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Why Core Measures Abstraction Matters to CEOs/CFOs

Why Core Measures Abstraction Matters to CEOs/CFOs. June 21, 2012. Objectives. Participants will understand: Quality and financial impacts of clinical process of care measures Critical issues related to clinical process of care reporting outcomes

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Why Core Measures Abstraction Matters to CEOs/CFOs

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  1. Why Core Measures Abstraction Matters to CEOs/CFOs June 21, 2012

  2. Objectives Participants will understand: • Quality and financial impacts of clinical process of care measures • Critical issues related to clinical process of care reporting outcomes • Staffing issues related to retrospective abstraction of clinical process of care measures

  3. Course Summary • Hospital Inpatient/Outpatient Core Measures • Background • Current • Quality Impact • Financial Impact • Critical Issues • What Next? Strategy and Staffing

  4. Hospital Inpatient/Outpatient Core Measures Background • Origins • Purpose • Players • Reporting

  5. Hospital Inpatient/Outpatient Core MeasuresCurrent • Value-Based Purchasing (VBP) • Annual Payment Update (APU) • TJC “Improving America’s Hospitals” • Medicare Hospital Compare

  6. Process of Care MeasuresQuality Impact • Data Collection Approach • Data Accuracy • Measure Analysis Suggestions • Sampling • Data Reported As: • Selected References • Flow Chart • Visual • Written • Measure Set • Set Measure ID# • Performance Measure Name • Description • Rationale • Type of Measure • Improvement Noted As: • Numerator Statement • Denominator Statement

  7. Process of Care Measures Quality Impact • Measure Set: Surgical Care Improvement Project (SCIP) • Set Measure ID#: SCIP-VTE-2 • Performance Measure Name: Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery • Description: Surgery patients who received appropriate Venous Thromboembolism (VTE) prophylaxis within 24 hours prior to Anesthesia Start Time to 24 hours after Anesthesia End Time. Specifications Manual – Measure Information Form - 22 pages 50 decisions points

  8. Process of Care MeasuresQuality Impact - SCIP-VTE-2 Decision Points • Excluded Populations: • Patients whose total surgery time is less than or equal to 60 minutes • Patients who stay less than two nights • Patients who expire perioperatively • Patients with reasons for not administering both mechanical and pharmacological prophylaxis • Patients who did not receive VTE Prophylaxis (as defined in the Data Dictionary) • Excluded Populations: • Patients less than 18 years of age • Patients who have a Length of Stay greater than 120 days • Burn patients (as defined in Appendix A, Table 5.14 for ICD-9-CM codes) • Patients enrolled in clinical trials • Patients who are on oral anticoagulation therapy prior to admission • Patients whose ICD-9-CM principal procedure occurred prior to the date of admission

  9. Process of Care MeasuresQuality Impact - SCIP-VTE-2 Scoring • VBP Achievement Threshold • FY 2013 – 93.07% • FY 2014 – 94.92% • VBP Benchmark • FY 2013 – 99.85% • FY 2014 – 99.83% • National Averages • 2008-2009 – 86% • 2009-2010 – 92% • 2010-2011 – 94%

  10. Process of Care MeasuresFinancial Impact • FY 2013 Value-Based Purchasing Program • 1% IPPS Base Operating DRG withhold • Clinical Process of Care (CPC) Domain • 12 measures • Patient Experience of Care (PEC) Domain • 8 dimensions • Higher of Achievement and Improvement score used for each measure/dimension • Measure scores summed into CPC Domain score • Dimension scores summed into PEC Domain score • CPC Domain score weighted 70% • PEC Domain score weighted 30%

  11. Process of Care MeasuresFinancial Impact • FY 2014 Value-Based Purchasing Program • 1.25% IPPS Base Operating DRG withhold • Clinical Process of Care (CPC) Domain • 70% to 45% • Patient Experience of Care (PEC) Domain • Remains 30% • Mortality Domain (Outcomes) – 25%

  12. .1000 .9500 .9000 .8500 Process of Care MeasuresFinancial Impact SCIP-VTE-2 Achievement/Improvement FY 2013 .9985 Benchmark .9307 Achievement Threshold Achievement Range Baseline 5 – Achievement Points 6 – Improvement Points .9000 .1000 .9500 .8500 .8950 Achievement Range Performance .1000 .8500 .9500 .9000 Improvement Range .9600

  13. Process of Care MeasuresFinancial Impact SCIP-VTE-2 Achievement/Improvement FY 2014 FY 2013 Achievement Threshold FY 2014 Achievement Threshold .9000 .1000 .9492 .9307 .9983 Benchmark Achievement Range .1000 .9000 FY 2013 Performance .9600 6– Achievement Points 4 – Improvement Points .9000 .1000 FY 2014 Performance Achievement Range .9750 Improvement Range

  14. Process of Care MeasuresVBP Financial Risk

  15. Critical IssuesValue-Based Purchasing • Reporting Period Lag • FY 2013 (begins 10/1/12) • Baseline period – 7/1/09 to 3/31/10 • Performance period – 7/1/11 to 3/31/12 • Estimated payment – 8/12 • Exact payment – 10/12

  16. Critical IssuesValue-Based Purchasing • Reporting Period Lag • FY 2014 (begins 10/1/13) • CPC and PEC • Baseline period – 4/1/10 to 12/31/10 • Performance period – 4/1/12 to 12/31/12 • Outcomes • Baseline period – 7/1/09 to 6/30/10 • Performance period – 7/1/11 to 6/30/12

  17. Critical IssuesValue-Based Purchasing • Measure Cycling • “Topped out” measures discontinued • FY 2011 – 45 measures reported • FY 2013 final rule – 8 measures discontinued

  18. Critical IssuesAPU Updates • Measure Cycling • FY 2014 Inpatient Quality Reporting • Retire 4 measures • Suspend data collection for 4 measures • Add 1 HAI measure • Add Stroke and VTE chart-abstracted measures • FY 2014 Outpatient Quality Reporting • Add 1 HAI measure • Add 6 chart-abstracted measures

  19. Critical IssuesNumber and Complexity of Measures • Inpatient Quality Reporting – APU payment determination • FY 2014 – 55 measures • FY 2015 - 72 measures • Complexity – VTE-1 • “…assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission.”

  20. Critical IssuesCDAC Validation • Clinical Data Abstraction Center (CDAC) verifies hospital-abstracted data for Hospital IQR Program is consistent and reproducible • Randomly assigned hospitals + previously failed hospitals • 12 cases per quarter • 75% validation rate per quarter (9 of 12 cases) • Interrater reliability • APU update

  21. Critical IssuesConcurrent Review • Identifying patients • Rounding • Care provided meets standards • Care documented appropriately • Care not given can’t be documented • Prospective rather than retrospective

  22. Critical IssuesMeaningful Use - Overview • Goal: achieve significant improvements in care through adoption and “meaningful use” of electronic health record and clinical decision support tools • Stage 1 • Implement 14 core objectives and 5 of 10 menu objectives • Implement 15 clinical quality measures • Stage 2 (Proposed) • Implement 16 core objectives and 3 of 5 remaining menu objectives • Implement 24 clinical quality measures

  23. Critical IssuesMeaningful Use - Implications • Less retrospective abstraction • Continued verification of clinical documentation processes • Process failure – measure fall-out • Automotive industry parallel – changing nature of work

  24. What Next? • Determine your quality strategy • What role does retrospective core measures abstraction play in that strategy? • Staffing to the strategy • Staffing issues • Staffing tactics

  25. Staffing Issues • Training/education • Economies of scale / scattered resources • Succession issues • Reporting lag

  26. Staffing To The Strategy • Turtle tactic – stretch current staff • Grasshopper tactic – find more fixed FTEs and increase training/education • Comparative Advantage tactic – external experts • Validation audits • Short-term staffing • Long-term outsourcing

  27. Staffing To The Strategy • If outsourcing, issues to address with vendors: • Experience • Quality control • Privacy • Outcomes – validation / interrater reliability • Reporting • Level of Collaboration • Opportunity costs

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