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Health Care Effectiveness Summer Quarterly Meeting

Health Care Effectiveness Summer Quarterly Meeting. July 19, 2011. LSU Medical Home. DIABETES. DIABETES. DISEASE. KIDNEY. DIABETES. CANCER. DIABETES. DISEASE. CANCER. ASTHMA. KIDNEY. CHF. ASTHMA. CANCER. CHF. CANCER. ASTHMA. CHF. ASTHMA. HIV. CHF. HIV. HIV. HIV.

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Health Care Effectiveness Summer Quarterly Meeting

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  1. Health Care EffectivenessSummer Quarterly Meeting July 19, 2011

  2. LSU Medical Home DIABETES DIABETES DISEASE KIDNEY DIABETES CANCER DIABETES DISEASE CANCER ASTHMA KIDNEY CHF ASTHMA CANCER CHF CANCER ASTHMA CHF ASTHMA HIV CHF HIV HIV HIV THROMBOGENIC STATE CONTROL GLYCEMIC CONTROL LIPID CONTROL DIET EXERCISE WEIGHT CONTROL SMOKING CESSATION SCREENING BLOOD PRESSURE CONTROL

  3. 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

  4. Funded in part by HRSA Grant #H97HA08476

  5. 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; OPH N=378 through March 2011

  6. 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

  7. 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

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

  9. Our colonoscopy levels have been rising across all sites

  10. Value Based Purchasing With Thanks to Simone Olivier!

  11. 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.

  12. Timeframes • For FFY 2013 VBP Program Baseline period = July 1, 2009 through March 31, 2010 Performance period = July 1, 2011 through March 31, 2012

  13. FFY 2013 Domains and Measures/Dimensions Two Domains 30% 70%

  14. Clinical Process of Care DomainMeasures • 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

  15. 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 toSurgery 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 PostoperativeSerum Glucose

  16. 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

  17. 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

  18. National Performance Standards used in Calculating the VBP Incentive National Benchmark Achievement Threshold Process of Care Measures HCAHPS

  19. 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

  20. 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)

  21. 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.

  22. 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 .

  23. Achievement Points vs. Improvement Points for HCAHPS Dimensions

  24. 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)

  25. Consistency Points for HCAHPS

  26. 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%

  27. Calculating an Overall VBP Score • Patient Experience of Care Domain Overall Score = Total points (achievement vs. improvement) + Consistency points 100  has a weight of 30% Example: 89 (total of final points + 20 consistency points) /100 = 89% 89 X 30% (domain weight) = 27%

  28. Overall VBP Score • Equals to the Process of Care Domain Score + Patient Experience of Care Domain Score 32% + 27% = 59% Overall VBP Score

  29. 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.

  30. 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

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