Quality Reporting:
Implications for Value Based
Purchasing
Host: Dr. Adrienne Mims
Facilitator: Dr. Kim Rask
Faculty:
Mary Cox
Suzanne Dalton Cathie Pritchard Melody Brown
Physician Leadership Network
Clinical Discussions 2013 Webinar Series
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Housekeeping
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Question & Answer session following the last
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URL to download the presentation will be emailed
following the presentation, along with post-activity
evaluation
3
Program Overview
Adrienne Mims, MD MPH
• Medical Director, Medicare Quality Improvement • Alliant GMCF4
Polling Questions
What is your role in the organization? (CMS,
Physician, Quality Improvement, Outreach,
Technical support, Analytical, other (fill in), etc.)
How involved are you with the Value Based
Purchasing? (very involved, moderately involved,
not involved)
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Webinar Topic Overview
Kimberly Rask, MD, PHD
• Medical Director
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Quality Reporting:
Implications for Value Based Purchasing
Kimberly Rask, MD PhD
Medical Director, Alliant GMCF July 10, 2013
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Today’s Agenda
Overview of Reporting Systems
QIO Presentations
• Success Stories
• Gaps/Barriers
• Q&A
Open Discussion Regarding Future Support
Opportunities
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Learning Objectives
Following today’s presentation, participants will be
better prepared to do the following in practice:
• Describe the differences in current reporting programs
• Discuss how the current reporting programs related to VBP
• Identify one critical success factor that can be applied to their
work
• Identify one challenge faced by participating hospitals that can
be addressed by their work
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Overview of Reporting
Programs
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Faculty:
Relationships
…
IQR,
OQR and HVBP
Mary Cox, R.N., B.A.
Director of CMS National Hospital Inpatient Quality Reporting Program at Telligen. Since joining Telligen in 1985, Ms Cox has managed a variety of data collection, data analysis, software development and testing related to MDS and OASIS QIES projects, Hospital Compare reporting, and hospital pay-for-reporting/pay-for-performance, focusing on a range of clinical topics as well as measure development, specification, and testing. Ms. Cox’s current duties include oversight and active involvement in
Telligen’s work on Centers for Medicare & Medicaid (CMS) Inpatient Hospital Data Collection and Reporting programs. Alignment of the Specification Manual for National Hospital Quality Measures, Hospital Data Collection, Public Reporting of hospital data on the CMS Hospital Compare web site, Pay for Reporting and Pay for Performance are some of programs she oversees. She has given multiple presentations and facilitated discussions related to the national hospital reporting programs.
Rela&onships…..
IQR, OQR and HVBP
July 10, 2013
Inpa=ent Quality Repor=ng Beginnings
•
Repor&ng Hospital Quality Data for Annual Payment
Update (RHQDAPU) Ini&a&ve.
– PURPOSE: Equip consumers with quality of care
informa&on to make more informed decisions about their health care, while encouraging hospitals and clinicians to improve the quality of inpa&ent care provided to all
pa&ents.
•
Hospital Inpa&ent Quality Repor&ng (IQR) Program is
Inpa=ent Quality Repor=ng Beginnings
• Hospital IQR Program began in fiscal year 2005.
• Sec&on 501(b) of the MMA requires IPPS hospitals submit a
set of 10 quality measures for each of the fiscal years
2005-‐2007 to receive full Medicare market basket update. Non-‐submission results in a .04 percentage point reduc&on for the annual payment update.
• With the Deficit Reduc&on Act of 2005, “the payment update
for FY2007 will be reduced by 2.0 percentage points for any IPPS hospitals that do not submit certain quality data in a form and manner, and at a &me, specified by the Secretary.”
Outpa=ent Quality Repor=ng Beginnings
•
Hospital Outpa&ent Payment Quality Data Repor&ng
Program (HOPQDR) Ini&a&ve.
– PURPOSE: Provide hospitals with a financial incen&ve to
report their quality of care measures data and provides CMS with data to help Medicare beneficiaries make more informed decisions about their health care.
•
Hospital Outpa&ent Quality Repor&ng (OQR)
Outpa=ent Quality Repor=ng Beginnings
• OQR is modeled a]er the current Hospital IQR Program.
• Mandated by the Tax Relief and Health Care Act of 2006.
• Hospitals report data to receive the full annual update
effec&ve for payments beginning in calendar year (CY) 2009.
• Non-‐submission results in a 2 percentage point reduc&on in
Subsec=on (d) Hospitals
• Hospitals located in one of the fi]y States or the District of
Columbia other than:
– A psychiatric hospital (as defined in 1861(f))
– A rehabilita&on hospital (as defined by the Secretary)
– A hospital whose inpa&ents are predominately individuals under 18
years of age
– Hospitals designated as Long Term Acute Care
– Hospitals designated as Cri&cal Access Hospitals (CAH)
– Hospitals recognized as a comprehensive cancer center or clinical
cancer research center
• Note: Inpa&ent repor&ng includes Indian Health Service
Inpa=ent Voluntary Repor=ng
• Hospitals excluded from the IQR program can submit data
voluntarily and can be publically reported.
• Pledge at any &me.
• Preview data prior to publica&on on Hospital Compare.
• Withhold publica&on of any or all of the data on Hospital
Outpa=ent Voluntary Repor=ng
• Hospitals excluded from the OQR program can submit data
voluntarily and can be publically reported.
• Pledge at specified &mes.
• Data are previewed, but decision to publish on Hospital Compare occurs during pledging.
• Two pledge op&ons.
– Voluntary to have all submifed data published on Hospital Compare
– Voluntary for quality improvement only – not published on Hospital
Hospital Value-‐Based Purchasing
• Star&ng in October 2012, Medicare began rewarding hospitals
that provide high quality care for their pa&ents.
• Established by the Affordable Care Act.
• Incen&ve is based on either:
– How well they perform on each measure, or
– How much they improve their performance on each measure
compared to their performance during a baseline period.
• PURPOSE: To promote befer clinical outcomes for hospital
pa&ents as well as improve their experience of care during hospital stays.
Inpa=ent Hospital Value-‐Based Purchasing (HVBP)
• August 1, 2011, CMS finalized policies related to Inpa&ent HVBP for
FY 2013.
• HVBP is funded by a percent withhold from par&cipa&ng hospitals’
Diagnosis-‐Related Groups (DRG) payments.
• Law requires that the total amount of value-‐based incen&ve
payments in aggregate be equal to the amount available for value-‐ based incen&ve payments.
• Hospitals must par&cipate in the CMS Hospital IQR Program and
must meet all requirements for that program to be in HVBP.
• Hospitals receiving a reduc&on in IQR for a fiscal year are not in
HVBP for that fiscal year. There is no HVBP withhold for that fiscal year.
Resources for Addi=onal Informa=on
§ CMS website
§ QualityNet website
§ HCAHPS website
§ Hospital Compare website
§ ListServes at hfps://www.qualitynet.org
§ IQR NCC staff
Mary Cox, RN BA
Mcox@iaqio.sdps.org 515-‐273-‐8853
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Faculty:
Exciting Time in
Healthcare Quality, Patient
Safety, and Infection Control
Suzanne Dalton, RN, BS, EdM
Suzanne Dalton has been with HQSI since 1999. Prior to joining HQSI, Ms. Dalton was Vice President, Patient Care Services at Barnert Hospital, Paterson, NJ and an adjunct professor at William Paterson College, Wayne, NJ.
Suzanne also completed the Johnson & Johnson – Wharton Fellows Program in Management for Nurse Executives.
She was a designated 9SOW CMS national quality improvement leader. In the 10SOW is managing the quality data reporting program and the reduction of healthcare acquired infections initiatives in NJ.
Exciting Time in Healthcare
Quality, Patient Safety,
and Infection Prevention
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Suzanne Dalton, RN, BS, EdM
Program Manager, Quality Data Reporting Program and Healthcare-Associated Infections Healthcare Quality Strategies, Inc.
This material was prepared by Healthcare Quality Strategies, Inc. (HQSI), the Medicare Quality Improvement Organization for New Jersey, 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-NJ-C.7.4-13-08 7/2013
Integrating IP and PI
Working to Meet Quality Data Reporting Requirements
n
Introduce IPs to the QDRP world and QNet
Successful Avenues of Communications
n
Traditional Audience: Performance Improvement
(PI) staff and process measure set data abstractors
n
Newsletters
n
Blast emails
n
Group educational sessions
• Validation
• New measure sets
• Changes to the Specification Manual
10SOW HIQRP Challenges
n
New Audience: Infection Preventionists (IPs)
n
Perhaps new to HIPQRP reporting
n
Outcome measures reporting
• NHSN
} Conferring rights
} Overlap of data entry between Aims 7.1: Reducing HAI and
HQSI’s Fast Track for IPs
n
Join National APIC
n
Partner with 2 New Jersey state chapters of APIC
• Presentations about HIQRP and VBP
• Standing Agenda item at monthly chapter meetings
• Rapid dissemination of information through their active
listservs
• Speaker at annual Joint Conference meetings of state
chapters of APIC and IDSA
n
QualityNet/NHSN as a resource
• Become a user
VBPs Roadmap Through CMS Fiscal Years
29 } Hospitals begin submitting quality data (RHQDAPU-Core Measures) } Failure to meet the requirement is 0.4% of APU 2005 } RHQDAPU begins expanding total number of measures 2007 } HIQRP } Failure to meet the requirement is 2% APU 2009 } VBP Measure Set Expands } DRG payments reduced by 1.25% } HIQRP continues 2014 } VBP continues } DRG payments reduced by 2% } HIQRP continues 2017 } VBP DRG payments reduced by 1% to hospitals } VBP allows hospitals to earn this money back through P4P } HIQRP continues } Failure to meet the reporting requirement is 2% APU 2013Frustration and Fatigue
n
Demands on hospital
staff to keep up with the
measures and the
constant changes –
now with financial
impact – as the
workload increases
n
The measures and
time frames for reporting are mind-boggling
Successes
n
HIQRP templates (including HAI measures/
validation) submitted timely
• No extensions needed even with Super Storm Sandy, flu
epidemic, overcrowded EDs and measles outbreak
n
Expanding multidisciplinary knowledge of HIQRP
requirements
• Employee Health Service with HCW immunization program
Lessons Learned
n
Infection preventionists want to share the
responsibilities and solutions beyond reporting of
data
• PIs and IPs most often have different reporting lines
• PIs and IPs need each other to be successful • Resource support of Infection Prevention Depts
} Surveillance, education, outbreaks, consultation, and data
entry into NHSN
} Infection Prevention is everyone’s business
Lessons Learned
n
Identify and partner with key stakeholders
• 7.1 Reducing HAI LAN facilitated by HQSI
} New Jersey APIC chapters and ESRD network partnership
– educational sessions CLABSI reporting, communications
between dialysis centers and hospitals, universal transfer form
n
Ongoing communication between departments
creates a shared accountability, urgency for action
and paves the road for sustainability
Contacts
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Suzanne Dalton, RN, BS, EdM
Program Manager
Quality Data Reporting and
Healthcare-Associated Infections
Healthcare Quality Strategies, Inc. 732-238-5570, ext. 2017
sdalton@njqio.sdps.org
Janet Phillips, RN
Quality Improvement Specialist Quality Data Reporting and
Healthcare-Associated Infections
Healthcare Quality Strategies, Inc. 732-238-5570, ext. 2024
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Faculty:
Success with Quality
Data Reporting Health Care
Excel (HCE)
Cathie Pritchard, LPN, RHIT
Cathie Pritchard, LPN, RHIT, is currently a quality data reporting technologist for the hospital setting at the Medicare QIO for Kentucky. She has been an LPN for 30 years and has been employed with HCE for 24 years. Ms. Pritchard extensively works with the hospitals in the state assisting with data collection and validation, analysis, and process improvement efforts. She is a key point-of-contact for hospitals and
provides ongoing statewide education related to these topics in meeting the needs of the
hospitals. As a result, Kentucky hospitals have achieved excellent passing scores, based on CMS’s current evaluation criteria for QIOs.
Success with Quality Data Reporting
Health Care Excel (HCE)
Cathie Pritchard LPN, RHIT
Quality Data Reporting Technologist July 10, 2013
Background HCE
§
Inpatient Prospective Payment System
(IPPS) Hospitals—65
§
Critical Access Hospitals (CAH)—29
§
77% of the hospitals are rural hospitals
§
HCE is a multi-state Quality Improvement
Organization (QIO)
Partners
§
Association for Professionals in Infection Control
(APIC)
§
Kentucky Hospital Association
§
Kentucky Rural Health Association
§
Indiana Rural Health Association
§
University of Louisville School of Public Health and
Information Sciences
§
Kentucky Department for Public Health
§
Multi-state QIOs
Friday Updates
§
Reminder of upcoming deadlines
§
Updates from the Centers for Medicare &
Medicaid Services (CMS)
§
Educational information
§
Invitations to Webinars and
teleconferences
Webinars
§
Specifications Manual Updates
§
New Measures
§
National Healthcare Safety Network
(NHSN)
NHSN Webinars
§
Series of Webinars with our partners and a
consultant from Surveillance Solutions
• NHSN Data Submission and Abstraction
• Surgical Site Infection (SSI) Surveillance
• Catheter-Associated Urinary Tract Infections (CAUTI)
• Ventilator-associated pneumonia (VAP)
• Introduction to Output and Analysis Using NHSN
• Problem Solving Using Centers for Disease Control
and Prevention (CDC)/NHSN Surveillance Definitions • Clostridium difficile (C. Difficile) Lab ID Events
Videos Recorded
§
Health Care Excel’s Medical Director
recorded the following videos
•
Improving Hospital-Consumer Assessment of
Healthcare Providers and Systems (HCAHPS)
Scores
•
Venous Thromboembolism Inpatient Quality
Measures
•
CAUTI: Making Hospitals Safer
•
C. difficile
Infection
CATHIE PRITCHARD, LPN, RHIT
CPRITCHARD@INQIO.SDPS.ORG
812-234-1499, EXTENSION 229
Thank You
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This material was prepared by Health Care Excel, the Medicare Quality Improvement Organization for Kentucky, 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-IN-INDPAT-13-028 07/03/2013
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Faculty:
Moving Forward with
Quality Improvement
Melody Brown, MSM
Melody has been working in
healthcare for over 30 years with her career beginning as a
Medical Technologist.
Additionally, she has served in Quality Management and
Education in the rural hospital setting prior to joining the work of the QIO.
July 10, 2013
Presenter:
Melody Brown, MSM Quality Advisor
Georgia Moving Forward with
Quality Improvement
Our Providers
•
106 acute care hospitals
•
32 critical access hospitals
•
Metro and rural mix
Hospital Support
•
Strong relationship with our hospitals
•
Strong relationship with our hospital association
•
Strong relationship with our state Office of
Activities with the Hospital Association
•
Co-host weekly calls, "Office Hours"
•
By invitation, join their bi-yearly statewide
meetings in metro Atlanta and South Georgia
•
Work together to provide a mentorship with
QIO Activities
•
"Technical Alert"
•
Monthly "Hospital Update" newsletters
•
Established helpline for hospitals
•
One-on-one webinars as needed
QIO Support Staff
•
Dedicated Technical Advisor
•
Infection Preventionist
Contact Information
Melody Brown, MSM ~ Quality Advisor
678-527-3466
Diana Smith ~ Technical Advisor
678-527-3417
Cindy Prosnak, RN CIC ~ Infection Preventionist
This material was prepared by Alliant GMCF, the Medicare Quality Improvement Organization for Georgia, 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. Publication No. 10SOW-GA-IIPC-13-82
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Q&A
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…
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• Significant success/barrier
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56
Open Discussion
Regarding Future
57
Q&A
We’d like to hear from you!
Please share
…
• Questions for the presenters
• Significant success/barrier
• Tools you have found useful
Use the “chat” feature -- or -- unmute your line using
* 6 * to speak
58
Adjournment
Post Activity Evaluation
• Please complete within one week: https://
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Certificate of completion
• Sent to those who complete the evaluation and certificate
