Washington State Hospital Association Medicaid Quality Incentive Web Conference June 3, 2013 1

Washington State Hospital Association

Medicaid Quality Incentive

Web Conference

June 3, 2013

1


PresentersPresenters

Carol Wagner, RNSenior Vice President, Patient SafetyWashington State Hospital Association

Daniel Lessler, MDChief Medical OfficerWashington State Health Care Authority


Thank YouThank You

• Vision and drive for quality incentive

Rep. Eileen Cody


Today’s PresentationToday’s Presentation

• History of the Medicaid Quality Incentive

• July 1, 2013 program and timeline• Purpose and goals• Measures• Factors to consider• Additional resources• Questions


HistoryHistory

• First Medicaid Quality Incentive was passed by the Washington State Legislature in 2010

• Among the first in the country• Tied to the Hospital Safety Net

Assessment • Significant quality improvements occurred• 90 percent of eligible hospitals earned an incentive payment

5


Medicaid Quality IncentiveMedicaid Quality IncentiveJuly 1, 2013July 1, 2013

• The program is included in the Hospital Safety Net Assessment legislation

Expected to Pass as Part of the Budget


TimelineTimelineJuly 1, 2013 - December 31, 2013 Hospitals collect performance data (Work force flu immunization October 1, 2013 to March 31, 2014)

April 2014 Chief Financial Officer attestation

May 2014 HCA determines which hospitals qualify for payment

July 2014 Qualifying hospitals receive incentive payment


Guiding PrinciplesGuiding Principles• Measures must be:

Evidence basedConsistent with national measures where possible

• Methodology for earning incentives: Recognize some measures may not be appropriate to

specialty, pediatric, psychiatric, or rehabilitation hospitalsRepresent real improvement in qualityDesigned so hospitals can earn incentive payments if

performance is at or above the benchmarkConsistent with areas Washington hospitals are working

on


Process for Selecting MeasuresProcess for Selecting Measures

Clinical experts from hospitals provided guidance for measure development

Improvement and sustaining measuresMoving safety and quality forward while sustaining

gains of first incentive program while also

Final selection by HCA in collaboration with WSHA, clinical experts, and payors


Payment IncreasesPayment Increases

• One percent inpatient Medicaid increase for non-critical access hospitals

• Acute general and pediatric hospitalsReceive increase across services based

on overall hospital performance

• Behavioral health hospitals and unitsIncrease based on behavioral health

measures


Funding for IncentivesFunding for Incentives

• The money comes from savings to the program as match rates improve with federal ACA enrollment.

• Will only be paid if there are sufficient funds to pay for it — we expect there will be.


Funding for IncentivesFunding for Incentives

• Quality incentive provided to all qualifying Washington hospitals

• No partial increasesHospitals receive either zero or one

percent increase


Selected MeasuresSelected MeasuresAcute, Rehabilitation, and Pediatric Acute, Rehabilitation, and Pediatric

ServicesServicesInfection PreventionImprovement Measure: Catheter Associated- Urinary Tract Infection Per Patient Day (Hospital-wide)

Sustaining Measure: Health Care Personnel (HCP) Influenza Vaccination Rate


Selected Measures Selected Measures Acute, Rehabilitation, and Pediatric Acute, Rehabilitation, and Pediatric

ServicesServices

ER is for Emergencies(Adult and pediatric hospitals with emergency rooms only)

Improvement Measure: Percent of Patients (all payors) with Five or More Visits to Emergency Room with Care Plans



ServicesServices

SafetyImprovement Measure: Falls with Injury Per Patient Day



ServicesServices

ReadmissionsImprovement Measure: Reducing Readmissions Rates



ServicesServicesSafe Deliveries: Induction Appropriateness and Elective Deliveries Prior to 39 Weeks(Applies to hospitals with obstetrical programs only)

Improvement Measure: Percent of Patients Undergoing Labor Induction with Documentation of Consent, Bishop Score, and Indication

Sustaining Measure: Percent of Patients with Elective Deliveries 37 to Less than 39 Weeks Gestational Age


Selected Measures: Selected Measures: Behavioral Health ServicesBehavioral Health Services

Improvement Measure: Percent Patients Post-Discharge Continuing Care Plan Transmitted

Sustaining Measures:•Health Care Personnel (HCP) Influenza Vaccination Rate•Percent of Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification


Incentive PaymentsIncentive Payments

• All non-Critical Access Hospitals have the opportunity to earn the one percent incentive based on their results

• Critical Access Hospitals are welcomed and encouraged to participate in improvement efforts, but cannot receive incentive payments

Hospitals with ten points in all eligible measures will be recognized.Includes critical and non-critical access hospitals.


Incentive MethodologyIncentive Methodology

• Current results used to set improvement goalsFor sustaining measures, hospital data were

arrayed in quartiles based on prior performance

• Points awarded for each quartileFor each measure, hospitals can earn 10, 5, 3,

or 0 pointsPoints averaged across all applicable measures

• Hospitals receiving an average score of 5 or above receive the increase


Methodology ExampleMethodology Example

The quartiles were then reviewed for:•Patient Safety•Appropriateness


Medicaid Quality Incentive Medicaid Quality Incentive ThresholdsThresholds

Measure Threshold Points

CA-UTI ICU >11.8 0

11.8-6.2 3

6.1-1.5 5

<1.5 10

CA-UTI Non-ICU >3.5 0

3.5-1.1 3

1.0-0.1 5

<0.1 10

Healthcare Personnel Influenza Vaccination

<85% 0

85-89.4% 3

89.5-93% 5

>93% 10




ER is for Emergencies <1% 0

1-4.9% 3

5-9.9% 5

>9.9% 10

Falls with Injury >1.5 0

1.5-0.85 3

0.84-0.70 5

<0.70 10

Induction Appropriateness <60% 0

60-71% 3

72-84% 5

>84% 10




Elective Delivery 37 to 39 Weeks

>2% 0

2-1.1% 3

1-0.1% 5

<0.1% 10

Behavioral Health: Post Discharge Continuing Care Plan Transmitted

<60% 0

60-69.9% 3

70-79.9% 5

>80% 10

Behavioral Health: Justification on Antipsychotic Medications

<85% 0

85-89% 3

90-94% 5

>94% 10


Earning the IncentiveEarning the Incentive

• Patient days should match those submitted in financials

• Reporting begins July 1, 2013, regardless of when Legislature passes budget

WSHA is here to help!


Additional ResourcesAdditional Resources

• WSHA webpage with definitions, methodology, and tools to help make successful

• Safe Tables to share best practices

http://www.wsha.org/qualityincentive.cfm

For official documents: See website. Items on this web conference may change.


Additional Training in JuneAdditional Training in June

Upcoming Events:• June 4 Safe Deliveries Safe Table• June 19 Reducing Infections

Measurement Details Web Conferences:• Web conference in June (date to be

determined)


Safe TablesSafe Tables

Safe Table Participation:•Sharing best practices•Learn together


Public/Private CollaborationPublic/Private Collaboration

And the many expert advisors

Thanks to the Medicaid Quality Incentive Advisory GroupDavid Fisher, MD Seattle Children’s

Karen Geheb, MD Pullman Regional (Critical Access Hospital)

Thuy Hua-Ly Health Care Authority

Daniel Lessler, MD Health Care Authority

MaryAnne Lindeblad, RN Health Care Authority

Michael Owens, MD Molina Healthcare of Washington

Gene Peterson, MD University of Washington Health System

Claudia Sanders Washington State Hospital Association

Larry Schecter, MD Providence Health & Services

Carol Wagner, RN Washington State Hospital Association


Questions?Questions?

Dr. Daniel Lessler - [email protected]

Carol Wagner, RN - [email protected]

Documents

Washington State Hospital Association Medicaid Quality Incentive Web Conference June 3, 2013 1