Health Care EffectivenessSummer Quarterly Meeting

July 19, 2011July 19, 2011

LSU Medical HomeD

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DIA

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CHF

CHF

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HIVHIV

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DIS

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KID

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CAN

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ASTH

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THROMBOGENIC STATE CONTROL

BLOOD PRESSURE CONTROL

GLYCEMIC CONTROL

LIPID CONTROL

SMOKING CESSATION

DIET EXERCISE WEIGHT CONTROL

SCREENING

Domain #1: Development of medical home patient rosters and orientation of patients to medical homes.

 Domain #2: Access to primary care, with subareas: Domain #3: Access to specialty care Domain #4: Primary care efficiency Domain #5: Wellness, with subareas: Domain #6: Chronic disease management and high-risk patient

management, with subareas: Domain #7: Patient perceptions of medical home experiences Domain #8: Provider perceptions of medical home experiences. Domain #9: Reduction of inpatient stays

Funded in part by HRSA Grant #H97HA08476

LaPHIE identified persons (N=345*)

• 40% <35 years of age• 72% black/African American• 38% female• MOT (most common)

– Of males• 22% MSM

– Of females and non-MSM• 27% heterosexual • 66% NIR/unknown

• 24% had no prior labs in OPH system• 32% had not been in LSU system for any HIV-related test or

care– Would have been missed in the absence of LaPHIE

Source: LaPHIE linked file; OPHN=378 through March 2011

Follow up

• Of those previously in care – Months return to care

• Median 20 (IQR 15 to 36)– CD4 at return to care

• Median 233 (IQR 120-333)• Of those not previously in care

– CD4 at first engagement in care• Median 247 (IQR 58-394)

• Of those followed at least 6 months – 82% had at least one LSU visit – 82% had at least one viral load and/or CD4

count – 62% had at least one HIV specialty visit in LSU

system

Source: OPH

Quality“ the degree to which health care

services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”

- AAP Policy Statement

7279

11376 6709

12369

11258

12236 7140

68368

.2

.25

.3

.35

SITES over QUARTERSGraph uses data from quarters 200703 through 201004

htn: Sustained BP > 140/90denom: in PC pop at least 3mos

The BP improvement levels seen for diabetes reflects a general improvement in BP levels in our PC population.

4004

7054

4428

7910

6358

7866

4569

42189

.1

.15

.2

.25

.3

.35

.4

.45

.5

SITES over QUARTERSGraph uses data from quarters 200701 through 201004

coloncancer: Colonscopy in past 10 yearsdenom: PC Sustained, 6/12

Our colonoscopy levels have been rising across all sites

Value Based Purchasing

With Thanks to Simone Olivier!

Requirements

• Legislation requires that the VBP program apply to payments for discharges starting October 1, 2012.

• To fund the VBP incentive pool our base DRG payments will be reduced by 1% starting FFY 2013. It will increase by .25% per year to 2% by 2017.

• The incentive pool will be budget neutral.

Timeframes

• For FFY 2013 VBP Program Baseline period = July 1, 2009 through March 31,

2010 Performance period = July 1, 2011 through

March 31, 2012

FFY 2013 Domains and Measures/Dimensions

HCAHPS

Process ofCare Measures

30%70%

Two Domains

Clinical Process of Care Domain Measures

• Total of 12 measures• Each measure is worth up to 10 points (improvement or

achievement points – whichever is higher)• A hospital can earn a total of 120 points• Hospitals need to have at least 10 cases for each measure to

qualify• 58% of the 12 measures are SCIP measures• CMS will only use the measures that hospitals qualify for or are

able to collect data on to calculate an overall score. Ex: EWE only qualifies for 9 of the 12 measures therefore total points possible = 90

Clinical Process of Care Domain MeasuresAcute Myocardial InfarctionAMI 2 Aspirin Prescribed at Discharge – removed 4/29/11AMI 7a Fibrinolytic Therapy Received Within 30 Minutes of Hospital ArrivalAMI 8 Primary Percutaneous Coronary Intervention (PCI) Received Within 90 Minutes of Hospital ArrivalHeart FailureHF 1 Discharge InstructionsHF 2 Evaluation of Left Ventricular Systolic (LVS) Function – removed 4/29/11HF 3 ACE Inhibitor or ARB for LVS Dysfunction – removed 4/29/11PneumoniaPN-2 Pneumococcal Vaccination – removed 4/29/11PN 3b Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in HospitalPN 6 Initial Antibiotic Selection for CAP in Immunocompetent PatientPN 7 Influenza Vaccination – removed 4/29/11Surgeries (as measured by Surgical Care Improvement (SCIP) measures)SCIP Card 2 Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the Perioperative PeriodSCIP VTE 1 Surgery Patients with Recommended VTE Prophylaxis OrderedSCIP VTE 2 Surgery Patients Who Received Appropriate VTE Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After SurgeryHealthcare Associated Infections (as measured by SCIP measures)SCIP Inf 1 Prophylactic Antibiotic Received Within One Hour Prior to Surgical IncisionSCIP Inf 2 Prophylactic Antibiotic Selection for Surgical PatientsSCIP Inf 3 Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End TimeSCIP Inf 4 Cardiac Surgery Patients with Controlled 6 AM Postoperative Serum Glucose

Patient Experience of Care Domain Dimensions (HCAHPS)

• Total of 8 dimensions• Each dimension is worth 10 points (improvement or

achievement points – whichever is higher)• Hospitals can also earn up to 20 “consistency points”• This equals to a total of 100 points possible• Hospitals need to have at least 100 HCAHPS surveys

during the performance period to qualify for the VBP program

Patient Experience of Care Domain Dimensions

1 - Communication with Nurses2 - Communication with Doctors3 - Responsiveness of Hospital Staff4 - Pain Management5 - Communication About Medicines6 - Cleanliness and Quietness of Hospital Environment7 - Discharge Information8 - Overall Rating of Hospital

National Performance Standards used in Calculating the VBP Incentive

The average performance score for

the top 10% of all hospitals during the

baseline period

The median performance score (50th

percentile) for all hospitals during the

baseline period

Process of CareMeasures

HCAHPS

National Benchmark

AchievementThreshold

Achievement Points vs. Improvement Points for Clinical Process of Care Measures

• How are achievement points awarded? If our performance score for the measure is: ► at or above the national benchmark = 10 points ► below the achievement threshold = 0 points ► between the national benchmark and the achievement threshold = a formula is used to determine # of points

National Baseline Period Hospital Baseline Period Hospital Performance Period

Indicator

Benchmark

Achievement

Threshold

Case Count

Rate

Case Count

Rate

Achievement

Points

Initial Antibiotic Selection for PN patients

98.0%

91.0%

45

99%

49

98%

10

Achievement Points vs. Improvement Points for Clinical Process of Care Measures

• How are improvement points awarded? If our performance score for the measure is: ► at or below our baseline period performance score = 0 points ► above our baseline period performance score = a formula is used

to determine # of points awarded ( range of 0 – 9 points)

National Baseline Period Hospital Baseline Period Hospital Performance Period

Indicator

Benchmark

Achievement

Threshold

Case Count

Performance

Case Count

Performance

Improvement

Points

Initial Antibiotic Selection for PN Patients

98%

91%

45

99%

49

98%

0

Achievement Points vs. Improvement Points for Clinical Process of Care Measures

• Final points awarded are the higher of the Achievement Points vs. the Improvement Points.

National Baseline Period Hospital Baseline Period

Hospital Performance Period

Indicator

Benchmark

Achievement

Threshold

Case

Count

Performance

Case

Count

Performance

Achievement

Points

Improvement

Points

Final Points

Initial Antibiotic Selection for PN patients

98%

91%

45

99%

49

98%

10

0

10

Achievement Points vs. Improvement Points for HCAHPS Dimensions

• Achievement/Improvement points for HCAHPS are calculated using the same method as for the Process of Care Measures .

Achievement Points vs. Improvement Points for HCAHPS Dimensions

National Baseline Period Hospital Baseline Period

Hospital Performance Period

Indicator

Benchmark

Achievement Threshold

Score

Score

Achievement

Points

Improvement

Points

Final Points

Nurses always communicated well

85%

75%

85%

81%

9

0

9

Consistency Points for HCAHPS

• CMS will use consistency points to recognize consistent achievement across the HCAHPS dimensions.

• If our lowest performance score for each HCAHPS dimension during the performance period is at or above the achievement threshold for that dimension = 20 consistency points

• If the lowest score is at or below the floor (minimum score) = 0 consistency points

• If the lowest score is between the achievement threshold and the floor = a formula is used to determine the # of consistency points (vary between 0-19)

Consistency Points for HCAHPS

Indicator

Achievement Threshold

Floor Hospital Performance Period Score

Nurses always communicated well 75% 39% 81% Doctors always communicated well 79% 52% 84% Patients always received help quickly from hospital staff 62% 30% 74%

Patients’ pain was always well controlled 69% 35% 77% Staff always explained about medicines before giving them to patients

59%

29%

71%

Patients’ rooms and bathrooms were always kept clean and quiet

63%

37%

76%

Patients were given information about what to do during their recovery at home

82%

50%

83%

Patients who gave their hospital a rating of 9 or higher on a scale of 0 to 10

66%

29%

78%

Lowest performance score from above dimensions

59%

71%

Receive all 20

consistency points

Calculating an Overall VBP Score

• Process of Care Domain Overall Score = Total points (achievement vs. improvement)

90 (only qualified for 9 measures)

has a weight of 70% Example: 41 (total of final points) / 90 = 46% 46 X 70% (domain weight) =

32%

Calculating an Overall VBP Score

• Patient Experience of Care Domain Overall Score =

Total points (achievement vs. improvement) + Consistency points100

has a weight of 30%

Example: 89 (total of final points + 20 consistency points) /100 = 89%

89 X 30% (domain weight) = 27%

Overall VBP Score

• Equals to the Process of Care Domain Score + Patient Experience of Care Domain Score

32% + 27% = 59% Overall VBP Score

Public Reporting of the VBP Scores and Payments

• In addition to what is presently posted on the Hospital Compare website, CMS will add each hospital’s domain-specific score and its overall VBP score.

Quality“ the degree to which health care

services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”

- AAP Policy Statement