Centers for Medicare Medicaid Services CMS

1. Centers for Medicare & Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) St. Mary�s Hospital, GJ, CO May 2009 Jean Peters-Lead Abstractor, Quality Kelly Arnold RN, Quality Review Coordinator for Stroke

2. Demonstration Project Hospital-what does that mean? The CMS Premier Demonstration project began in 2003 St. Mary�s is the only participating hospital in Colorado. The CMS/ Premier Demonstration Project was developed to evaluate the effectiveness Pay for Performance incentives to improve quality of care. The data on the first three years of the project has shown that performance in these evidenced-based indicators has exceeded those of other hospitals without the incentive. Often, measures trialed become measures required for CMS to be used for public reporting such as the Surgical Care data. The Surgical Care data was required in this project before CMS required it of all hospitals.

3. Demonstration Project Hospital-what does that mean? Projects already in progress: AMI, CABG, HF, Pneumonia and Hip and Knee repl., Surgical Care Improvement Project (SCIP) Of 1.1 million patients treated in the above 5 clinical areas in HQID hospitals, an additional 300,000 recommended evidence-based cares were received during the first 3 years of the project Year 6 of the project (2009) includes stroke measures An aggregate score called the Composite Quality Score places hospitals into deciles for benchmarking and to determine who receives additional CMS reimbursement bonuses.

4. Stroke Measure Reporting Started January 2009�we�ve done two months Ischemic stroke ICD-9 Principal Discharge Dx only Measures are: Thrombolytic administered Early antithrombotic Dysphagia screening Discharge antithrombotic Discharged on cholesterol reducing medication DVT/VTE prophylaxis Anticoagulation in AFIB Smoking cessation advice/counseling

6. GWTG vs. CMS Measure Reporting The measures are the same as the 7 GWTG/Performance achievement set plus the addition of the Dysphagia measure The 8 measures are defined the same by CMS and GWTG, and some of the CMS definitions are even more clear Requires in-depth review of ischemic stroke patient�s chart-D/C principal dx ICD-9 (additional to GWTG) in a different database

7. Big Differences This data must endure a chart validation process by the CMS-only printable, documented record used, no inferences Black and white definitions Professional abstraction followed to the letter e.g.-dictation time, med administration time CMS�s �Perfect-care Score� uses Dysphagia screening in the calculation whereas GWTG�s �Defect-free score� does not. CMS�s �Composite Score� also includes Dysphagia screening whereas GWTG�s �Composite Score� does not.

8. Lessons Learned So Far Dysphagia evaluation becomes a driver for Perfect-care score Afib history has to have no-anticoagulation rationale documented or it is not compliant Even more precise documentation required for measures to be met Early ambulation very difficult to abstract and what is really sufficient to prevent DVT? Discussion regarding requiring DVT prophylaxis for all stroke due to lack of evidence re: ambulation Able to ask questions, make comments and provide suggestions at this point to clarify chart review Great way to double-check GWTG data entry results and vice versa Thank heavens we implemented GWTG Dec. 2007!

9. References CMS/Premier HQID: http://www.premierinc.com/quality-safety/tools-services/p4p/hqi/index.jsp Pay for Performance: http://www.premierinc.com/quality-safety/tools-services/p4p/index.jsp Clinical conditions and measures-year 6: http://www.premierinc.com/quality-safety/tools-services/p4p/hqi/specifications-by-focus-area-year6.jsp