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Cal Hospital Compare
Board of Directors Meeting Agenda Wednesday, June 5, 2019
10:00am – 12:00pm PT
Webinar Information
Webinar link: https://zoom.us/j/4437895416
Phone: 1-669-900-6833
Access code: Code: 443 789 5416
Time Agenda Item Presenters and Documents
10:00-10:10
10 min.
Welcome and call to order
- Approval of past meeting summary
Ken Stuart, Board Chair
10:10-10:30
20 min.
Organizational updates
- Welcome Thai Lee, Covered California
- Covered CA report on poor performers
o Letter to QHPs
o Hospital notification in progress
o Report overlap
Bruce Spurlock, Executive
Director
Ken Stuart, Board Chair
10:30–11:30
60 min.
TAC analytic updates
- Patient Safety Honor Roll
o Current state
o Version 2.0
- ED as a performance category
- General updates
o CMS data refresh
o Maternity measures
Mahil Senathirajah, IBM Watson
Health
Frank Yoon, IBM Watson Health
Alex Stack, Director
11:30-11:40
10 min.
Opioid Safe Hospital Designation
- Update & next steps
Alex Stack, Director
11:40-11:50
10 min.
Business plan
− Financial report
Bruce Spurlock, Executive
Director
11:50-12:00
10 min.
Wrap-up
Adjourn
− Wednesday, August 7, 2019 – 10:00am to 2:00pm
(In Person - Oakland)
Bruce Spurlock, Executive
Director
Ken Stuart, Board Chair
Cal Hospital Compare
Board of Directors Meeting Summary
Wednesday, April 3, 2019
10:00am – 2:00pm PDT
Attendees: Bruce Spurlock, Alex Stack, Tracy Fisk, Libby Hoy, Chris Krawczyk, Lance Lang, Helen Macfie,
Mahil Senathirajah, Kristof Stremikis, Ken Stuart, Kevin Worth
Guests: Aimee Moulin, BRIDGE
Summary of Discussion:
Agenda Items Discussion
Welcome & call to
order
• The meeting commenced at 10:04am Pacific Time. The meeting attendees formally
introduced themselves.
• The Cal Hospital Compare Board meeting summary of February 13, 2018 was motioned
and approved.
Organizational
Updates • Celia Ryan, passed away in December 2018 and Kevin Worth is now representing Kaiser
as a board member.
• Julie Morath is stepping down from the board and has resigned from her position with
HQI. Patty Atkins is replacing Julie on the CHC board. CHC is currently looking to add a
second hospital representative to replace Julie Morath. HQI is continuing with CHIPSO,
data analytics; most of the work in the improvement space is no longer housed within
HQI. Helen Macfie will continue to monitor CHC’s role over the next 3-6 months.
• Libby Hoy shared updates for PFE with HQI and HSAG
• Ken Stuart and Chris Krawczyk provided an overview of the Healthcare Payment Data
Review Committee:
o State or federal dollars for an all payers claims database is spearheaded by OSHPD. A
multi-stakeholder committee is being created. The NAVO consulting group is
supporting the initiatives. The APCD Council is establishing a common layout for the
collection of APCD data. The first deliverable is a report due back to the legislature in
June 2020. A standard data set for all plans are in development by the US Department
of Labor, including self-funded plans. The review committee will meet monthly and
provide recommendations to OSHPD.
o All meetings and information will be made publicly available on the OSHPD website.
Board members are welcome to attend the meetings. OSHPD is currently in
discussions with Medi-Cal regarding receiving their claims data.
o Kristof Stremikis commented that this is an amazing opportunity for the state. He
questioned if the data can potentially be linked with CHC to compliment quality with
cost data and encouraged the board. Kristof recommended that board members
submit a use case.
• Anthem Update
o Mark Reynolds and David Pryor reviewed CHC’s data and concluded that the vast
majority of measures do not have great discrimination. After further analysis,
Anthem made the decision not to fund CHC in 2019 but explained that there is a
strong possibility that participation will resume in 2020. A formal memo was created
and distributed to the board. Bruce commented that CHC can sustain through 2019,
particularly with the support of data use fees and/or the Covered CA poor performers
report.
o Lance Lange questioned what the best approach is moving forward in determining
the foundation for scoring measures. IBM Watson provided some analysis on this -
when hospitals do not submit all the data impacts “scoring/tiering” – either no rating
or only give 3 categories, time-based measures could potentially add depth to the
scoring (need standard deviation info). Bruce discussed alternative ways CHC can
develop thresholds to differentiate the data. Bruce’s opinion is that the most logical
venue to generate equity is through the CA health plans.
• Report on Patient Safety Poor Performers
o Alex Stack reviewed the poor performer report which with a combination of
signals/methodology, identified 44 poor performing hospitals. The report is
confidential and should not be distributed.
o Hospitals will need to be contacted that they are listed on the report. Bruce will notify
the board when the hospitals have been contacted. Health plans and others will be
required to pay a fee to access the report.
o The report was formally motioned, seconded and approved by the board.
Opioid Safe Hospital
Designation • Alex Stack introduced Aimee Moulin who provided an overview on the Opioid Safe
Hospital Designation program. Alex Stack reviewed the draft opioid safe hospital
assessment and explained the methodology behind its design. Feedback was gathered
from the Opioid Workgroup, TAC and stakeholders to help develop this tool. Alex also
reviewed the proposed scoring options.
• The board formally motioned, seconded and approved to formally adopt and utilize the
opioid safe hospital assessment tool
• CHC will host a five part no cost opioid safe hospital webinar education n series starting
May 9th. The webinars are designed for Chief Medical Officers, Chief Nursing Officers,
Chief Quality Officers, Quality and Emergency Department leadership, and other
individuals involved in improving opioid safety.
TAC Analytic
Updates • Per the board’s recommendation, additional members have been added to the TAC to
include Patty Atkins, John Bott, Carolyn Brown, Gayle Sandhu and Paul Young.
General Updates • CHC is exploring whether to include ED measures as a performance category to further
differentiate individual hospital ratings
• The CMS data was released February 28, 2019 and the CHC website will be refreshed in
April.
Patient Safety Honor
Roll
• PSHR version 2.0 is expected to be released in late 2019.
• Mahil Senathirajah reviewed the four possible approaches including adding measures,
fixed performance thresholds, using multiple years of data, and creating a composite
measure
• Kevin Worth emphasized that effective patient communication correlates with HCAHPS
and safety.
• Bruce discussed the current ongoing challenges being that there is no agreed upon
national definition or data set for patient safety and there is missing national data “hard
targets “with absolute level of performance identifying a “safe hospital”. What is the best
way to move forward, what process makes the most sense and is voting an option to find
a consensus? The board recommended seeking feedback from the TAC.
Business Plan • Bruce reviewed the current financial report and annual budget for 2019.
Next
Meeting/Meeting
Adjournment
• The next CHC Board Meeting will be held on June 5, 2019 from 10:00am-12:00pm PT via
Zoom webinar
• The meeting formally adjourned at 1:34pm Pacific Time
Board of Directors
Page 1 of 1 Revised 06/03/19
David Hopkins Pacific Business Group on Health Senior Advisor Consultant to the Consumer-Purchaser Alliance [email protected] Libby Hoy Founder and CEO PFCC Partners [email protected] Christopher Krawczyk, PhD Chief Analytics Officer Office of Statewide Health Planning & Development [email protected] Lance Lang Chief Medical Officer Covered California [email protected] Thai Lee Senior Quality Specialist Covered California [email protected] Helen Macfie Vice President, Performance Improvement Memorial Care Hospital [email protected] Bruce Spurlock Executive Director Cal Hospital Compare, Cynosure Health [email protected] Kristof Stremikis Director, Market Analysis and Insight California Health Care Foundation [email protected] Ken Stuart Administrative Manager San Diego Electrical Health & Welfare Trust [email protected]
Katharine Traunweiser VP, Clinical Quality Blue Shield of California [email protected] Kevin Worth Executive Director, Risk Mgmt. & Patient Safety Kaiser Permanente Northern California Region [email protected]
Other Contributors Tracy Fisk Executive Assistant Cynosure Health [email protected] Rhonda Lewandowski Senior Director Client Services IBM Watson Health [email protected] Mahil Senathirajah Senior Director IBM Watson Health [email protected] Alex Stack Project Manager Independent Consultant Cynosure Health [email protected] Frank Yoon Senior Statistician IBM Watson Health [email protected]
Cal Hospital Compare
Board of Directors June 5, 2019
10:00am -2:00pm Pacific Time
Webinar link: https://zoom.us/j/4437895416
Phone: 1-669-900-6833
Access code: Code: 443 789 5416
Proposed Agenda
Welcome & call to order
Organizational updates
TAC analytic updates
Opioid Safe Hospital Designation
Business plan
Wrap Up
2
Organizational Updates
3
Welcome!
• Thai Lee, Senior Quality Specialist, Covered California
Covered CA report on poor performers
• Letter to QHPs
• Hospital notification in progress
• Report overlap
Report Overlap:
PSHR 1.0 & Poor Performer
Hospital PSHR 1.0
Two-thirds above the 50th percentile &
none below the 25th percentile
Poor Performer
Two-thirds below 50th percentile & none
above the 75th percentile
Adventist
Health
Glendale
• Achieved via LF score; did not meet
the algorithmic criteria
• 2 measures < 25th percentile
• HAI5 (MRSA)
• PSI90
• Met the algorithmic criteria
UCSF
Moffit/Long
Beach
• Achieved via LF score; did not meet
the algorithmic criteria
• 2 measures < 25th percentile
• HAI3 (SSI: Colon)
• HAI6 (C. diff)
• Met the algorithmic criteria
• Payment Reduction Determined by
CMS HAC Reduction Program
• CDPH 2017 HAI Trend
4
BOD Discussion
Leave hospitals on both reports?
Remove hospitals from the PSHR and leave on the Poor Performer
report?
As a general rule, Inclusion on the Poor Performer Report excludes a
hospital from the PSHR?
Remove hospitals from both reports?
5
TAC Analytic Updates
6
PSHR Current State
• Secretary announcement in progressVersion 1.0
(HAI & PSI90)
• Expand eligible hospitals
• Identify relevant measures & process
• Consider fixed threshold – on holdVersion 2.0
7
Previous Guidance
• Treat hospitals equally
• Do not impute missing data Enhance methods to
promote transparency and maximize eligible hospitals
• Expanding hospital eligibility
• Supporting achievement
• TAC reviewed possible approaches
Improve methods so all hospitals can achieve honor
roll status over time
• PSHR “version 2.0” expected late 2019Timeframe
8
Possible Approaches
9
Adding measures
(Feb. 25 mtg)
1
Fixed Performance Thresholds
(March 27 mtg)
2
Using multiple years of data
(future meeting as warranted)
3
Creating a composite measure
(for discussion)
4
Summary of TAC Discussion To Date
Adding Measures: Project Team modeled the impact of adding measures to the composite: HCAHPS, Sepsis Measure and use of PSI component measures
Total of 15 scenarios evaluated
Analysis showed that addition of the measures achieved the goal of expanding the number of eligible hospitals: from 233 to 303
Fixed Performance Thresholds: Project Team also modeled the establishment of fixed performance thresholds based on prior year data and their application to current year data
Approach succeeded in enabling more hospitals to achieve PSHR status over time as performance improves
However, TAC members raised concerns about the addition of specific measures and their connection to patient safety (e.g., HCAHPS patient experience measure re: Nurse Communication)
10
…Summary of TAC Discussion To Date
In response, at the May 29 TAC meeting, Project Team presented options to
revise the methodology so that PSHR is based on either:
1. a composite measure
2. a revised algorithmic approach
Rationale: both options provide TAC/Board with opportunity to weight
measures potentially allaying TAC members’ concerns
For example, the HCAHPS Nurse Communication measure could be down-weighted
11
Outcome of TAC Meeting
TAC had a rich discussion of the pros/cons/implications of the
approaches
Inclusion of structural measures
Need to expand number of hospitals eligible for PSHR
However, TAC did not come to a conclusion re: either of the two
options
12
TAC Discussion Reflects Ongoing
Challenges in Patient Safety Field
No agreed upon national definition or data set for “Patient Safety”
Disagreement at TAC and Board about what measures are included/excluded reflects the national dialogue
A broader definition of safety with more measures and measure types increases the number of eligible hospitals AND increases the number of dissenting views
Missing national “hard targets” with absolute level of performance identifying a “safe hospital”
Continual improvement emphasized over meeting a threshold
Is “zero” the right target?
13
Board Guidance
For discussion
1. How important is it to expand number of eligible hospitals?
Accomplished through addition of measures
2. How important is it to broaden the definition of patient safety?
Also implies addition of measures
3. How important is it to allow all hospitals to achieve PSHR status over time?
4. Should CHC embark on development of a more complex methodology: composite measure, alternative algorithmic approach?
Will the opportunity to weight domains/measures address concerns regarding the inclusion/exclusion of specific measures?
14
ED Wait Time Measures
15
ED Wait Time Measures – Performance
Categorization
Currently, CHC does not assign performance categories to ED Wait Time
measures because they are measured in minutes
ED1 – Average Time patients spent in the emergency department before they were admitted to the hospital
OP18 – Average time patients spent in the emergency department before being sent home
OP20 – Average time patients spent in the emergency department before they were seen by a health
professional
OP21 – Average time patients spent in the emergency department with broken bones before getting pain
medication
IBM Watson Health’s statistician reviewed the data available to determine if
there is a reasonable way to assign performance categories consistent with
the rigorous statistical approach used for other measures
That approach incorporates the statistical uncertainty in measure rates
16
…ED Wait Time Measure – Performance
Categorization
Conclusion: ED Wait Time measures cannot be scored since required measure
information (specifically, hospital-level standard deviation) is not available.
As an alternative, ED Wait Time measures could be scored without
consideration of statistical uncertainty in rate by directly applying thresholds:
Poor: Above 90th percentile
Below Average: Between 75th and 90th percentile
Average: Between 25th and 75th percentile
Above Average: Between 25th and 10th percentile
Superior: Below the 10th percentile
17
…ED Wait Time Measure – Performance
Categorization
Pros:
Enables performance categorization for ED wait time measures
Cons
Scoring approach ignores statistical uncertainty
Incorporating statistical uncertainty in performance categorization is an
essential feature of Cal Hospital Compare’s proprietary methodology; the
alternative approach is statistically inconsistent with it
TAC reviewed issue but did not have a strong, collective opinion
Question for Board: Does Board support scoring of measures by
direct comparison to thresholds?
18
General Updates
19
• Q2 data update complete
• No new measures added
CMS Data
• Annual data refresh scheduled for June, 2019 using CMQCC’s active track data for CY2018
• New measure: Percent Deliveries by Certified Nurse Midwives
Maternity Data
Opioid Safe Hospital Designation
20
DESIGNATING OPIOID SAFE HOSPITALS
Questions? Contact Alex Stack, Director, Programs & Strategic Initiatives at [email protected]
For more than a decade, Cal Hospital Compare (CHC) has been providing Californians with objective hospital performance ratings. CHC is a non-profit organization that is governed by a multi-stakeholder board, with representatives from hospitals, purchasers, consumer groups, and health plans. In effort to accelerate improvement and recognize high performance by California hospitals, CHC publishes an annual Patient Safety Honor Roll and Low-Risk C-section Honor Roll.
To address California’s opioid epidemic and accelerate hospital progress to reduce opioid related deaths, this fall CHC will designate select hospitals as Opioid Safe for the purpose of supporting continued quality improvement and recognizing hospitals for their contributions fighting the epidemic. CHC along with other partners will publicly recognize hospitals designated as Opioid Safe.
To measure opioid safety, CHC received funding from California Health Care Foundation (CHCF) to collaboratively design the Opioid Safe Hospital Self-Assessment. This self- assessment measures opioid safety across 4 domains:
1. Preventing new opioid starts2. Identifying and managing patients with Opioid Use Disorder3. Preventing harm in high-risk patients4. Applying cross-cutting organizational strategies
The self-assessment period starts May 13, 2019 and closes September 18, 2019.
To learn more about the Opioid Safe Hospital Designation program please join us for a
one-hour free kick-off webinar on May 9 at 11:00 am PST. This webinar is designed forChief Medical Officers, Chief Nursing Officers, Chief Quality Officers, Quality and Emergency Department leadership, and other individuals involved in improving opioid safety. At the end of the webinar, participants will have:
• Considered the value of participating in the Opioid Safe Hospital program
• Examined four domains of opioid safety as measured by the Opioid Safe Hospital Self-Assessment and exchanged strategies for evaluating your hospital’s performance
• Described how to leverage the Opioid Safe Hospital Self-Assessment to enhance the vital workyour hospital is already doing to reduce opioid related deaths
• Heard from peer hospitals the steps they have taken to implement opioid safe strategies asoutlined in the Opioid Safe Hospital Self-Assessment
• Communicated how CHC can support hospital progress through a 4-part monthlywebinar series starting June 2019
Register online HERE for the upcoming May 9th kick-off webinar,
Addressing California’s Opioid Epidemic – Introducing the Opioid Safe Hospital
Program, & subsequent no cost 4-part Opioid Safe Hospital Webinar Series
Program Launch
21
Webinar Series
• Kickoff webinar May 9th
• Specific technical assistance Jun – Sept
• CMEs available
Resources
• Relevant resources available on Cal Hospital Compare & mapped to self-assessment tool
Self-Assessment
• Survey window May 13 – Sept 18, 2019
• Submit responses via e-survey
• Spot “audits”
Program Trajectory
22
Coordinate announcements with Honor Rolls
Funding for 3 years
Transition to Substance Use
Disorder in 2020
Capture/spread successes &
lessons learned
Scale support nationally
Resources & Follow Up Materials
23
Source: Cal Hospital Compare Website – About – Opioid Safe Hospital Designation
TAC Next Steps
Encourage your hospitals and peers to apply
Develop relevant threshold
Announce Opioid Safe Hospitals Fall 2019
24
Business Plan
25
Accrual Basis Cal Hospital Compare
Profit & Loss Budget vs. Actual January through April 2019
Jan - Apr 19 Budget $ Over Budget
Income
Direct Public Support
Health Plans 355,000.00 375,000.00 (20,000.00)
Total Direct Public Support 355,000.00 375,000.00 (20,000.00)
Grants
CHCF 2,341.25 - 2,341.25
Total Grants 2,341.25 - 2,341.25
Investments
Interest Income 1,699.07 100.00 1,599.07
Total Investments 1,699.07 100.00 1,599.07
Total Income 359,040.32 375,100.00 (16,059.68)
Gross Profit 359,040.32 375,100.00 (16,059.68)
Expense
Bank Fees 108.29 600.00 (491.71)
Contract Services
Accounting Fees 603.75 3,000.00 (2,396.25)
Contract Services - Admin Asst 142.18 2,000.00 (1,857.82)
Contract Services - CHC 57,081.68 165,000.00 (107,918.32)
Contract Services - CHCF 2,341.25 - 2,341.25
Contract Services - Other - 1,000.00 (1,000.00)
Contract Services - Truven - 190,000.00 (190,000.00)
Legal Fees - 500.00 (500.00)
Total Contract Services 60,168.86 361,500.00 (301,331.14)
Operations
Postage, Mailing Service 74.00 - 74.00
Web Hosting - 6,000.00 (6,000.00)
Total Operations 74.00 6,000.00 (5,926.00)
Travel and Meetings
Convention & Meeting - 800.00 (800.00)
Travel 432.44 300.00 132.44
Total Travel and Meetings 432.44 1,100.00 (667.56)
Total Expense 60,783.59 369,200.00 (308,416.41)
Net Income 298,256.73 5,900.00 292,356.73
Page 1 of 2
Accrual Basis Cal Hospital Compare
Balance Sheet As of April 30, 2019
Apr 30, 19
ASSETS
Current Assets
Checking/Savings
Wells Fargo - 5281 26,685.94
Wells Fargo Checking - 9825 146,123.67
Total Checking/Savings 172,809.61
Accounts Receivable
Accounts Receivable 240,000.00
Total Accounts Receivable 240,000.00
Other Current Assets
Fidelity Brokerage - 5256 252,138.16
Total Other Current Assets 252,138.16
Total Current Assets 664,947.77
TOTAL ASSETS 664,947.77
LIABILITIES & EQUITY
Liabilities
Current Liabilities
Accounts Payable
Accounts Payable 17,262.54
Total Accounts Payable 17,262.54
Total Current Liabilities 17,262.54
Long Term Liabilities
Restricted
CHCF - Opioid Safe Hospital 12,658.75
Total Restricted 12,658.75
Total Long Term Liabilities 12,658.75
Total Liabilities 29,921.29
Equity
Unrestricted Net Assets 336,769.75
Net Income 298,256.73
Total Equity 635,026.48
TOTAL LIABILITIES & EQUITY 664,947.77
Page 2 of 2
Board Meeting Schedule – 2019*Schedule is in Pacific Time
Wednesday, August 7, 2019 – 10:00am to 2:00pm (In Person
- Oakland)
Wednesday, October 2, 2019 – 10:00am to 12:00pm (Call)
Wednesday, December 4, 2019 – 10:00am to 2:00pm (In Person – Oakland)
26
Appendix: PSHR Methodologies
27
PSHR 1.0 Methods – A Reminder:
Six Selected Measures and Leapfrog Grade
Healthcare-Associated Infections (Source: CMS Hospital Compare Jan 2017 -Dec 2017 measurement period)
CLABSI
CAUTI
SSI Colon Surgery
MRSA
CDI
AHRQ PSI 90 Composite (Source: CMS Hospital Compare October 2015 to June 2017 measurement period)
Leapfrog Hospital Safety Grade (Source: Leapfrog Grades for Spring 2017, Fall 2017, and Spring 2018)
28
PSHR 1.0 Methods (cont.)
To be included in the algorithmic method, hospitals must have scores for at least 4 of the 6 measures.
Tier 1
The hospital meets the algorithm approach with two-thirds of their measures above the 50th percentile (and none below the 25th percentile) AND has Leapfrog Grades of at least an A, A, B for the last three reporting periods. 19 hospitals (8% of eligible hospitals).
Tier 2
The hospital meets the algorithm approach with two-thirds of their measures above the 50th percentile (and none below the 25th
percentile) OR has Leapfrog Grades of at least an A, A, B for the last three reporting periods. 54 hospitals (23% of eligible hospitals).
40 hospitals met algorithmic criteria alone 29
Typical Steps in Developing a Composite
In considering right approach to PSHR 2.0, review of key steps in
typical composite development might be useful
TAC Question: Which of these steps should we adopt, maximizing
PSHR value within project resources?
1. Identify and review available measures
2. Select measures
• Typical Considerations: clinical importance/impact, availability,
performance gaps, external target, risk adjustment, harmonization,
evidence-base, reliability, validity, feasibility, usability
3. Optional: Assign measures to domains
• Example domains: HAIs, PSIs, HCAHPS
30
…Typical Steps in Developing a
Composite
4. Standardize measure scores (e.g., z-scores)
5. Weight domains and/or measures
Options include:
1. Policy-based (consensus of CHC TAC and Board)
➢ Consider same type of factors as for measure selection
2. Reliability weighted
➢ Determined by empirical characteristics of component measures, e.g., their
correlations, reliability
3. Opportunity weighted
➢ Weighted by size of denominator populations
4. Equal weighting
31
…Typical Steps in Developing a
Composite
6. Establish standards and adjustments for missing data
Minimum denominator sizes
Re-distribute weights
7. Calculate single hospital-wide composite score
8. Establish threshold for PSHR qualification
Based on composite score
Necessary to consider relative scoring thresholds (e.g., 75th percentile and
above of composite score)
9. Compare hospital composite score to threshold to determine PSHR
status
10. Option: establish fixed performance threshold to apply to future years
32
Illustrative Example of Key Composite
Step – Domain Weighting
Previous work identified four domains
Questions:
Does TAC wish to identify and weight domains or, alternatively, move directly to
simply weighting individual measures?
Are there other domains to be considered?
What information would TAC need to support domain policy weighting decisions?
33
DomainNumber of Measures
Policy Weight Assigned by TAC -
Example
1 HAI 5 40%
2 PSI 10 35%
3 HCAHPS 5 20%
4 SEP-1 1 5%
Total 100%
…Illustrative Example of Key Composite
Step – Measure Weighting
For policy weighting, consider the following measure attributes: clinical
importance/impact, availability, performance gaps, external target, risk
adjustment, harmonization, evidence-base
Illustrative example using HAIs on next slide
For clinical importance/impact and evidence-base, IBM Watson Health would
obtain information from NQF reports and conduct a mini-literature review to
bring to TAC
For example, Archives of Surgery article shows trauma patients with HAIs had
mortality odds ratio 1.5 to 1.9 times higher than control
IBM Watson Health analysis showed excess LOS and higher costs for admissions with
CAUTI
34
…Illustrative Example of Key Composite
Steps – Measure Weighting
35
Performance Gap
Measure Impact - Total California Infections
Availability -# Reporting
Hospitals
P25 P50 P75 Percent Of Hospitals
with Rate < 1.0
External Target -National
Target SIR by 2020*
Risk Adjusted?
Harmonization - Used by Leapfrog?
Harmonization - NQF
Endorsed?
TAC Decision
to Include?
TAC Assigned
Policy Weight
CLABSI 1,331 225 0.41 0.71 1.10 70% 0.50 Yes Yes Yes Yes 30%
CAUTI 2,037 248 0.46 0.85 1.39 60% 0.75 Yes Yes Yes Yes 10%
Colon: SSI 667 190 0.26 0.80 1.36 59% 0.70 Yes Yes Yes No N/A
MRSA 620 182 0.40 0.75 1.20 65% 0.5 Yes Yes Yes Yes 40%
C. Diff. 6,724 285 0.54 0.74 0.98 78% 0.7 Yes Yes Yes Yes 20%
* from HHS Office of Disease Prevention and Health Promotion
Alternative Algorithmic Approach
Simplified alternative to full composite measure development
Maintain approach of assessing performance of each measure against target
E.g., measure rate must be better than 50th percentile of CalHospitalCompare hospitals
TAC assigns points to measures to reflect their policy weights
Establish minimum measure criteria
E.g., hospital must have available rates for measures that account for 50% or more of total possible points
Establish minimum point threshold for PSHR qualification
E.g., hospital must achieve at least 75% of available points
Necessary to consider relative scoring thresholds
Table on following slide illustrates approach
36
Example of Alternative Algorithmic
Calculation
37
Example for Hospital XXMeasure Threshold Criteria Threshold
(SIR)Hospital
Rate (SIR)Did
Hospital Pass
Threshold?
Measure Points
(Assigned by TAC)
Points Achieved
by Hospital
CLABSIBetter than 50th percentile 1.00 0.99 Yes 10 10
CAUTIBetter than 50th percentile 0.80 0.70 Yes 15 15
Colon: SSIBetter than 50th percentile 0.90 1.00 No 5 0
MRSABetter than 50th percentile 1.10 1.00 Yes 5 5
C. Diff.Better than 50th percentile 0.80 N/A N/A 15 N/A
Total Available Points (based on available hospital measures) = 35 A
Total Possible Points (All Measures) 50 B
Percent Available Points of Total Possible 70% =A/B
Does Hospital Meet Minimum Measure Criteria (rates available for more than 50% of Total Possible Points) Yes
Total Points Achieved by Hospital = 30 C
Percent Points Achieved of Available 86% =C/A
Min. Percent of Available Points Required to Qualify for PSHR = 75%
Does hospital qualify for Honor Roll? Yes
Covered California Patient Safety Poor Performer Report Letter to Qualified Health Plans
Page 1 of 3 May 2019
Dear QHP Account Representative: We are writing to you today to announce the completion of an analysis of patient safety performance in California hospitals. Cal Hospital Compare (CHC) is a multi-stakeholder organization including purchasers, health plans, hospitals, the California Hospital Association (CHA) and the Hospital Quality Institute (HQI), as well as industry experts and consumer advocates. At the request of Covered California, to fulfill its commitment under Attachment 7 to establish a definition of Outlier Poor Performance, over the last two years CHC developed a broadly endorsed methodology to use a composite of common measures of patient safety to look at the full spectrum of hospital performance. Background CalHospitalCompare is the entity that publishes maternity hospital performance as collected by the California Maternity Quality Care Collaborative (CMQCC). The C-section target for NTSV C-sections is based on the Healthy People 2020 target of 23.9% and the California Secretary of Health and Human Services has announced the Honor Roll for those hospitals that have achieved the target. Covered California worked with you and other QHPs to require lower performing maternity hospitals to achieve the national target as a marker of high quality care. Patient Safety Patient Safety incorporates a broad framework of available measures and CHC initially looked for an existing composite measure to provide a summary score. Unfortunately, there are no publicly reported patient safety composite measures for all hospitals in California. Leapfrog uses voluntary data collection with results available by subscription for a subset of California hospitals. CMS has the Hospital Acquired Condition Reduction Program (HACRP) which combines five hospital acquired infections and the broad AHRQ measure of safety, the PSI 90, to identify the bottom quartile of performance for annual publication and financial penalties. CHC, however, sought a methodology that identified the full range of performance to create a Patient Safety Honor Roll. The initial task was to identify top performing hospitals utilizing both the six publicly available measures already used by CMS and the Leapfrog Group’s Hospital Safety Score. Like the NTSV C-section Honor Roll, the Patient Safety Honor Roll creates a performance standard and a methodology to look across domains to recognize and promote performance improvement. Once he is confirmed by the legislature, we expect to engage the new California Secretary of Health and Human Services, Dr. Mark Ghaly, in announcing this honor roll. CHC has performed a similar analysis to identify poor performing hospitals in the patient safety arena. CHC started with a “reverse-methodology” of the patient safety honor roll utilizing both the six publicly available measures already used by CMS in the HACRP and the Leapfrog Group’s Hospital Safety Score and adding the CMS HACRP list and a report from the California Department of Public Health focused only on Hospital Acquired Infections. A poor performers report was created which includes 43 hospitals which was recently approved by the CHC Board. Using these four independent reports from different sources, hospitals in the report have up to three separate “signals of concern” indicating they need to improve their patient safety practices and performance. The more “signals of concern” the stronger the evidence that a hospital needs to prioritize improvement in this area. Yet, even one “signal of concern” is problematic since the large majority of California hospitals have none. Through the CHC committee structure and Board of Directors, the hospital community actively participated and approved the methodology and the report.
Covered California Patient Safety Poor Performer Report Letter to Qualified Health Plans
Page 2 of 3 May 2019
There is no current plan for CHC to publish this report. The goal remains challenging each individual hospital in California to reduce avoidable complications and to do so promptly. QHPs play the key role in conveying that message in managing their contractual relationship with hospitals. We will reconsider publication in a couple years depending on the rate of progress. Additionally, it is important to note that the measures used in three of the four sources used in this analysis do not fully reflect the breadth of important aspects of patient safety. Covered California has long been interested in adding Adverse Drug Events to the list and is working with national leadership to establish standard measures. Measures for effective treatment of Sepsis appear closer to being ready to use and CHC is evaluating a number of other measures that can be added over time. Next Steps Now that the report is final and approved, we are requesting that you obtain the report from CHC, evaluate and engage hospitals in your networks and reinforce the expectations and goals you have communicated over the last several years. Your work to establish reimbursement based on quality should be aligned with these goals to incentivize and support hospital improvement to better serve your members and all patients in California. Covered California will review how you have used the report at the next scheduled Quarterly Business and Quality Improvement Strategy Review meeting in early fall 2019. Developing the methodology, collecting/analyzing the data and creating a report for approval and dissemination has built-in costs. To obtain the report from CHC, the attached 2019 Data Use Fees document outlines a range of options to pay for CHC data. The minimum charge of $25,000 will give you the specified items listed in the Data Use Fees document, but QHPs are encouraged to consider additional participation levels to address other topics in the hospital performance measurement and improvement domain. For QHPs with fewer than 25 hospitals in their networks, the charge will be discounted to $15,000. Please contact Bruce Spurlock, M.D., Executive Director at (916) 835-0204 or [email protected] to request the report and answer any questions you may have Thank you for your support in making California hospitals the safest in the nation and for your commitment to quality for your members. Signed, Bruce Spurlock, MD Executive Director, CalHospitalCompare Lance Lang, MD, Chief Medical Officer, Covered California PS: We also want to call your attention to the attached announcement of the CalHospitalCompare program to designate Opioid Safe Hospitals. CHC was fortunate to receive a grant from CHCF to facilitate five no-cost webinars for the hospitals to have an opportunity to learn from each other how to implement the various practices addressing the opioid epidemic. The webinars will describe in detail the designation and highlight peer-to-peer examples of successful adoption and spread of these practices. The introductory webinar is scheduled for May 9 at 11 AM PT and we’d like to invite as many hospitals that are interested in reviewing the program, the self-assessment tool and hearing from the hospitals
Covered California Patient Safety Poor Performer Report Letter to Qualified Health Plans
Page 3 of 3 May 2019
how they would address some of the areas in the tool. The final self-assessment tool will be publicly available on the CHC website a few days prior. Can you or your staff disseminate the attached flyer to promote the program to your hospital systems as you deem appropriate? The target audience is anyone working on the opioid epidemic in hospitals but would often include quality, ED, Pharmacy, IT, CMO/CNO. All are welcome, and hospitals can elect who is best to attend. Individuals can register for one or all of the webinars on calhospitalcompare.org. Thank you, Bruce and Lance Lance Lang, MD FAAFP Chief Medical Officer P 916.228.8838 C 510-333-8629 E [email protected] Covered CaliforniaTM 1601 Exposition Blvd, Sacramento, CA 95815 CoveredCA.com For assistance please contact: Gina Uybungco, Plan Manager Carrier Management Unit Plan Management Division P 916.228.8349 E: [email protected] Covered CaliforniaTM 1601 Exposition Blvd, Sacramento, CA 95815 CoveredCA.com
