementation approaches.

2. To offer WHA member hospitals secure access to reports on

the WHA Quality Center website.

3. To address WHA member needs as hospitals consider the

impact of Value Based Purchasing.

VBP Program Overview

Goals according to CMS

•

Transition Acute Care hospitals to Medicare Pay for Performance

• Align payment incentives (and penalties) to promote both:



Achievement of high quality care



Improvement in care quality

• Program was outlined in the PPACA

• Secretary of HHS and CMS are charged with implementation

Key Exclusions

• Critical Access Hospitals

hospital VBP demonstration will be established)

• Specialty Hospitals

• Hospitals with small numbers



Fewer than 4 useable Process measures or

•

Funded by Medicare IPPS payment reductions:

•

1.0% reduction in FFY 2013, increasing each year by .25% to 2.0%

for FFY 2017 and beyond

•

Budget-neutral:

•

each year’s pool fully distributed to hospitals in that same year

•

Payment adjustments applied to base operating amount:

•

excluding IME, DSH, low-volume adjustments, and outliers

0.0 0.5 1.0 1.5 2.0 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010

Percent Carve-Out for VBP Pool

VBP Program Funding

Oct. Nov. Dec. Jan. Feb. Mar. Apr. May June July Aug. Sept. FFY 2009 2008 2008 2008 2009 2009 2009 2009 2009 2009 2009 2009 2009 FFY 2010 2009 2009 2009 2010 2010 2010 2010 2010 2010 2010 2010 2010 FFY 2011 2010 2010 2010 2011 2011 2011 2011 2011 2011 2011 2011 2011 FFY 2012 2011 2011 2011 2012 2012 2012 2012 2012 2012 2012 2012 2012 FFY 2013 2012

Proposed Baseline Period (reflects quality data from

Dec. 2010 Hospital Compare release --most

recent release)

Proposed Performance

Period

(will reflect quality data from Dec. 2012 Hospital Compare

release) Release of Final Rule

(by law, VBP performance standards must be published 60-days prior to start of performance

period) Medicare IPPS payment

adjusted based on hospital

performance

First Year VBP Implementation Timeline

Source: HANYS

• Clinical Process of Care Domain

• 17 process measures

• Patient Experience of Care Domain

• HCAHPS Survey (8 HCAHPS dimensions)

FFY 2013

• All of the above plus:

• Outcome of Care Domain

• Mortality, AHRQ measures, HACS

• Possible efficiency measures

• Medicare spending per beneficiary

• Internal hospital efficiency

• Others

• Possible nursing sensitive care measures

FFY 2014

Determine points for each measure • Higher of achievement or improvement Combine each measure’s points into domain scores • Sum of points earned divided by total possible points for domain

Linear Scoring Model

FFY 2013 FFY 2014 FFY 2015 FFY 2016 FFY 2017

Process Domain Score: 31% 1% Carve-Out 1.25% Carve-Out 1.5% Carve-Out 1.75% Carve-Out 2% Carve-Out

HCAHPS Domain Score: 6% Dollars Contributed to VBP $147,000 $184,000 $221,000 $258,000 $294,000

Overall VBP Score (70%

Process, 30% HCAHPS): 24% Estimated Payment from VBP Pool $82,075 $102,733 $123,391 $144,050 $164,150 Payment Percentage: 56% Dollars Left in the VBP Pool for _{Redistribution} ($64,925) ($81,267) ($97,609) ($113,950) ($129,850)

Sample Hospital 0% 20% 40% 60% 80% 100% 120% 140% 160% 180% 200% 220% 240% 260% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Pa ym en t Pe rc en ta ge Score

Linear Payment Scenario

Detailed Scoring Explanations…

Additional documents are posted on the Quality Center Reports page for detail on the VBP scoring method:

Any Questions, so far?

Brian Potter, VP Finance and Operations 608.268.1814

[email protected]

Accessing Tools & Quality Reports

NEW

– Secure Hospital Reports Area

1. Enter your hospital’s MedicareID#

2. Default password is Pass_MedicareID# 3. Once in, you may change the password

NOTE: This login is Hospital Specific; not for an individual user

ABC Hospital

Your Hospital’s Tools and Reports Page

Select a button to choose a report, then hit “Get Report”

Text in blue is supplementary

information such as: • Instructions

Introduction to the VBP Score Tool

• Developed by the South Carolina Hospital Association (and generously shared with WHA)

What is the VBP Tool?

A pre-programmed spreadsheet that allows much more timely analysis of a hospitals VBP Score (compared to the lag present in Hospital Compare)

Features:

1. Based in MS Excel v. 2007

2. Macro enabled calculations and graphing throughout the tool.

3. One page for data entry – very user friendly.

4. Easy to update with most current data.

5. No “small number” flagging – great for CAH’s.

6. Includes a scorecard/dashboard format – red, yellow, green flags

7. Analyzes (1) acute myocardial infarction (AMI); (2) heart failure;

What the VBP Score Estimating Tool is not

These reports ARE NOT intended to provide actual results as most variables in the final models have not yet been determined by CMS. THESE REPORTS ARE INTENDED ONLY TO ASSIST HOSPITALS IN

PREDICTING POTENTIAL CASH IMPACT BASED ON THE BEST AVAILABLE DATA AT THE TIME OF THE REPORT OR THE MOST RECENT UPDATED MODEL.

The Benefit:

You get a head start on watching your trends and

focusing your improvements to move the dial on

Using the VBP Template

Value Based Purchasing Score Estimator Tool

Instructions for Use – Print these out for easy reference; located on your

hospital’s reports page

Step 1: Open the VPB Excel Spreadsheet. (Requires MS Excel 2007)

Using the VBP Spreadsheet

Step 2: Enable the embedded Macros in the spreadsheet.

Select the Options box as below

In the Security Alert dialogue box, select the “Enable this content”,

and Choose OK to proceed. (See the red arrows below). If this step is not

complete, selecting the Medicare ID will not be possible, and the

Using the VBP Spreadsheet

Step 3: Quality Measure Inputs

After completing the steps to enable embedded Macros, select the Quality Measures Input tab

You will see a spreadsheet that allows entry of numerators and denominators for the proposed VBP quality measures. At the top is a selection box in which you will choose your hospital’s Medicare ID number. You will see your hospital’s name reflected on each page, and calculations will be based on publicly available baselines for your facility.

Using the VBP Spreadsheet

Step 4: Data Entry

At first, manual entry of numerators or denominators is needed for a 13 month period. If data is available on a similarly formatted

Using the VBP Spreadsheet

Step 5: Reviewing the data

Using the VBP Spreadsheet

Step 6: Customize the Dashboard feature

Updating the VBP Estimator Tool

Ongoing Use of the VPB Tracker

Each month, as your quality measures numerators and denominators become available, simply select the “Advance 1 Month” button, and the next month’s column will appear on the right side of the spreadsheet.

Using HANYS Quality Reports

HANYS is the Healthcare Association of New York State, from which

WHA obtains numerous financial reports.

The HANYS reports available on the WHA Quality Center site are

populated with the most current data available from CMS/Hospital

Compare.

Reports will be made available through WHA on a quarterly basis

(or as soon as Hospital Compare measures are updated).

ABC Hospital

Other Reports for your Hospital

Four HANYS Reports:

• VBP Report based on current Hospital Compare data

• Quality Indicators Report • Medicare Readmission

• HCAHPS Benchmark Report

HANYS Reports – VBP Estimate

FFY 2013 FFY 2014 FFY 2015 FFY 2016 FFY 2017

Process Domain Score: 31% 1% Carve-Out 1.25% Carve-Out 1.5% Carve-Out 1.75% Carve-Out 2% Carve-Out

HCAHPS Domain Score: 6% Dollars Contributed to VBP $147,000 $184,000 $221,000 $258,000 $294,000

Overall VBP Score (70%

Process, 30% HCAHPS): 24% Estimated Payment from VBP Pool $82,075 $102,733 $123,391 $144,050 $164,150 Payment Percentage: 56% Dollars Left in the VBP Pool for _{Redistribution} ($64,925) ($81,267) ($97,609) ($113,950) ($129,850)

Sample Hospital 0% 20% 40% 60% 80% 100% 120% 140% 160% 180% 200% 220% 240% 260% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Pa ym en t Pe rc en ta ge Score

Linear Payment Scenario

HANYS Reports - HCAHPS

Your Hospital

Also has HCAHPS

HANYS Reports -Readmissions

Updating Hospital Reports

The South Carolina Hospital association updates the VBP Template with each release of CMS proposed rule changes.

HANYS Reports are updated as the data is made available in Hospital Compare.

WHA will post any updates to the Quality Center, and notify QI Managers via e-mail.

E-mail

From: Stephanie Sobczak

Suggested Next Steps

1. Access the Hospital Quality Reports on the WHA Quality Center website. 2. Download the Value Based Purchasing Template

3. Following the instructions, enter 13 months of your quality indicators data on the spreadsheet.

4. Then examine the template and the HANYS reports and collaborate with Finance to make an assessment of strengths and areas for improvement. 5. You will be notified by e-mail with a link to the Quality Center website,

Thank you!

Any Questions?

Stephanie Sobczak, QI Manager 608.268.1847

[email protected]

Brian Potter, VP Finance and Operations 608.268.1814