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

1. What’s Hot & What’s Notin the Core Measure Field Brenda Bartkowski, CMA, CCA, BS HPA Manager, Clinical Data Abstraction Amy Wirth Sales Executive July 17, 2013

2. 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.

3. What’s • 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

4. What’s • Value-Based Purchasing (VBP) • Why? • Rewards based on following best clinical practices • How well hospitals enhance patients’ experiences of care • Patients receive higher quality care

5. What’s • Value-Based Purchasing (VBP) • How? • Must report on minimum of 4 Hospital VBP measures • Minimum of 10 cases per measure

6. What’s • Value-Based Purchasing (VBP) • When? • Began with FY2013 • Participating hospitals already receiving incentive payments

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

8. What’s 12 Clinical Process of Care Measures

9. What’s 8 Patient Experience of Care Dimensions

10. 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.

11. What’s How will hospitals be evaluated? Achievement Points Awarded by comparing an individual hospital’s rates during the performance period with all hospitals’ rates from the baseline period. Improvement Points Awarded by comparing an individual hospital’s rates during the performance period to that same individual hospital’s rates from the baseline period.

12. What’s Proposed Weights VBP

13. What’s • EPs that began participation in 2011 or 2012 • EPs that began participation this year (2013) • EPs that plan to begin participation in 2014

14. What’s

15. 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

16. 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

17. 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

18. What’s Not • 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

19. What’s Not

20. 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 ▪ Measure Refinement ▫ SCIP-Inf-4

21. What’s Not • 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

22. What’s Not • Validation ▫ ED ▫ STK / VTE ▫ Quarterly Appeals

23. What’s Not Hospital Readmissions Reduction Program

24. What’s Not • 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)

25. Resources • Medicare’s Hospital VBP Scores are now available:http://www.medicare.gov/hospitalcompare/data/VBP/hospital-vbp.aspxDetails 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/ ORhttps://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?AspxAutoDetectCookieSupportCMS’s readmissions reduction program:http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html andhttps://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-2013-0154-0001NFQ Website:http://www.qualityforum.org/Home.aspx

26. Amphion’s Core Measures Solutions • What’s right now?Outsourcing Core Measures! • What’s Not?Overworked hospital staff

27. Thank you for the opportunity to speak with you today For more information on Amphion’s solutions, contact Amy Wirth at888-830-2644 x1634 orAmy.Wirth@amphionmedical.com