Blue Cross Blue Shield of Michigan (BCBSM) designates small, rural acute care facilities that provide access to care in areas where no other care is available as peer group 5 facilities (PG5). Additionally, many of these hospitals are also classified as Critical Access Hospitals (CAH) by Medicare. The BCBSM PG 5 Hospital Pay‐for‐Performance (P4P) program provides these hospitals with an opportunity to demonstrate value to their communities and customers by meeting expectations for access, effectiveness and quality of care. BCBSM recognizes that rural hospitals seek to be a part of the value equation that these incentive programs provide. The goal of BCBSM’s Hospital Incentive Programs is to develop innovative and collaborative programs that improve both patient and population‐based quality, increase hospital‐physician alignment, and decrease costs.
The peer group 5 hospital community can provide valuable feedback about the P4P program through the peer group 5 P4P Advisory Group. This group is dedicated to collaboratively discuss each year’s P4P program and evaluate program measures to ensure each positively challenges rural hospitals to deliver the most value to the communities they serve. The PG5 P4P Advisory group includes representatives from BCBSM, the Michigan Health & Hospital Association (MHA), and members of the PG5 hospital community – membership and contact information can be found in Appendix A. Peer group 5 hospitals may contact these representatives to provide comments related to the P4P program, and any comments received will be presented at future Advisory Group meetings for consideration.
In order to better reflect the value that the PG5 P4P program delivers to rural hospital communities, the 2014–2015 program has realigned selected program components and their weights to increase the inherent value of existing program measures, as well as the introduction of two measures closely aligned with existing program measures and current hospital efforts. The following sections describe each key aspect of the 2014–2015 PG5 Pay‐ for‐Performance program.
The PG 5 Hospital Pay‐for‐Performance program described in this document is effective April 1st, 2014 through March 31st, 2015. Performance in the program determines up to six percentage points of a rural hospital’s payment rate, effective October 1st, 2015.
Program
Overview
2014 Peer Group 5
Hospital Pay‐for‐Performance Program
April
2014
through
March
2015
2014–2015
P4P
Program
Structure
Although the program structure has changed slightly, the 2014‐2015 PG5 P4P program contains many of the same program components as previous program years. This program year includes a new Health of the Community program component, worth 30% of the P4P program. This component will consist of two existing measures, Community Service Plan (CSP) and HCAHPS survey submission, as well as the introduction of a new Population Health Management Attestation initiative. The Clinical Quality Indicator portion of the P4P will be worth 30% and maintain the same four CMS outpatient measures from the previous program year. The Quality Initiative program component will be worth 40% of the program and participation in two quality initiatives is required. Hospitals may still participate in more than two quality initiatives and be scored on the two top performing initiatives, excluding MICAHQN participation for CAH hospitals.
Pre
‐
Qualifying
Condition
&
CEO
Attestation
Form
Culture of Patient Safety Survey
In order for hospitals to participate in the PG5 P4P program, each much first meet the culture of patient safety survey pre‐qualifying condition. Peer group 5 hospitals must conduct a hospital‐wide patient safety assessment survey at least once every two years, in either 2013 or 2014. There are two eligible surveys:
Hospital Survey on Patient Safety Culture (HSOPSC) Safety Assessment Questionnaire (SAQ)
The survey can be assessed by a vendor, online assessment tool, or a hospital self‐assessment process, but the assessment process must provide guidance for how to make improvements in patient safety culture. A hospital wishing to use an alternative survey may contact BCBSM for review and consideration.
CEO Attestation Form
The P4P also requires hospitals to submit a yearly CEO attestation to BCBSM. This attestation certifies that the information being sent to BCBSM for the PG5 P4P program is true and to the best of the knowledge of each hospital. Additionally, the form also provides documentation for each of the individual program components, provides information on the results of the patient safety assessment, and outlines any activities the hospital plans to implement to address findings from the assessment. The CEO attestation form will be distributed via email to PG5 P4P representatives by April 1, 2015 and should be submitted to BCBSM by fax or email at
[email protected] by June 1, 2015.
Health
of
the
Community
(30%)
The Health of the Community is a new program component for the 2014‐2015 P4P program year and houses program measures dedicated to improving the overall health of rural communities. Two of the three measures included in this program component are existing measures: the Community Service Plan (CSP) and submission of HCAHPS survey information for selected questions. The newly introduced Population Health Management Attestation measure is focused towards increasing rural hospitals’ awareness of population‐health management initiatives to improve patient care across the entire care continuum. The Health of the Community program component will be worth 30% of the program, and each of the three measures will be equally weighted at 10% each.
Community Service Plan (10%)
In order to offer hospitals credit for the investments each is already making to improve the health of their communities, BCBSM has included the Community Service Plan (CSP) dimension to the P4P. The goal of the CSP is for each hospital to provide a high‐level narrative of their community service initiatives. As with years past, hospitals will receive full credit for submitting at least one CSP proposal (Appendix C).
In order to better reflect the value that the CSP delivers to the P4P, the CSP measure has been relocated from the Clinical Quality Indicator section to the Health of the Community component for this program year. Successful submission of at least one CSP(s) to BCBSM will be worth 10% of the P4P.
HCAHPS Survey (10%)
Beginning with the 2014‐2015 P4P program year, all hospitals will be required to collect HCAHPS survey information, at a minimum, for the following four questions:
Question 3 – During this hospital stay, how often did nurses explain things in a way you could understand?
Question 7 – How often did doctors explain things in a way you could understand? Question 19 – Did hospital staff talk with you about whether you would have the help
you needed when you left the hospital?
Question 20 – Did you get the information in writing about what symptoms or health problems to look out for after you left the hospital?
Unlike previous program years, HCAHPS survey submission is no longer accepted as an alternative to participation in one or more MHA Keystone quality initiatives. Hospitals can either submit HCAHPS data directly to BCBSM or attest that HCAHPS data has been submitted to the CMS Hospital Compare website via CEO attestation form.
Population Health Management Attestation (10%)
As the landscape of health care shifts towards a population‐based focus, BCBSM would like to introduce a program element that increases awareness of population‐health management within rural hospital communities. BCBSM will share various population‐based reports and tools with PG5 hospitals to become more familiar with BCBSM’s population‐health management efforts and begin to formulate ideas for how your rural hospital can lead a population‐health focus effort, in partnership with local physicians and other area providers, to increase the value of health care delivered to your communities. These reports are distributed to the hospital community semi‐annually: mid‐June and mid‐December, each year. As part of the 2014‐2015 program year, hospitals will be required to review each of the population‐health management reports provided by BCBSM and briefly state, via attestation form, how each
hospital plans to use this information to begin to form partnerships with the provider community to better manage the health of their shared patient populations (Appendix D). BCBSM recognizes that each rural hospital may find themselves at different points on the continuum of population‐based care, so hospitals will receive full credit for completing the Population‐Health Management Attestation form in the first year.
Clinical
Quality
Indicators
(30%)
The Clinical Quality Indicator program component of the 2014‐2015 program year will maintain the four outpatient measures from the prior program year. Each quality indicator will be worth 7.5% and program weights for measures with less than 20 cases will be equally redistributed across remaining eligible measures:
CMS Indicator Program Weight
OP ‐ 4a Aspirin at arrival ‐ overall (AMI & chest pain) 7.5% OP ‐ 5a Median time to ECG ‐ overall (AMI & chest pain) 7.5% OP – 18b Median Time from ED Arrival to ED Departure for Discharged ED Patients 7.5% OP ‐ 20 Door to Diagnostic Evaluation by a Qualified Medical Personnel 7.5%
Scoring Thresholds
Hospitals will be scored on the above clinical quality indicator measures by comparing actual performance against scoring thresholds. BCBSM encourages that thresholds increase each year or that measures be retired when nearly all hospitals meet > 95% compliance. Each June, representatives from BCBSM, MHA and the hospital community meet to review the prior year’s hospital performance on these measures and establish new scoring thresholds. Because the quality data from the previous program year is not available until June 1st, thresholds are established during the first quarter of current program year. Scoring thresholds for the 2014‐ 2015 program year will be communicated to hospitals no later than June 30, 2014.
Quality
Initiatives
(40%)
The Quality Indicator program component requires hospitals to participate in at least two of the following initiatives:
Michigan Critical Access Hospital Quality Network (MICAHQN) Participation MHA Keystone Initiatives
o Adverse Drug Events o CAUTI
o Falls and Pressure Ulcers o Sepsis
Participation in the MICAHQN is mandatory for all CAH facilities. If a hospital chooses to participate in more than two quality initiatives, BCBSM will score the P4P program using the two highest performing quality initiatives (excluding MICAHQN for CAH).
Hospitals will also be eligible to participate in selected MHA Keystone Initiatives for credit in the 2014‐2015 program year. MHA will communicate eligible Keystone Initiatives and corresponding scoring indexes to the hospital community as a separate appendix before the beginning of the program year on April 1st, 2014. Please refer to this supplemental MHA Keystone Peer Group 5 Quality Initiative Performance Index for detailed scoring information. Hospitals with questions regarding MHA Keystone Initiatives or eligibility may contact Ewa Panetta at MHA, [email protected].
Quality Initiative Performance Index
A hospital’s quality initiative score is determined by its performance on specific measures related to MICAHQN and MHA Keystone initiatives and will each be worth up to 20%.
Performance Index scores will be shared with hospitals prior to their submission to BCBSM. Hospitals should contact either the MHA Keystone or MICAHQN representative if interested in obtaining performance status at any time during the program period.
P4P
Incentive
Payments
BCBSM will communicate P4P payment rates to hospitals by July 31, 2015 with rates becoming effective October 1, 2015.
The BCBSM Peer Group 5 P4P program, established by the BCBSM Participating Hospital Agreement for Peer Group 5 facilities, determines up to six percentage points of a participating hospital’s inpatient and outpatient payment rate. Each hospital’s P4P payment rate is based on their individual performance in the areas of patient safety, clinical measures and quality initiatives. Regardless of a hospital’s fiscal year end, the P4P payment rate is effective for a twelve month period beginning on October 1st.
Pay‐for‐Performance payment rates are calculated by multiplying a facility’s final P4P score by the 6 percent maximum payment rate that each peer group 5 hospital is eligible to receive. For those hospitals earning a P4P score less than 100%, the difference between the corresponding P4P payment rate and 6 percent maximum is subtracted from your overall reimbursement rate. If applicable, any rate adjustments made for the 2013‐2014 P4P program year will be added back at this time.
In October, hospital’s earning less than the full six percentage points attributed to P4P performance can expect to receive a revised rate sheet from BCBSM’s Facility Reimbursement department.
Appendix
A
PG5
Advisory
Group
Representatives
PG5 Hospital Representatives
Chris Wilhelm Ed Gamache Wanda Bartholomew
COO President and CEO Director of Quality & Outcomes
Charlevoix Area Hospital Harbor Beach Community Hospital Hayes Green Beach Memorial Hospital
14700 Lake Shore Dr 210 South First St. 321 East Harris St
Charlevoix, MI 48720 Harbor Beach, MI 48441 Charlotte, MI 48813
(231) 547‐4024 (989) 479‐3201 (517) 543‐1050 x 1225
[email protected] [email protected] [email protected]
Brenda Bolsby Rodney Nelson Carolyn Vanwert
QA/Risk Management CEO Case Management & Quality Analyst
Marlette Regional Hospital Mackinac Straits Health System MidMichigan ‐ Gladwin
2270 Main Street 1140 North State Street 515 Quarter St
Marlette, MI 48452 St. Ignace, MI 49781 Gladwin, MI 48624
(989) 635‐4009 (906) 643‐0456 (989) 246‐9426
[email protected] [email protected] [email protected]
Anne Barton Betsie Edwards Joanne Urbanski
Director, Quality Resources Director of Nursing Services CEO
Promedica Herrick Hospital Sheridan Community Hospital South Haven Community Hospital
500 East Pottawattamie St 301 North Main Street 955 South Bailey Ave
Tecumseh, MI 49286 Sheridan, MI 48884 South Haven, MI 49090
(517) 424‐3461 (989) 291‐6293 (269) 639‐2810
[email protected] [email protected] jurbanski@sh‐hs.org
[email protected] [email protected]
William Roeser Barb Cote
CEO Director, Total Quality Management
Sparrow Ionia Hospital Spectrum Health Reed City
479 Lafayette St 300 North Patterson Rd
Ionia, MI 48846 Reed City, MI 49677
(616) 527‐4200 (231) 832‐7159
[email protected] barb.cote@spectrum‐health.org
Appendix
A
PG5
Advisory
Group
Representatives
MHA Representatives
Bill Jackson Sam Watson Joe Stephansky
Senior Vice President Senior Vice President Senior Director, Policy
MHA MHA Keystone Center MHA
2112 University Park Drive 2112 University Park Drive 2112 University Park Drive
Okemos, MI 48864 Okemos, MI 48864 Okemos, MI 48864
(517) 323‐3443 (517) 886‐8362 (517) 703‐8649
[email protected] [email protected] [email protected]
Marilyn Litka‐Klein Brittany Bogan Ewa Panetta
Vice President, Health Finance Senior Director Project Coordinator
MHA MHA Keystone Center MHA Keystone Center
2112 University Park Drive 2112 University Park Drive 2112 University Park Drive
Okemos, MI 48864 Okemos, MI 48864 Okemos, MI 48864
(517) 703‐8603 (517) 886‐8313 (517) 886‐8364
[email protected] [email protected] [email protected]
BCBSM Representatives
Kristen Frey Mike Andreshak Jerry Noxon
Health Care Analyst Director Director
BCBSM BCBSM BCBSM
600 E. Lafayette 600 E. Lafayette 600 E. Lafayette
Detroit, MI 48226 Detroit, MI 48226 Detroit, MI 48226
(313) 448‐4746 (313) 448‐3905 (313) 448‐6916
Appendix
B
MICAHQN
Scoring
Index
Michigan Critical Access Hospital Quality Network (MICAHQN)
Measure Name Weight Measure Performance Points Earned
Participation in
Meetings 100
All four meetings (in‐person or
teleconference) 100
Two or three meetings 75
One meeting 25
Did not attend any meeting 0
Hospitals with questions regarding MICAH Quality Network measure performance may contact Angie Emge
Email: [email protected] Phone: (517) 355‐7757
Appendix
C
BCBSM
Community
Service
Plan
(CSP)
Proposal
Peer Group 5
Hospital Pay‐for‐Performance Program
Community Service Program
April 2014 through March 2015
Hospital Name: _____________________________________________________________
Completed Community Service Plan proposal(s) must be returned to BCBSM with a signed, PG5 P4P CEO Attestation form by June 1, 2015.
Identify Program
Counties Served
Health Status of Population
Monitoring/Measurements of population (baseline and re‐ measurement) Communication of program/interventions Participation/Partnerships Rate of success
Appendix
D
BCBSM
Population
Health
Management
Attestation
Form
BCBSM Peer Group 5 Pay‐for‐Performance Program (P4P)
Population Health Management Attestation Form
4/1/2014 – 3/31/2015 P4P (Due June 1, 2015)
I certify that I have reviewed the information being sent to BCBSM for Peer Group 5 Pay‐for‐Performance Program,
and it is true to the best of my knowledge. This includes documentation for the components listed below:
Review the following BCBSM Population‐Health Management reports:
Population Insights Report
Population Profiling Tool
1. Hospital Profile Tab 3. Supplemental Data Report
2. SubPO Profile Tab 4. OSC Dashboard
PGIP Physician Organizations (PO) with whom Hospital has a shared patient population:
Physician Organization SubPO
Describe Physician Organization collaboration plan:
Acute Care Facility(s) with whom Hospital has strategic partnership or established transfer/referral patterns:
Hospital Name Health System, if applicable
Describe Other Acute Care Facility action plan:
_________________________________________ Printed Name _________________________________________ Signature _________________________________________ Facility Name _________________________________________
President or Chief Executive Officer
_________________________________________ Date _________________________________________ Facility Code
