2012-13 SHIP Grant Kickoff

2012-13 SHIP Grant KickoffAGENDA:

10:00 – 10:15 Opening Remarks

10:15 – 11:00 Value Based Purchasing Overview (Lou Semrad, HTH)

11:00 – 11:45 HCAHPS (Kate Valakos, Press-Ganey, remote)

11:45 – 12:30 Lunch

12:30 - 1:15 Tools and Resources, Data drives improvement(Lou)

1:15 - 2:00 ICD-10 (Kathy Whitmire, HTH)

Value Based Purchasing Overview

Learning Objectives:

Participant will be able to describe what VBP is & why CMS has implemented it.

Participant will be able to explain why it is important to embrace VBP

Participant will understand why “every patient encounter is important”

Participant will understand what changes will occur to VBP in the near future

Participant can list at least 5 best practices that can be applied/implemented in their organization.

Participant can identify at least 4 culture elements of high performing hospitals

2012-13 SHIP Grant Kickoff

Value Based Purchasing Overview

What is VBP:

• ACA authorized the Secretary of HHS to initiate programs to decrease the cost of healthcare, & improve quality

• VBP is one of these programs.

• Started October 1, 2012 for qualifying PPS hospitals

• Non-qualifying PPS (low volume) and CAH are currently exempt (no napping for CAH)

KSF: No matter your hospital size or form of reimbursement, embrace VBP.

2012-13 SHIP Grant Kickoff

Value Based Purchasing Overview

Not All Hospitals Are Created Equally:

Qualifying PPS hospitals: you vs. 3,000 other qualifying hospitals > carrot & stick approach

Non-qualifying PPS & CAH (most likely scenario): you vs. hospitals with similar average daily census. > likely just a carrot approach

2012-13 SHIP Grant Kickoff

Value Based Purchasing Overview

Carrot & Stick Approach:

For qualifying hospitals, a percentage of Medicare reimbursement is withheld

Hospitals have the opportunity to earn some or all of the withheld money back. About half, will earn an additional amount of money

For FFY 2013, participating hospitals will earn points for: > performance on core measures (Process of Care) > performance on HCAHPS (Patient Experience)

For FFY 2014, hospitals will earn points for keeping patients alive

2012-13 SHIP Grant Kickoff

Value Based Purchasing Overview

Carrot & Stick Approach:

How much money is at risk? How much money is in play?

FFY 2013 1.00% ~2.00%

FFY 2014 1.25% ~2.50%

FFY 2015 1.50% ~3.00%

FFY 2016 1.75% ~3.50%

FFY 2017 2.00% ~4.00%

KSF: Leaderships definition of VBP (stick or carrot)

2012-13 SHIP Grant Kickoff

Value Based Purchasing Overview

Carrot Approach:

• Low volume PPS and CAH – likely scenario is CMS will estimate savings to Medicare and use that amount (budget neutral) as a carrot to improve quality and patient experience. Notice that the likely scenario does not include a contribution or holdback.

• Google “CAH and VBP” and read the white paper by HRSA dated September 2011.

2012-13 SHIP Grant Kickoff

Value Based Purchasing Overview

Common Terms of VBP:

Floor (Patient Experience Domain only) – the worst performing hospital

Thresholds – the score of the 50th percentile

Benchmarks – the score of the top 5% of the hospitals

Baseline – your score during the baseline period (9 month period)

Performance – your score during the performance period (9 month period)

Improvement Points – points awarded for improving your performance score vs your baseline score.

Achievement Points – points awarded based on where your performance score is vs. the nations threshold and benchmark score.

2012-13 SHIP Grant Kickoff

Value Based Purchasing Overview

Clinical Domain:

Process Measures:

2012 – 12 core measures

2013 – 13 core measures (adding SCIP-9, removal of urinary cath)

Focus is on ED and surgery

How involved is your Medical Staff?

KSF: Implementation and adherence to Clinical pathways

2012-13 SHIP Grant Kickoff

2012-13 SHIP Grant Kickoff

VBP Measure 2013 2014 Proposed 2015

Proposed 2016

AMI-7 (fibrinolytics) ✔ ✔ ✔ ✔AMI-8a (PCI) ✔ ✔ ✔ ✔AMI-10 (statin @ d/c) n/a n/a ✔ ✔HF-1 (d/c instructions) ✔ ✔ ✔ ✔PN-3b (blood culture) ✔ ✔ ✔ ✔PN-6 (abx selection) ✔ ✔ ✔ ✔SCIP-Inf-1 ✔ ✔ ✔ ✔SCIP-Inf-2 ✔ ✔ ✔ ✔SCIP-Inf-3 ✔ ✔ ✔ ✔SCIP-Inf-4 ✔ ✔ ✔ ✔SCIP-Inf-9 (cath removal) n/a ✔ ✔ ✔SCIP-VTE-1 (prophylaxis) ✔ ✔ remove n/a

SCIP-VTE-2 ✔ ✔ ✔ ✔SCIP-Card-2 ✔ ✔ ✔ ✔

Value Based Purchasing Overview

Patient Experience Domain:

HCAHPS:

2012 – 8 measures

2013 – 8 measures

Measures doctors to housekeeping to the patients memory (discharge instructions & communication about medications)

KSF: Everyone on the hospital staff must understand how they can impact the Patient Experience Domain score.

2012-13 SHIP Grant Kickoff

Value Based Purchasing Overview

Rearview Mirror:

Performance periods:

FFY 2013 – July 2011 to March 2012

FFY 2014 – April 2012 to December 2012 / Outcomes: July 2011 to June 2012

FFY 2015 – January 2013 to December 2013 / Outcomes: October 1, 2012 to June 30, 2013.

2012-13 SHIP Grant Kickoff

Value Based Purchasing Overview

2012-13 SHIP Grant Kickoff

Studer Group 2012

Value Based Purchasing Overview

Best Practices:

1. To whose expectations are you and your staff performing to (theirs, yours or the patients)?

2. Clinical pathways: Medical Staff must support leadership’s effort to drive standardization & understand why. They must be engaged.

3. Staff – patient interaction: Does every member of the staff know about VBP and their role in improving the patient experience

4. Behavior expectations: Does the staff know what is expected of them and are they held accountable? (Be nice to patients vs. introduce yourself, explain why you are there and how long upon contact with the patient, make eye contact and smile)

2012-13 SHIP Grant Kickoff

Value Based Purchasing Overview

Best Practices continued:

5. Communication/transparency: Data must be shared with the staff. Do you?

6. Hourly rounding - opportunity to build trust and consistency in messaging (key words that they will hear again don’t miss this opportunity to coach up the patient)

7. Leader rounding with purpose – opportunity to coach up staff, visibility

8. Post-discharge follow-up – who & what is discussed?

2012-13 SHIP Grant Kickoff

Value Based Purchasing Overview

Culture of High Performing Hospitals:

Educated staff that perform to high service levels & standards

Dedication to identifying and participating in PI initiatives

Culture of accountability

Engaged employees and Medical Staff

Leadership visibility and supportive in nature

Culture of transparency

2012-13 SHIP Grant Kickoff

Value Based Purchasing Overview

Your HTH Team:

Jimmy Lewis – CEO, 770-363-7453

Kathy Whitmire – Managing Director, 706-491-3493

Lou Semrad – Clinical Services, 706-474-0434

Kristy Thompson – Hometown Health University, 706-839-7143

2012-13 SHIP Grant Kickoff

Value Based Purchasing Overview

2012-13 SHIP Grant Kickoff