Everything you ever wanted to know about Value-Based Purchasing* *But were afraid to ask

Everything you ever

wanted to know

about Value-Based

Purchasing*

*But were afraid to ask

John Murray, MBA

Director, Patient Experience Deric Hebert

Director, Engineering Services

Discussion

• What is Value-Based

Purchasing?

• How are Texas and

Houston area

hospitals performing?

• What can we do to

Value-Based Purchasing

Medicare

From ‘passive payer’ to ‘active purchaser of quality health care’

Quality Reporting Systems Pay for Performance

Hospital Inpatient

Quality Reporting Program (IQR) Hospital Outpatient

Quality Reporting Program (HOQR) Physician

Quality Reporting Program (PQRI)

Goal = Higher quality & more efficient care

• The Hospital IQR Program is intertwined with the Hospital VBP Program: • VBP measures are selected from the IQR measure set.

• Reporting infrastructures overlap.

© Mark E. Damon - All Rights Reserved

A: Saving Money B: Improving Quality

True or False

• Value-based Purchasing is all about MONEY…??

Value-Based Purchasing

Definition

VBP is a payment methodology that

rewards quality of care through

payment incentives and transparency.

In health care, value can be broadly considered to be a function of quality,

efficiency, safety, and cost. In VBP,

providers are held accountable for the quality and cost of the health care

services they provide by a system of

rewards and consequences, conditional

upon achieving pre-specified performance measures. Incentives are structured to

discourage inappropriate,

Value-Based Purchasing

Goals

CMS set out the goals for the Medicare Hospital VBP program as:

• Improve clinical quality,

• Reduce adverse events and improve patient safety, • Encourage more patient-centered care,

• Avoid unnecessary costs in the delivery of care, • Stimulate investments in structural components or

systems—such as IT capability and care

management tools and processes—that have been proven effective in improving quality and/or

efficiency, and

• Make performance results transparent and comprehensible so that consumers can be

empowered to make value-based decisions about their health care and to encourage hospitals and clinicians to improve the quality of care.

Value-Based Purchasing

Methodology

• Payments impacted beginning in Federal Fiscal Year (FFY) 2013 which began on October 1st, 2012.

• Program is funded by % withheld from all patient DRG Base Operating payments during the impact year (approx $917m in FY2013).

• VBP program is budget neutral at Federal level - funds withheld from low performing hospitals must be paid out to others.

• Withhold increases from 1.0% in 2013 to 2.0% in 2017.

• Break-even point to earn back all withheld funds is ~50th _%ile.

• Highest performers have the potential to earn more than the original amount withheld.

• Scoring methodology is based on two performance measurement periods, (1) a baseline period and (2) a performance period. Initially each is a 9

1%

_1.25%

_1.5%

_1.75%

2%

1%

2%

3%

_3%

3%

1%

_1%

1%

0.7%

1.4%

2.8%

2013

2014

2015

2016

2017

Value-Based Purchasing

Readmissions

Hosp Acq Conditions

Medicare Payment Reform

Value Based Purchasing

Measures Used to Calculate Score

Patient Experience

(HCAHPS) Measures

HCAHPS Measures

Domains

Communication with Nurses Communication with Physicians Staff Responsiveness Pain Control Communication on Medications

Room Quiet and Clean Discharge Information Overall Rating 0-10

Goals:

Standardize patient satisfaction data

Aid consumer choice by making patient

satisfaction indicators available to the

public

Create increased public accountability by

reimbursing hospitals based on

HCAHPS survey categories

(Domains)

 Communication with Nurses

 Communication with Doctors

 Room kept clean

 Room quiet at night

 Responsiveness of Staff

 Communication about New Meds

 Pain Management

 Discharge Information

 Overall Hospital Rating

 Likelihood to Recommend Hospital

Question and scoring format

 Frequency based response scale

 Scoring based on Top Box

percentage - the percentage of possible ‘best’ scores (top box) earned.

 Vendor also assigns a percentile rank for each question, based on relative position in database

Top Box Response

Top Box Response

VBP Calculation

Scoring

Each

individual

measure

Improvement

0-9 points

Achievement

0-10 points

Score in Performance Period compared to Baseline Period Performance period score Compared to threshold and

Value Based Purchasing

FFY2013 Total Performance Score

Clinical Process 12 Process Measures AMI (2 measures) CHF (1 measure) Pneu (2 measures) HAI (4 measures) SCIP (3 measures) Up to 10 Points each Patient Experience Score Clinical Process Score Weight (70%) Weight (30%)

x

)

+

x

)

(

(

Value-Based Purchasing

Determining Financial Impact

Maximum Redistributed Funds Available Existing Funds Withheld FFY 2013

High Performing Hospitals + up to 0.8%

Median Hospitals Break Even

Lowest Performing Hospitals - up to 1%

CMS compares all hospitals’ Total

Performance scores to determine how

a hospital’s base operating DRG

Medicare Payment Reform

Final Thoughts

nn

FFY2014

VBP Measurement Periods

Domain

Baseline Period

Performance Period

Clinical Process (Quality) Apr 1, 2010 – Dec 31, 2010 (9 months) Apr 1, 2012 – Dec 31, 2012 (9 months) Patient Experience (HCAHPS) Outcomes (Mortality) Jul 1, 2009 – Jun 30, 2010

Final Thoughts

nn

FFY2015

Measurement Periods

Domain Weight Baseline Period Performance Period Clinical Process of

Care 20% Jan 1, 2011 – Dec 31, 2011 Jan 1, 2013 – Dec 31, 2013 Patient Experience

of Care 30% Jan 1, 2011 – Dec 31, 2011 Jan 1, 2013 – Dec 31, 2013 Outcomes

30%

Oct 1, 2010 – Jun 30, 2011 Oct 1, 2012 – Jun 30, 2013

 Mortality

 AHRQ Oct 15, 2010 – Jun 30, 2011 Oct 15, 2012 – Jun 30, 2013

 CLABSI Jan 1, 2011 – Dec 31, 2011 Feb 1, 2013 – Dec 31, 2013

FFY2015

Thresholds and Benchmarks

What can we do to Improve?

1. Awareness and Education

Frontline Staff Departmental Leaders

 Understand the Methodology.

 Assemble teams to research performance on current and future VBP measures to identify improvement opportunities and drivers of performance.

 Ensure compliance with standards to promote high reliability.

Hospital Executives System Executives

 Foster and promote high reliability culture.  Set strategic direction and establish

improvement goals.

 Provide resources required to support improvement initiatives.

Hospital Board

 Oversight

What can we do to Improve?

2. Evaluate the impact of deficiencies

 Establish the performance gap

 Use VBP reports to pinpoint measures which are not

achieving the maximum 10 points

 Identify the performance needed and how many

additional points are to be gained.

 Quantify the potential gain

What can we do to Improve?

3. Identify Improvement Opportunities

Examine performance on each VBP indicator to identify

improvement opportunities.

Conduct research to understand where and why

deficiencies are occurring.

Identify improvement opportunities to enhance high

reliability and make recommendations to senior leaders.

Track progress on actions established by monitoring

How Engineering Operations Impact VBP

VBP & Engineering



Team connection - owners of the patient experience.



Begin with the end in mind.



What outcomes do you want?



What behaviors/actions will create those outcomes?



Develop team engagement.



Give team POWER to make decisions concerning

patient satisfaction.



Recognize and reward those go above call of duty to

provide exceptional service.



Start every service event with patient satisfaction in

mind.

If you see it you own it!



Impressions begin long before arrival.



External influences (marketing, word of mouth) affect

perceptions.



Evaluate the customer journey from the patient/family

perspective.

Customer Main Entrance



Signage

• Clear?

• Condition?

• Current?

Customer Main Entrance



Landscaping?

Parking



Adequate and properly defined?



Striping and directional's fresh and accurate?

Potholes & Curbs

Customer Main Entrance



Trash pickup?

Outside Entrance

Noise Matters



Noise = sleep deprivation



Sound environment top stressor



Affects perception of care

Noise Makers



Turn down radios and cell phones



Repair things that squeak , rattle, and roll!



Get a Yacker Tracker!

Working with EVS



Build an alliance



EVS is in rooms everyday



Train EVS to identify maintenance issues



Develop a daily EVS checklist



Lamps



Drains



TV



Nurse Call



Walls , wallpaper, corner guards



Window treatments



BONUS – Turn the T-stat up!

If you see it you own it!

Questions?

[email protected] 713.338.6771