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August 13, 2013

CMS National Dry Run: Risk-Standardized Payment Measure: Acute Myocardial Infarction 30-day Episode of Care. August 13, 2013. Agenda. Introductions ( next) Purpose of Dry Run and Measure Proposed Implementation Dry R un Overview Measure Details Resources Questions and Answers.

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August 13, 2013

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  1. CMS National Dry Run:Risk-Standardized Payment Measure: Acute Myocardial Infarction 30-day Episode of Care August 13, 2013

  2. Agenda • Introductions (next) • Purpose of Dry Run and Measure • Proposed Implementation • Dry Run Overview • Measure Details • Resources • Questions and Answers

  3. Introductions • Centers for Medicare & Medicaid Services (CMS) • Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (CORE) • Mathematica Policy Research (MPR)

  4. Agenda • Introductions • Purpose of Dry Run and Measure (next) • Proposed Implementation • Dry Run Overview • Measure Details • Resources • Questions and Answers

  5. Purpose of Dry Run • Educate hospitals about new measures • Provide hospitals with results and data • Help hospitals interpret results and data • Encourage hospitals to ask questions

  6. Defining Common Terms • Cost: the amount incurred in providing services • Payment: the amount paid on behalf of a Medicare patient for health care services • Risk-standardized payment: an amount that has been modified to make payments comparable across hospitals

  7. Why report a payment measure? • Inpatient hospitalizations contribute to rising healthcare costs1, 2 • Payments reflect costs from Medicare’s perspective • Variations in care patterns affect payments made by CMS • Payments reported in conjunction with outcome quality measures, such as AMI mortality, will illuminate high-value care • Health Care Cost Institute, 2010; • Jha AK, et. al., Health Affairs, 2009

  8. Why measure payment for an acute myocardial infarction (AMI) episode? • AMI is a common and expensive condition among Medicare beneficiaries • AMI episode requires care in hospital and post-discharge • There is substantial variation in payments • In hospital practice patterns • Post-discharge care

  9. Variability in Payments • Mean national payment: $20,751 • Hospital risk-standardized payment (RSP) range: $13,909 - $28,979 Mean national payment is for 2008-2009 and is in 2009 dollars

  10. Addressing Affordable Care • Making care more affordable is a priority within the National Quality Strategy (NQS) and CMS Quality Strategy • In response to the NQS, CMS is analyzing efficiency. Currently measures exist in the following programs: • Hospital Inpatient Quality Reporting Program • Hospital Value-Based Purchasing Program • Hospital Outpatient Quality Reporting Program • Physician Value-Based Modifier Program • Support efforts to make payments and quality more transparent to consumers and providers

  11. Agenda • Introductions • Purpose of Dry Run and Measure • Proposed Implementation (next) • Dry Run Overview • Measure Details • Resources • Questions and Answers

  12. Proposed Implementation • In the IPPS FY 2014 Final Rule, CMS added the AMI payment measure to the Inpatient Quality Reporting (IQR) program • If finalized, CMS will publicly report the measure results on Hospital Compare

  13. Agenda • Introductions • Purpose of Dry Run and Measure • Proposed Implementation • Dry Run Overview (next) • Measure Details • Resources • Questions and Answers

  14. Dry Run Overview • Timeline: August 5 – September 4, 2013 • Access to Hospital-Specific Reports • QualityNet • Results: • Hospital-Specific Report (HSR) • Measure Information and Instructions Report • Resources: • Methodology reports, FAQs, other materials • cmsepisodepaymentmeasures@yale.edu

  15. 2013 Dry Run Timeline

  16. Agenda • Introductions • Purpose of Dry Run and Measure • Dry Run Overview • Measure Details (next) • Proposed Implementation • Resources • Questions and Answers

  17. Measure Design • Hospital-level, risk-standardized payments for an AMI episode of care • Admission to 30 days post-admission • Includes payments for the index admission and post-discharge settings, including: • Home health agency • Non-institutional providers (e.g., physicians and independent labs) • Durable medical equipment • Inpatient • Skilled nursing facility • Outpatient • Hospice

  18. Data Source • Chronic Condition Warehouse (CCW) Data • Medicare administrative claims data • 100% of patients with a primary discharge diagnosis of AMI • Why use CCW? • Can follow patients across multiple care settings using a unique patient identifier

  19. Inclusion Criteria • Non-federal short-term acute care hospitals • Critical access hospitals (CAH) are included • Dry run includes patients: • Discharged in 2008-2009 • ≥65 years of age • Principal discharge diagnosis of AMI (defined by ICD-9 codes 410.xx, excluding 410.x2) • Randomly select one index admission per patient for patients with multiple admissions

  20. Exclusion criteria

  21. Transferred Patients • Payments for both admissions and post-discharge care are combined to calculate total payment • Total payment assigned to the initial admitting hospital

  22. Prorating Payments • Payments made for care that begins during measurement period but ends after measurement period are prorated

  23. Payment Calculation • Includes payments from admission to 30 days post-admission • Incorporates claims from across all care settings • Removes or averages payment adjustments unrelated to care • Geography (wage index, cost of living) • Policy adjustments (IME, DSH, etc.)

  24. Removing Payment Adjustments • Goal is to assess payments influenced by clinical decisions • Payment adjustments such as wage index are unrelated to clinical decisions/practice patterns of care • Using actual payments would not allow for a fair comparison across hospitals

  25. Removing Payment Adjustments: Stripping/Standardizing • To isolate differences in payments that reflect practice patterns, the measure estimates payments by: • Stripping: • Removing geographic adjustments • Removing policy adjustments • Standardizing: • Average payments across geographic areas when geographic differences cannot be removed

  26. Risk Adjustment • Accounts for differences in patient characteristics and comorbidities across hospitals • Includes: • Secondary diagnosis codes from index admission (except for potential complications of care) • All diagnosis codes from previous year from: • acute inpatient hospital stays • hospital outpatient care • physician, radiology, and laboratory services

  27. Risk-Standardized Payments • Calculating risk-standardized payment (RSP)

  28. Categorizing Hospital Results • Categories of measure results: • Less than U.S. average national payment • No different than U.S. average national payment • Greater than U.S. average national payment • Number of cases too small (<25 cases) • Final RSP reported with interval estimate

  29. Categorizing Hospital Performance

  30. Agenda • Introductions • Purpose of Dry Run and Measure • Proposed Implementation • Dry Run Overview • Measure Details • Resources (next) • Questions and Answers

  31. Resources • http://www.QualityNet.org

  32. Questions & Comments • Email Q&A period August 5 – September 4, 2013 cmsepisodepaymentmeasures@yale.edu Note: Please do NOT email or attach to emails any patient identifiable information

  33. Questions?

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