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Quality Reporting: Initiatives at the Federal and State Level

Quality Reporting: Initiatives at the Federal and State Level. Presented by: Richard Schirmer, MBA, FACHE July 2012. THA – Who We Are.

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Quality Reporting: Initiatives at the Federal and State Level

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  1. Quality Reporting: Initiatives at the Federal and State Level Presented by: Richard Schirmer, MBA, FACHE July 2012

  2. THA – Who We Are • The Texas Hospital Association is a nonprofit trade association representing Texas hospitals and health systems. In addition to providing a unified voice for health care, THA serves its 500+ members with timely information, data analysis, education on essential operational requirements, networking and leadership opportunities.

  3. THA – What We Do • Since its founding in 1930, THA has grown and evolved with the hospital industry itself. Today, THA is the leading advocacy organization for Texas hospitals. The Association’s staff is committed to helping hospitals navigate the complex, ever-changing legislative and regulatory environment, while working toward common solutions for better health care policy at the state and federal levels. • THA also serves as a resource for the State of Texas in the areas of disaster planning and response, data services and regulatory development.

  4. Executive Summary…..

  5. Plethora of Quality Initiatives • pleth·o·ra • noun • 1. overabundance; excess: a plethora of advice and a paucity of assistance. • 2. Pathology Archaic . a morbid condition due to excess of red corpuscles in the blood or increase in the quantity of blood.

  6. Impact of Quality Initiatives Improving quality helps bottom line • Venous Thromboembolism Prophylaxis • Beta Blockers for AMI • Prophylactic antibiotics prior to surgery Improving quality worsens bottom line • Eliminating 39 weeks elective deliveries Let’s do what is best for the PATIENT-we ALL have a vested interest!!!!!! Steve Berkowitz MD

  7. Federal Initiatives: Affordable Care Act

  8. Federal Quality Based Payment Reforms

  9. Federal Initiatives: Readmissions

  10. Federal Initiatives: Readmissions

  11. Federal Initiatives: Readmissions • Y1 - CMS proposes existing 30-day readmissions measures (over 3 yrs) • Heart attack, heart failure, pneumonia • Hospitals with “excess” readmissions penalized up to 1% in FY 2013 on all Medicare discharges • ACA: exclude unrelated, planned. CMS’ proposal fails to do so. • CMS proposes that hospitals with fewer than 25 discharges for each condition be excluded

  12. Patient Compliance Is Never An Issue

  13. What Happens If You Remove Cost From The Equation?

  14. Federal Initiatives: Value Based Purchasing

  15. VBP Quality Measures: 2013 • For FY 2013, CMS finalized 13 total measures • 13 process measures • HCAHPS patient satisfactions-8 measures • Patient outcomes-2014-3 measures • For FY 2013, performance measured July 1, 2011 – March 31, 2012

  16. Scoring Hospitals’ VBP Performance • Hospitals will receive the higher of their attainment or improvement score on each measure • Score on each domain equals points earned out of total possible points • FY 2013payment based on: FY 2014 payment based on: • Payment details next year HCAHPS 30% Process 70% HCAHPS 30% Outcomes 25% (30%) Process 45% (20%) Efficiency 0% (20%)

  17. Federal Initiatives: Hospital Acquired Conditions

  18. Hospital Acquired Conditions ACA imposes financial penalties on hospitals with high HAC rate. • Current-Reduced payments to hospital where one of 8 HACs was not present on admission. • VBP Policy-Proposed for October 2013. Recently withdrawn • HAC Policy-Beginning October 2014, hospitals with HAC rate in bottom quartile of national average (i.e. high rate) will suffer a 1% payment reduction for ALL Medicare inpatient DRGs.

  19. Preventable Hospital Acquired Conditions • Foreign Object After Surgery • Air Embolism • Blood Incompatibility • Pressure Ulcers (Stage III and IV) • Falls and Trauma • Vascular Catheter Associated Infections • Catheter Associated UTI • Poor Glycemic Control

  20. State Initiatives

  21. State Initiatives: HAI Reporting

  22. Mandatory State Reporting of Healthcare-associated Infections

  23. Who must report? • Long-term acute care hospitals that have an adult or neonatal intensive care unit (ICU) or critical care unit (CCU) • Critical access hospitals with ICU/CCU/NICU and/or that perform National Healthcare Safety Network (NHSN) surgical procedures • General hospitals (adult, pediatric, adolescent) with ICU/CCU/NICU and/or that perform National Healthcare Safety Network (NHSN) surgical procedures

  24. Reporting of HAIs • Central line-associated bloodstream infections in hospital special care settings • Surgical site infections • Adult general hospitals and ASCs: colon surgeries, hip & knee arthroplasties, abdominal & vaginal hysterectomies, vascular procedures, and coronary artery bypass grafts • Pediatric/adolescent general hospitals: ventriculoperitoneal shunt procedures (including revisions and removal), cardiac procedures 9excluding thoracic) and spinal surgeries with instrumentation

  25. Public Access to Data • Compile and make available to the public a summary, by health care facility • Publish the summary at least annually and place on website • Allow health care facilities to submit concise written comments

  26. Phased In Reporting • Phase in reporting beginning in October of 2011 • All facilities report: central line-associated bloodstream infections • Surgical centers and general hospitals report: knee arthroplasties • Knee arthroplasties ICD-9th Revision codes. Knee prosthesis – 00.80-00.84, 81.54 and 81.55 • Pediatric/adolescent hospitals report:ventricularoperitoneal shunts • Ventriculoperitoneal shunts ICD-9th Revision codes. Ventriculoperitoneal shunts including revision and removal of shunt – 02.2, 02.32-02.35, 02.39, 02.42, 04.43 and 54.95

  27. Phased In Reporting • Beginning in January 2012 • Surgical centers and general hospitals report: hip arthroplasties and coronary artery bypass grafts • Pediatric/adolescent hospitals report: cardiac procedures

  28. Phased In Reporting • Beginning January 2013 • Surgical centers and general hospitals report: abdominal & vaginal hysterectomies, colon surgeries, and vascular procedures • Pediatric/adolescent hospitals report: spinal surgeries with instrumentation

  29. How to Report • National Healthcare Safety Network (NHSN) developed and sustained by the Centers for Disease Control & Prevention will be the designated reporting system. • §200.3(e). Facilities shall report HAI data on patients who are admitted to the facility for inpatient treatment of a surgical site infections associated with a procedure listed in §200.4 of this title within 30 calendar days of the procedure or within 1 year of the procedure if the procedure involved an implant. • §200.3(e)(2). If the facility treating the patient did not perform the surgery, the treating facility shall notify the facility that performed, document the notification, and maintain this documentation for audit proposes.

  30. Future Activities • What will be implemented at a later date • Reporting of respiratory syncytial virus • Receiving reports from the public • Reporting of preventable adverse events (PAE) • An event included in the list of serious events identified by the National Quality Forum • An event or condition for which the Medicare program will not provide additional payment to the facility.

  31. State Initiatives: Patient Identification System

  32. Patient Identification System Texas DSHS is required to develop a statewide standardized patient risk identification system that will allow hospital personnel to readily identify a patient with a specific medical risk. Each hospital will be required to implement the state identification system unless they are allowed an exemption because the hospital adopts a different identification system that is evidenced based. SB 7 (82nd Session). May potentially include colored wristband ID initiative developed by SA Hospital Council several years ago.

  33. Patient Identification System • Three mandatory colors (AHA’s Alert Colors) • Red-Allergies • Yellow-Fall Risk • Purple-DNR • Two optional colors • Green-Latex Allergy • Pink-Restricted Extremity

  34. Coming Attractions-MD Related • MD feedback reports (200+ MDs)-2010 • MD feedback reports (Iowa, Kansas, Missouri, Nebraska) – all MDs • Most of claims based measures depend on patient compliance to some degree (fill prescription or keep appointment) • Implementation of value modifier in 2015 may increase participation in 2012 (payment impact)

  35. In Conclusion……..

  36. Questions? Richard Schirmer, MBA, FACHE Vice President, Health Care Policy Analysis Texas Hospital Association rschirmer@tha.org 512/465-1056

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