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Value-Based Purchasing What ED Docs Need to Know NOW

Value-Based Purchasing What ED Docs Need to Know NOW. Paul Hildebrand, MD Regional Medical Director FHS/NEP-TH. VBP Cliff Notes Version. CMS reimbursement, beginning in FY 2013, tied to performance and patient satisfaction measures.

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Value-Based Purchasing What ED Docs Need to Know NOW

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  1. Value-Based PurchasingWhat ED Docs Need to Know NOW Paul Hildebrand, MD Regional Medical Director FHS/NEP-TH

  2. VBP Cliff Notes Version • CMS reimbursement, beginning in FY 2013, tied to performance and patient satisfaction measures. • Baseline year as basis for achievement of improvement was 7/1/09 - 3/31/10

  3. VBP Cliff Notes Version • Measurement for FY 13 payments begins July 1, 2011 (3 weeks from now) and runs through March 31, 2012 - total of 9 months. • Measures are • PCI within 90 minutes for STEMIs (PCI Hosps) • Thrombolytics within 30 minutes for STEMIs in Hosps using thrombolytics • Blood Cultures before Antibiotics in Pneumonia, • Correct Antibiotics for CAP immunocompetent. • Patient Satisfaction from IP Healthstream Survey

  4. VBP Cliff Notes Version • Strategies to achieve excellence are: • Code STEMI. Goal: Door to Balloon < 60 minutes; or thromboytics within 30 minutes. • Pneumonia Order Set on all Pneumonia pts. • Reinforce with Nursing to document BC prior to Antibiotic • Check/Circle CAP for antibiotic choice scoring • Check/Circle Immune-Deficient if appropriate - exclusion. • Patient Satisfaction Strategies: • AIDET • Site-Based RPI-Ws. • Smile, Communicate, Communicate, Communicate. • Document Exceptions

  5. Value-Based Purchasing • Links Medicare payment to quality performance • PPS hospitals only (no Critical Access hospitals) • Uses a subset of Hospital Compare measures • An overall value-based purchasing score will be calculated for each hospital

  6. Value-Based Purchasing • A pool of VBP funds will be redistributed to hospitals based on performance • Budget Neutral • This pool will be funded by an across-the-board reduction to Medicare IPPS payments • 1% in FY 2013 • Increases by 0.25% each year • 2% for FY 2017 and beyond • FY 2013 each Hospital has deducted 1% of Medicare reimbursement and earns back that 1% and perhaps more if performance compared to other hospitals is exceptional

  7. VBP Measures • Original proposal was 17 clinical process of care measures and 8 HCHAPS measures • Now12 clinical process of care measures and 8 HCAHPS measures

  8. ED Measures Performance 7/1/11 - 3/31/12 (9mos) • AMI - PCI within 90 minutes (Door to Balloon). Benchmark 100% • Pneumonia - Blood Cultures before antibiotics. Benchmark 100% • Pneumonia - Appropriate Antibiotic CAP Immuno-Competent. Benchmark 99.58% Our Goal for above is 100% • HCAHPS - Taken from IP Survey. ED Impacts score so held accountable.

  9. VBP Details • Baseline period: July 1, 2009 through March 31, 2010 • Performance period: July 1, 2011 through March 31, 2012 - begins in 3 weeks! • Will calculate a benchmark and achievement threshold for each measure (already done) • Benchmark: Average of top 10% • Achievement threshold: Median

  10. VBP Scoring: Achievement Points • If at or above the benchmark: 10 points • If below achievement threshold: 0 points • Below the benchmark and above achievement threshold: between 1 and 9 points

  11. VBP Scoring: Improvement Points • If at or below the baseline: 0 points • If above the baseline: Between 0 and 9 points based on improvement from the baseline towards the benchmark • Example on next slide has achievement and improvement scores of 7, so the score is 7. If one were higher than the other, the higher one would be used.

  12. VBP Scoring- Methodology

  13. Explanation of Example • On the previous slide the score of 54 was in the Baseline year, the score of 86 in the Performance year. • The VBP Achievement score (50%tile) was 65 and the Benchmark score (90%ile) was 95. • The Score of 85 was between Achievement and Benchmark and resulted in 7 points on the performance point spread • 85 also represented an improvement from 54 and resulted in 7 points on the Improvement point spread.

  14. VBP Scoring: Consistency Points • Looks at lowest HCAHPS score for the reporting period • If above the achievement threshold (median) then a full 20 points achieved • If below achievement threshold, will score between 0 and 19 points depending on how low the lowest score is

  15. Overall VBP Score • Calculate score out of 100 for both process and patient experience measures • Weighting: • 70% from clinical process of care measures • 30% from patient experience of care (HCAHPS) measures • Scores used to calculate hospital’s gain or loss under the program • Scores will be publicly posted Nov 2012 • Medicare reimbursement FY 2013 based on Scores. • Hospital won’t know how it did until 11/12!

  16. Value-Based PurchasingWhat ED Docs Need to Know NOW PHYSICIAN/MLP BEING ORIENTED(signature) MEDICAL DIRECTOR/DESIGNEE (signature) When complete, please sign and return to: 505 South 336th Street, Suite 600 Federal Way, WA 98003

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