National Provider Call: Hospital Value-Based Purchasing (VBP) Program

National Provider Call:

Hospital Value-Based Purchasing (VBP) Program

Fiscal Year 2016 Overview for

Beneficiaries, Providers and Stakeholders

Cindy Tourison, MSHI

Lead, Hospital Inpatient Quality Reporting and Hospital Value- Based Purchasing

April 29, 2014

Agenda

Topics and Objectives

FY 2016 Hospital VBP Program

Introduction and Exclusions

Domains and Measures/Dimensions Baseline and Performance Periods Evaluating Hospitals

Hospital Eligibility Domain Weighing

FY 2016 Baseline Report Resources

Objectives

 Identify new and readopted Measures for FY 2016

 Review baseline and performance periods

 Know how to read your FY 2016 Baseline Report

Hospital VBP Program

Introduction

Hospital Value-Based Purchasing (VBP) Program

Initially required in the Affordable Care Act and further defined in Section 1886(o) of the Social Security Act

Quality incentive program built on the Hospital Inpatient Quality Reporting (IQR) measure reporting infrastructure

Hospitals will be paid for inpatient acute care services based on the quality of care, not just quantity of the services provided

Funded by a 1.75% reduction from participating hospitals’ base operating Diagnosis-Related Group (DRG) payments for FY 2016

Who is eligible for the program?

As defined in Social Security Act Section 1886(d)(1)(B), the program

applies to subsection (d) hospitals located in the 50 states and the District of Columbia

Hospital VBP Program

Exclusions

Who is excluded from the Hospital VBP Program?

Hospitals subject to payment reductions under the Hospital IQR Program Hospitals and hospital units excluded from the Inpatient Prospective Payment System (IPPS)

Hospitals cited for deficiencies during the performance period that pose immediate jeopardy to the health or safety of patients

Hospitals with less than the minimum number of domains calculated

Hospitals paid under Section 1814 (b)(3) and received an exemption from the Secretary of HHS

Hospitals excluded from Hospital VBP will not have 1.75%

withheld from their base operating DRG payments in FY 2016.

Domains and Measures/Dimensions

FY 2016

Domains and Measures/Dimensions

Clinical Process of Care

AMI-7a: Fibrinolytic therapy received within 30 minutes of hospital arrival

IMM-2: Influenza Immunization

PN-6: Initial antibiotic selection for community-acquired pneumonia in immunocompetent patient

SCIP-Inf-2: Prophylactic antibiotic selection for surgery patients

SCIP-Inf-3: Prophylactic antibiotics discontinued within 24- hours after surgery end time

SCIP-Inf-9: Urinary catheter removed on post-operative day 1 or post-operative day 2

SCIP-Card-2: Surgical patients on beta-blocker therapy prior to arrival who received a beta-blocker during the perioperative period

SCIP-VTE-2: Surgical patients who received appropriate venous thromboembolism prophylaxes within 24-Hours prior to surgery to 24-hours after

Domains and Measures/Dimensions

Patient Experience of Care

Hospital Consumer Assessment of

Healthcare Providers and Systems Survey (HCAHPS) Dimensions

Communication with Nurses Communication with Doctors

Responsiveness of Hospital Staff Pain Management

Communication About Medicines Cleanliness and Quietness of Hospital Environment

Discharge Information

Domains and Measures/Dimensions

Outcome

30-Day Mortality Measures

MORT-30-AMI MORT-30-HF MORT-30-PN

AHRQ Measure

PSI-90 Composite

Healthcare Associated Infection (HAI) Measures

CLABSI CAUTI

SSI:

Domains and Measures/Dimensions

Outcome: Mortality Measures

Mortality Measures

Claims-Based Measures

Utilizes admissions for Medicare Fee-for-Service (FFS) beneficiaries aged ≥65 years discharged from subsection(d) and Maryland acute care hospitals having a principal discharge diagnosis of Acute Myocardial Infraction, Heart Failure, or Pneumonia, and meeting other measure inclusion criteria

Reported as survival rates

MORT-30-AMI: Acute Myocardial Infarction (AMI) 30-Day Mortality Rate

MORT-30-HF: Heart Failure (HF) 30-Day Mortality Rate MORT-30-PN: Pneumonia (PN) 30-Mortality Rate

Domains and Measures/Dimensions

Outcome: AHRQ PSI-90

Agency for Healthcare Research and Quality (AHRQ) Measure PSI-90 Composite

• Composite of 8 underlying component patient safety indicators (PSIs) which are sets of indicators on potential in-hospital complications and adverse events

during surgeries and procedures

• Claims-Based Measure

PSI 03 Pressure Ulcer Rate

PSI 06 Iatrogenic Pneumothorax Rate

PSI 07 Central Venous Catheter-Related Bloodstream Infection Rate PSI 08 Postoperative Hip Fracture Rate

PSI 12 Postoperative Pulmonary Embolism or Deep Vein Thrombosis Rate PSI 13 Postoperative Sepsis Rate

PSI 14 Postoperative Wound Dehiscence Rate PSI 15 Accidental Puncture or Laceration Rate

Domains and Measures/Dimensions

Outcome: HAI Measures

Healthcare-Associated

Infections (HAI) Measures

CLABSI: Central line-associated blood stream infections among adult, pediatric and neonatal ICU patients

CAUTI: Catheter-associated urinary tract infections among adult and pediatric ICUs

SSI: Surgical site infections specific to Abdominal hysterectomy and Colon surgery

Domains and Measures/Dimensions

Efficiency: MSPB Measure

MPSB-1: Medicare Spending Per Beneficiary (MSPB)

Claims-Based Measure

Includes risk-adjusted and price-

standardized payments for Part A and Part B services provided 3-days prior to hospital admission through 30-days after hospital discharge

Baseline and Performance Periods

FY 2016

Evaluating Hospitals

Performance Standards

Benchmark

Average (mean) performance of the top ten percent of

hospitals during the baseline period

Achievement Threshold

Performance at the 50

percentile (median) of

hospitals during the baseline

period

Evaluating Hospitals

(1 of 2)

A higher rate is better for the following measures/dimensions:

Clinical Process of Care Measures Patient Experience of Care Measures 30-Day Mortality Measures*

MORT-30-AMI MORT-30-HF MORT-30-PN

*Note: The 30-day Mortality Measures are reported as survival rates;

Evaluating Hospitals

(2 of 2)

A lower rate is better for the following measures:

AHRQ PSI-90 Composite HAI Outcome Measures

CLABSI CAUTI SSI

Abdominal Hysterectomy Colon Procedure

Efficiency Measure*

*Note: Unlike other measures, the Efficiency Domain measure, MSPB, utilizes data from the performance period to calculate the benchmark and

Evaluating Hospitals

Achievement vs. Improvement

Achievement Points

Awarded by comparing an individual hospital’s rates during the performance period with all hospital’s rates from the baseline period

Rate equal to or better than benchmark = 10 points Rate lower than the achievement threshold = 0 points Rate equal to or better than the achievement

threshold and lower than the benchmark = 1-10 points

Improvement Points

Awarded by comparing an individual hospital’s own rates from the baseline period to the performance period

Rate equal to or lower than the baseline period rate = 0 points

Rate between the baseline period rate and the benchmark = 0-9 points

Hospital Eligibility:

Clinical Process of Care Domain

Clinical Process of Care Domain Measures

A measure must have at least 10 eligible cases during the baseline period to have an improvement score calculated on the Percentage Payment Summary Report

A measure must have at least 10 eligible cases during the performance period to have either an achievement or improvement score calculated on the Percentage Payment Summary

Report

The Clinical Process of Care Domain requires at least 4 out of the 8 measures to be scored in order for the domain score to be included in the Total Performance Score (TPS) on the

Percentage Payment Summary Report

Hospital Eligibility:

Patient Experience of Care Domain

HCAHPS Survey

Requires at least 100 completed HCAHPS surveys during the baseline period to have an improvement score calculated on the Percentage Payment Summary Report

Requires at least 100 completed HCAHPS surveys during the performance period to have either an achievement or improvement score calculated on the Percentage Payment Summary Report

The Patient Experience of Care Domain requires at least 100 completed HCAHPS surveys during the performance period for the domain score to be included in the Total Performance Score (TPS) on the Percentage Payment Summary Report

Hospital Eligibility

Outcome Domain (1 of 4)

30-Day Mortality Measures

A measure must have at least 25 eligible cases during the baseline period to have an improvement score calculated on the Percentage Payment Summary Report

A measure must have at least 25 eligible cases during the performance period to have either an achievement or improvement score calculated

Hospital Eligibility

Outcome Domain (2 of 4)

AHRQ PSI-90 Composite

The measure must have at least 3 eligible cases on any one

underlying indicator during the baseline period to have an

improvement score calculated on the Percentage Payment Summary Report

The measure must have at least 3 eligible cases on any one

underlying indicator during the

performance period to have an either an achievement or improvement score calculated on the Percentage Payment Summary Report

Hospital Eligibility

Outcome Domain (3 of 4)

HAI:

CLABSI/CAUTI/SSI

A measure must have at least 1 predicted infection calculated by the Centers for Disease Control (CDC) during the baseline period to have an improvement score calculated on the Percentage Payment Summary Report

A measure must have at least 1 predicted infection calculated by the Centers for Disease Control (CDC) during the performance period to have either an

achievement or improvement score calculated on the

Percentage Payment Summary

Hospital Eligibility

Outcome Domain (4 of 4)

Outcome domain

Requires at least 2 of the 7 measures to be scored in order for the domain score to be included in the Total Performance Score (TPS) on the Percentage Payment Summary Report

Hospital Eligibility:

Efficiency Domain

• The measure must have at least 25 eligible episodes of care during the baseline period to have an

improvement score calculated on the Percentage Payment Summary Report

• The measure must have at least 25 eligible episodes of care during the performance period to have either an improvement or achievement score calculated

• The Efficiency Domain requires at least 25 eligible episodes of care during the performance period to be scored in order for the domain score to be

included in the Total Performance Score (TPS) on the Percentage Payment Summary Report

Hospital Eligibility

Total Performance Score

Hospitals need scores for at least 2 out of 4 domains to receive a Total Performance Score (TPS)

Excluded domain weights are proportionately distributed to the remaining domains to calculate the TPS

Domain Weighting

Sample Scenario

A hospital meets minimum case and measure requirements for the Clinical Process, Patient Experience and Outcome domains, but does not meet the minimum number of episodes required for the Efficiency domain

FY 2016 Baseline Report

Clinical Process of Care

Clinical Process of Care Measures

8 measure details including benchmarks, achievement thresholds, numerators, denominators and hospital baseline rate

Sample Clinical Process of Care Report

FY 2016 Baseline Report

Patient Experience of Care

Patient Experience of Care Dimensions

8 dimension details including floor values, benchmarks,

achievement thresholds, a hospital’s baseline rate and number of completed surveys during the baseline period

Sample Patient Experience of Care Report

FY 2016 Baseline Report

Mortality Measures

Outcome Measures

30-Day Mortality Measures

Measure details, including the number of eligible discharges, benchmarks, achievement thresholds and a hospital’s baseline rate

AHRQ PSI-90 Composite

Measure details, including index value, achievement threshold and benchmark

Healthcare Associated Infections

Measure details including number of observed infections (numerator), number of predicted infections (denominator), standard infection ratio (SIR), achievement threshold and benchmark

Sample Outcome Report

FY 2016 Baseline Report

Efficiency

Efficiency Measure

MSPB measure details, including MSPB amount (numerator), median MSPB amount (denominator), MSPB measure and number of episodes

Sample Efficiency Measure Report

FY 2016 Baseline Reports

Coming Soon

When to Expect Your Baseline Measure Reports

Notifications will be sent to hospitals and QIOs when the reports are available on My QualityNet

Reports are only available on My QualityNet to hospital users who are active, registered QualityNet users and assigned the following My QualityNet roles:

Hospital Reporting Feedback – Inpatient role

(Required to receive the report)

File Exchange & Search role

(Required to download the report from My QualityNet)

Questions?

Resources

Technical questions or issues related to accessing the report

QualityNet Help Desk email address: [email protected] or call (866) 288-8912.

More information on the FY 2016 Baseline Measures Report

“How to Read Your FY 2016 Percentage Payment Summary Report” guide available on QualityNet in the Hospital VBP section on the Hospital Value-Based Purchasing (VBP) page (direct link):

https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage

%2FQnetTier3&cid=1228772237202.

Note: This document will be posted to the QualityNet when the reports are released.

Frequently Asked Questions (FAQs) related to Hospital VBP

FAQs are available via the Hospital-Inpatient Questions and Answers tool at the following link: https://cms-ip.custhelp.com.

Ask Questions related to Hospital VBP

Submit questions using the Hospital-Inpatient Questions and Answers tool at the following link: https://cms-ip.custhelp.com.