Exploring the Value Equationcoruralhealth-wpengine.netdna-ssl.com/wp-content/uploads/...Performance Pillars Span Market, Value, and Finance Market Inpatient Market Share Inpatient

Exploring the Value Equation

Hospital Strength INDEX

October 17, 2018

© 2018 The Chartis Group, LLC. All Rights Reserved. Page 2

A Framework for Understanding

and Assessing Rural Provider Performance

Series 1

IDNsState

Assoc.

DeptHealth

RuralHosp.

Univ.

CMMI

Nat’lAssoc.

Utilized today by Tennessee and Colorado to provide rural-relevant analytics to all rural facilities. Previously leveraged state-wide in Iowa, California, Arkansas and Oklahoma.

Leveraged by DoH in Ohio, Maine, New Mexico and Mississippi as cornerstone of rural health programming.

Cornerstone for monitoring performance across 25 Montana CAHs participating in a 3-year innovation program.

Trusted by Critical Access and Rural & Community Hospitals nationwide as a comprehensive and objective tool for measuring performance.

Utilized by NRHA and NOSORH for advocacy efforts and basis of annual award programs.

Used by leading health systems to better understand individual facility performance as well as to compare with systems with similar rural investments.

Penn State and Michigan State rely on INDEX analytics as foundation for state-wide rural programming. Other participating universities have been, Wisconsin and University of Nevada.


Hospital Strength INDEX®

Provides a comprehensive and objective assessment of all rural and

Critical Access Hospitals.

Offers the first national rating system to include the roughly 1,300

Critical Access Hospitals and 900 Rural & Community Hospitals.

Benchmarks performance to peers nationally using percentile ranks.

Aggregates CMS data for more than 50 rural-relevant indicators

organized into 8 Performance Pillars.

Provides transparent and actionable performance metrics, updated

three times per year.


Performance Pillars Span Market, Value, and Finance

Market

Inpatient Market

Share

Inpatient Market

Share

Outpatient

Market Share

Diagnostics

Market Share

Emergency

Market Share

Other OP

Surgery Market

Share

Value

Quality

Emergency (ED)

Outpatient (OP)

Immunization

(IMM)

Outcomes

HF Readmission

PN Readmission

Hospital-Wide

Readmission

Proprietary

Mortality Score

Patient

Perspective

All Domains

Cost

Adjusted IP

Costs

Adjusted OP

Costs

Charges

Adjusted IP

Charges

Adjusted OP

Charges

Finance

Financial

Stability

Capital

Efficiency

See Full Methodology

http://www.ivantageindex.com/2018-methodology/


INDEX Reports

Performance Summary Pillar Report Indicator Report


CO CAH Network Performance to Peers

Market Value Finance

Overall INDEX

Score

IP Market

Share

OP Market

ShareQuality Outcomes Patient Sat. Cost Charges

Financial

Stability

CO CAH

Median 54 50 78 86 59 70 16 44 73

All U.S. CAH

Median 51 40 46 62 49 65 36 64 51

CO CAH

Network vs.

US CAHs


The Value Equation

Value

Quality

Cost


The Numerator of Value


Quality Deep-Dive – The Numerator

OP20 Med Time ED Door to Doc

OP21 Med Time Pain Mgmt Long

BoneOP22 Patients Left

w/o Being Seen IMM2 Flu VaccineIMM3 Healthcare Staff Flu Vaccine

CO CAHMedian

14 min

(0-29 min)

39 min

(38-81 min)0%

87%

(48-100%)

98%

(93-100%)

U.S. CAH Median

17 min 44 min 1% 91% 92%

INDEX Quality Pillar

ED1b Med Time ED Arrival to Admit

OP4 Aspirin at Arrival

OP5 Med Time to ECG

OP18b Med Time ED Arr to Depart

CO CAH Median

86%ile165 min

(102-234 min)

98%

(91-100%)

10 min

(5-11 min)

103 min

(80-116 min)

U.S. CAH Median

62%ile 202 min 97% 7 min 105 min

Source: Hospital Compare – Process of Care Core Measures Q2 2017


Outcomes Deep-Dive – The Numerator

30-Day HF Readmit

30-Day PN Readmit

30-Day PN Mortality

30-Day HF Mortality

Hosp-Wide Readmit

Hosp All-Cause Mort Score*

CO CAHMedian

21.6%

(20.6-23%)

16.5%

(15.5-18.1%)

16.0%

(13.6-20.6%)

12.8%

(11.5-15.4%)

15.0%

(14.2-15.9%)

-1.53

(-5.33-1.53)

U.S. CAH Median 21.5% 16.6% 15.9% 12.4% 15.2% -1.0

*Hospital Risk-Adjusted All-Cause Mortality Score. A positive score indicates all-cause mortality rate is lower than expected based upon your cases and patient mix. A negative score indicates all-cause mortality rate is higher than expected.

Source: Hospital Compare – Mortality/Readmissions (July 2013-June 2016), MedPAR 2016 Final Rule (October 2015-September 2016)


Patient Perspectives Deep-Dive – The Numerator

INDEX Patient Perspectives

PillarDefinitely

Recommend Rating 9 or 10 CleanlinessNurse

CommunicationDoctor

Communication

CO CAH Median

70%ile77%

(60-87%)

79%

(67-87%)

80%

(70-96%)

83%

(76-90%)

86%

(76-92%)

U.S. CAH Median

65%ile 75% 77% 81% 84% 86%

Responsiveness Pain ManagementMedications Well

ExplainedDischarge

Instructions Quietness

CO CAH Median

79%

(69-83%)

74%

(63-91%)

69%

(54-75%)

89%

(78-94%)

70%

(58-80%)

U.S. CAH Median

77% 74% 69% 89% 67%

Source: Hospital Compare – HCAHPS Q2 2017


2018 National Rural Health Day Preview

Quality• Estes Park• Mt San Rafael• Rio Grande• Sedgwick County• Spanish Peaks• Yuma District

Outcomes• Aspen Valley• East Morgan• Estes Park• Grand River• Pikes Peak• Sedgwick County• Spanish Peaks

Patient Perspectives• Aspen Valley• Colorado Canyons• East Morgan• Estes Park• Gunnison Valley• Pagosa Springs• Wray Community

National Rural Health DayNovember 15, 2018


The Denominator of Value


Cost Variation

• Productivity

• Skill Mix

• Tenure

• Unions

• Agency Staff

• Benefits

• Centralized Services

• Marketing

• Cost Report

Optimization

• Level of

“Systemness”

• GPO

• Physician Preference

• Clinical Variation

• Volumes

• Contracted Services

• Contract Rollover

• EHR

• Telemedicine

• Rural Connectivity

• Technology

Advances

• “Keeping up with

the Jones”

Staffing Corporate Allocations Medical Supplies Technology


Reimbursement Hurdles to Value

Cost-Based Reimbursement at Odds with Value

Payments as a Percentage of Charge

Fee for Service

Collections/Revenue Cycle

Bundled Payments

ACO / Shared Savings

Alternative Payment Models

Value Based Purchasing


Reimbursement Maze


Cost & Charge Analysis

DRG 192 - COPD



DRG 195 – Simple Pneumonia



DRG 690 – Kidney & UTI



CT Scan



ED Level III



Colonoscopy


Value Based Purchasing / Alternative Payments


Quality/Efficiency will Impact Bottom Line

CMS Value-Based Purchasing


How Would Colorado CAHs Perform under VBP?

If 2020 CMS VBP rules were in effect, CO CAHs could expect:

$1.1M Medicare revenue (2%) withheld across all CAHs

$2.5M maximum reimbursement across all CAHs with 100%ile performance across all measures

$1.1M expected reimbursement across all CAHs based upon performance

$1.4M Left on the TableHCAHPS Deep-Dive*

Measure Modeled Revenue Forfeited

Overall Satisfaction $15,657

Discharge Instructions $15,657

Quietness & Cleanliness $15,657

Nurse Communication $15,657

Doctor Communication $10,960

Medication Explanation $9,394

Staff Responsiveness $6,263

TOTAL $89,245

*For one Colorado CAH


Advocacy for Critical Access VBP Principles (NRHA)

Small, rural hospitals should be included in a robust, rural relevant quality performance

measurement program

Mandate a sophisticated statistical analysis to ensure that low volumes do not significantly

reduce measure reliability

The small, rural measurement system should be adaptable for multiple uses: insurers,

regulatory agencies, etc.

Measurement system should include:

Clinical processes

Patient Safety

Patient Satisfaction

Adequate Technical Assistance should be funded to ease implementation of performance

measurement programs

Data Warehouse: non-proprietary

Only upside – no further erosion of reimbursement


The Rural Health Safety Net is Under Pressure

Rural Hospital Payor Mix is 55%

Governmental2

Rural Non-Rural

83 Rural Hospital

Closures Since 20101

1 Univ. North Carolina Sheps Center, February 20182 CMS Healthcare Cost Report Information System (HCRIS), Q3 2017. Operating margin is computed in accordance with Flex Monitoring Team guidance. Hospitals for which data are unavailable or identified as outliers are excluded.


Troy Brown

Manager, Chartis Center for Rural Health(207) 518-6707

[email protected]

Documents

Exploring the Value Equationcoruralhealth-wpengine.netdna-ssl.com/wp-content/uploads/...Performance Pillars Span Market, Value, and Finance Market Inpatient Market Share Inpatient