What’s Hot & What’s Not in the Core Measure Field

1© 2013 Amphion Medical Solutions 1

BRENDA BARTKOWSKI, CMA, CCA, BS HPA

MANAGER, CLINICAL DATA ABSTRACTION

AMY WIRTHSALES EXECUTIVE

JULY 17, 2013

What’s Hot & What’s Notin the Core Measure Field

2© 2013 Amphion Medical Solutions

What’s Hot & What’s Not

DISCLAIMER: This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference. This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.


Value-Based Purchasing (VBP)

What is hospital value-based purchasing?

A Centers for Medicare & Medicaid Services (CMS) initiative Rewards acute-care hospitals for quality of care to Medicare recipients

What’s



Why?

Rewards based on following best clinical practices How well hospitals enhance patients’ experiences of care Patients receive higher quality care

What’s



How?

Must report on minimum of 4 Hospital VBP measures Minimum of 10 cases per measure

What’s



When?

Began with FY2013 Participating hospitals already receiving incentive payments

What’s


This information on Hospital Value Based Purchasing was retrieved from the National Provider Call on HVBPg from March 14, 2013 .

What’s

FY 2015 Finalized Domains and Measures/Dimensions


What’s

12 Clinical Process of Care Measures

1 AMI-7a Fibrinolytic Therapy Received within 30 Minutes of Hospital Arrival

2 AMI-8 Primary PCI Received within 90 Minutes of Hospital Arrival3 HF-1 Discharge Instructions4 PN-3b Blood Cultures Performed in the ED Prior to Initial

Antibiotic Received in Hospital5 PN-6 Initial Antibiotic Selection for CAP in Immunocompetent

Patient6 SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour Prior

to Surgical Incision7 SCIP-Inf 2 Prophylactic Antibiotic Selection for Surgical Patients8 SCIP-Inf-3 Prophylactic Antibiotics Discontinued within 24 Hours

After Surgery9 SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m.

Postoperative Serum Glucose10 SCIP-Inf-9 Postoperative Urinary Catheter Removal on

Postoperative Day 1 or 211 SCIP-Card-2 Surgery Patients on a Beta Blocker Prior to Arrival

That Received a Beta Blocker During the Perioperative Period12 SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous

Thromboembolism Prophylaxis within 24 Hours


What’s

8 Patient Experience of Care Dimensions

1 Nurse Communication2 Doctor Communication3 Hospital Staff

Responsiveness4 Pain Management5 Medicine Communication

6 Hospital Cleanliness & Quietness

7 Discharge Information8 Overall Hospital Rating


What’s

5 Outcome Measures

1 Efficiency Measure

Represents a new measure for the FY 2015 program that was not in the FY 2014 program.

1 MSPB-1 Medicare Spending per Beneficiary measure

Measure / Dimension RateClinical Process of Care Measures Higher is betterPatient Experience of Care Dimensions Higher is betterMortality Measures (Survivability) Higher is better

1 MORT-30-AMI – Acute Myocardial Infarction (AMI) 30-day mortality rate

2 MORT-30-HF – Heart Failure (HF) 30-day mortality rate3 MORT-30-PN – Pneumonia (PN) 30-day mortality rate4 PSI-90 – Patient safety for selected indicators (composite)5 CLABSI – Central Line-Associated Bloodstream Infection


How will hospitals be evaluated?

Achievement Points

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

Improvement Points

Awarded by comparing an individual hospital’s rates duringthe performance period to that same individual hospital’srates from the baseline period.

What’s


What’s

Proposed Weights VBP

Measure 2015 2016 2017Process of Care 20% 10% 10%Patient Experience 30% 25% 25%Outcome 30% 40% 50%Efficiency 20% 25% 25%Safety 15%


EPs that began participation in 2011 or 2012 EPs that began participation this year (2013) EPs that plan to begin participation in 2014

What’s


What’s


▪ MU Stages 1 & 2 Comparisons▫ Must meet 19 objectives in Stage 1▫ Clinical Quality Measure Reporting (CQM) required▫ No incentive payment if any of the objectives are not met

▪ Timelines▫ MU Stage 1 Final Rule = July 2010▫ MU Stage 2 Final Rule = August 2012▫ MU Stage 2 Final Rule Effective FY 2014 = October 1, 2013

What’s


▪ Clinical Quality Measures for Stage 1▫ ED = 2▫ STK = 7▫ VTE = 6

▪ Clinical Quality Measures for Stage 2▫ ED = 3 ▫ PN = 1 ▫ Early Hearing Detection = 1▫ STK = 7 ▫ SCIP = 3 ▫ Healthy Newborn =

1▫ VTE = 6 ▫ PC = 2▫ AMI = 4

What’s


▪ Highlights of MU Stage 2 Objectives▫ Use CPOE ▫ Use certified HER technology▫ Record demographics ▫ Medication reconciliation and▫ Record/chart changes summary of care▫ Record smoking status ▫ Submit electronic data▫ Use clinical decision support ▫ Automatically track medications▫ Provide patients access to their info▫ Protect electronic health info▫ Import lab results▫ Generate lists

What’s


Medicare EPs: How to Avoid Payment Adjustments▫ Mandated to begin January 1, 2015▫ Based on MU data submitted prior to 2015▫ Applied to Medicare physician fee schedule amount▫ Will increase if MU is not demonstrated in subsequent years

What’s Not


What’s Not


Measure Suspension▫ AMI – 1 ▫ AMI – 3▫ AMI – 5▫ SCIP-Inf-6

▪ Measure Retirement▫ AMI ▫ IMM

○ AMI-2 ○ IMM-1○ AMI-10 ▫ SCIP

▫ PN ○ SCIP-Inf-10○ PN-3b

▫ HF○ HF-1○ HF-3

What’s Not

▪ Measure Refinement ▫ SCIP-Inf-4


HBIPS▫ CMS is not collecting data on HBIPS1▫ CMS is collecting data on HBIPS-2, 3, 4, 5, 6, 7

○ HBIPS-2 – 7 are required○ HBIPS-2, 3 are event measures○ HBIPS-4 – 7 are discharge measures

○ No validation for HBIPS data

What’s Not


Validation▫ ED▫ STK / VTE▫ Quarterly Appeals

What’s Not


What’s Not

Hospital Readmissions Reduction Program

◊ Affordable Care Act ◊ October 1, 2012◊ ADDITIONAL penalty from CMS

▫ Up to 1%▫ Grows to 3% by October 1, 2014


Readmission Measures▫ Defined readmission▫ Adopted readmission measures▫ Established methodology to calculate▫ Established policy of using the risk adjustment methodology▫ Established an applicable period

○ For FY 2013○ For FY 2014

▪ Readmissions Adjustment Factor▫ FY 2013 – the higher of the Ratio or 0.99 (1% reduction)▫ FY 2014 – the higher of the Ratio or 0.98 (2% reduction)▫ FY 2015 – the higher of the Ratio or 0.97 (3% reduction)

What’s Not


Medicare’s Hospital VBP Scores are now available:http://www.medicare.gov/hospitalcompare/data/VBP/hospital-vbp.aspx

Details on how to calculate MSPB measure scores, and more on VBP, please view The Official Website for the Medicare Hospital Value-based Purchasing Program:http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html?redirect=/Hospital-Value-Based-Purchasing/

OR

https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1228772039937 Medicare’s “Hospital Compare”:http://www.hospitalcompare.hhs.gov/hospital-search.aspx?AspxAutoDetectCookieSupport

CMS’s readmissions reduction program:http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html

and https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1228772412458

Proposed Rule Site: http://www.ofr.gov/OFRUpload/OFRData/2013-16555_PI.pdf

Comment Site: http://www.regulations.gov/#!submitComment;D=CMS-2013-0154-0001

NFQ Website: http://www.qualityforum.org/Home.aspx

Resources


What’s right now?Outsourcing Core Measures!

What’s Not?

Overworked hospital staff

Amphion’s Core Measures Solutions

27© 2013 Amphion Medical Solutions 27

For more information on Amphion’s solutions, contact Amy Wirth at

888-830-2644 x1634 [email protected]

Thank you for the opportunity to speak with you today

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What’s Hot & What’s Not in the Core Measure Field