Post on 16-Jul-2020
V a l u e B a s e d
P u r c h a s i n g S e r i e s
The first performance
period has ended…what
now?
Presented by:
Craig Deao, MHA
Objectives
At the conclusion of this video you will be able to:
Discuss where we stand within the Value-Based
Purchasing timeline
Describe the key changes taking effect for the 2014
performance period
W h e r e w e ’ v e b e e n . . .
Implementation Timeline
We Are Here
CY 2009 CY 2010 CY 2011 CY 2012 CY 2013
1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
Baseline Period
(Jul 2009 – Mar 2010 ) Performance Period
(Jul 2011 – Mar 2012 ) Payments Affected
(Oct 2012 – Sept 2013 )
Incentive
Payments Announced
Implementation Timeline
We Are Here
CY 2009 CY 2010 CY 2011 CY 2012 CY 2013
1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
Baseline Period
(Jul 2009 – Mar 2010 ) Performance Period
(Jul 2011 – Mar 2012 ) Payments Affected
(Oct 2012 – Sept 2013 )
Incentive
Payments Announced
Value Based Purchasing FY 2013
12 Process of Care Measures
(* 70% Weight)
HCAHPS
(* 30% Weight)
1% Base operating DRG
payments
Performance attainment and improvement
will determine total
hospital reimbursement
Implementation FY 2013 (October 2012) Source: Value Based Purchasing Program final rule 4.29.11
W h e r e w e ’ r e g o i n g . . .
Value Based Purchasing FY 2014
Process of Care Measures (45% Weight)
HCAHPS Composites (30% Weight)
1.25% Base operating
DRG payments
Performance attainment and improvement
will determine total
hospital reimbursement
Outcomes (25% Weight)
New 2014
update
Note: Implementation FY 2014 Source: OPPS VBP Final rule 11.1.11
2014 VBP Reimbursement Periods New 2014
update
CY 2009 CY 2010 CY 2011 CY 2012 CY 2013
1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
Process of Care & HCAHPS
Baseline Period
(Apr-Dec 2010)
Process of Care & HCAHPS
Performance Period
Outcomes
Baseline Period
(Jul 2009 – Jun 2010)
Outcomes
Performance Period
(Jul 2011 – Jun 2012)
CY 2009 CY 2010 CY 2011 CY 2012 CY 2013
1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
(Apr-Dec 2012)
2014 Proposed vs. Final Rule
Eliminated the Efficiency Domain
Finalized the Outcomes Domain and associated measures
Eliminated the composite scores for Hospital Acquired
Conditions (HACs) and AHRQ Measures (initially part of
Outcomes Domain)
Addition of Core Process Measure: Postoperative Urinary
Catheter Removal on Postoperative Day 1 or 2
(SCIP-Inf-9)
Finalized domain weighting
Released new floor, threshold and benchmark numbers for
the 2014 performance periods
Note: Implementation FY 2014 Source: OPPS VBP Final rule 11.1.11
New 2014
update
2014 Patient Experience of Care Domain (HCAHPS)
Note: Implementation FY 2014 Source: OPPS VBP Final rule 11.1.11
Green = increased threshold from 2013
Red = decreased threshold from 2013
Floor
2013
National
Threshold
2014
National
Threshold
2013
National
Benchmark
2014
National
Benchmark
Communication with Nurses 42.84% 75.18% 75.79% 84.70% 84.99%
Communication with Doctors 55.49% 79.42% 79.57% 88.95% 88.45%
Responsiveness of Hospital Staff 32.15% 61.82% 62.21% 77.69% 78.08%
Pain Management 40.79% 68.75% 68.99% 77.90% 77.92%
Communication about Medicines 36.01% 59.28% 59.85% 70.42% 71.54%
Hospital Cleanliness & Quietness 38.52% 62.80% 63.54% 77.64% 78.10%
Discharge Information 54.73% 81.93% 82.72% 89.09% 89.24%
Overall Rating of Hospital 30.91% 66.02% 67.33% 82.52% 82.55%
New 2014
update
Improvement Achievement Consistency
The greater of the two
scores will be used for each
composite
Achievement – Improvement – Consistency HCAHPS Scoring
Based on achievement
performance in ALL
composites or lowest
index composite will be
used Note: Implementation FY 2014 Source: OPPS VBP Final rule 11.1.11
New 2014
update
2014 Final Rule Process of Care Measures
Measure ID Measure 2013 National
Threshold
2014 National
Threshold 2013 National
Benchmark
2014 National
Benchmark
AMI–7a
Fibrinolytic Therapy Received Within
30 Minutes of Hospital Arrival 0.6548 0.8066 0.9191 0.9630
AMI–8a
Primary PCI Received Within 90
Minutes of Hospital Arrival 0.9186 0.9344 1.0000 1.0000
HF–1 Discharge Instructions 0.9077 0.9266 1.0000 1.0000
PN–3b
Blood Cultures Performed in the
Emergency Department Prior to Initial Anti-biotic Received in Hospital
0.9643 0.9730 1.0000 1.0000
PN–6
Initial Antibiotic Selection for CAP in
Immunocompetent Patient 0.9277 0.9446 0.9958 1.0000
New 2014
update
Green = increased threshold from 2013
Red = decreased threshold from 2013
Note: Implementation FY 2014 Source: OPPS VBP Final rule 11.1.11
2014 Final Rule Process of Care Measures
Measure ID Measure 2013 National
Threshold
2014 National
Threshold 2013 National
Benchmark
2014 National
Benchmark
SCIP–Inf–1
Prophylactic Antibiotic Received Within
One Hour Prior to Surgical Incision 0.9735 0.9807 0.9998 1.0000
SCIP–Inf–2
Prophylactic Antibiotic Selection for
Surgical Patients 0.9766 0.9813 1.0000 1.0000
SCIP–Inf–3
Prophylactic Antibiotics Discontinued
Within 24 Hours After Surgery End Time 0.9507 0.9663 0.9968 0.9996
SCIP–Inf–4
Cardiac Surgery Patients with Controlled
6AM Postoperative Serum Glucose 0.9428 0.9634 0.9963 1.0000
SCIP–Inf–9
Postoperative Urinary Catheter Removal
on Post Operative Day 1 or 2 N/A 0.9286 N/A 0.9989
New 2014
update
Green = increased threshold from 2013
Red = decreased threshold from 2013
NEW
Note: Implementation FY 2014 Source: OPPS VBP Final rule 11.1.11
2014 Final Rule Process of Care Measures
Measure ID Measure 2013 National
Threshold
2014 National
Threshold 2013 National
Benchmark
2014 National
Benchmark
SCIP–Card–2
Surgery Patients on a Beta Blocker Prior
to Arrival That Received a Beta Blocker
During the Perioperative Period 0.9500 0.9565 1.0000 1.0000
SCIP–VTE–1
Surgery Patients with Recommended
Venous Thromboembolism Prophylaxis
Ordered 0.9307 0.9462 0.9985 1.0000
SCIP–VTE–2
Surgery Patients Who Received
Appropriate Venous Thromboembolism
Prophylaxis Within 24 Hours Prior to
Surgery to 24 Hours After Surgery
0.9399 0.9492 1.0000 0.9983
New 2014
update
Green = increased threshold from 2013
Red = decreased threshold from 2013
Note: Implementation FY 2014 Source: OPPS VBP Final rule 11.1.11
2014 Outcome Measures
Measure ID Measure National
Threshold National
Benchmark
MORT–30–
AMI
Acute Myocardial Infarction (AMI) 30-
Day Mortality Rate (shown as survival
rate)
0.8477 0.8673
MORT–30–HF Heart Failure (HF) 30-Day Mortality
Rate (shown as survival rate) 0.8861 0.9042
MORT–30 PN Pneumonia (PN) 30-Day Mortality
Rate (shown as survival rate) 0.8818 0.9021
Note: Implementation FY 2014 Source: OPPS VBP Final rule 11.1.11
New 2014
update
HCAHPS & Mortality
“[W]hen we controlled for a hospital’s clinical
performance, higher hospital-level patient
satisfaction scores were independently associated
with lower hospital inpatient mortality rates.”
Source: Glickman SW et al, Patient Satisfaction and Its Relationship with Clinical Quality
and Inpatient Mortality in Acute Myocardial Infarction, Circ Cardiovasc Qual Outcomes
2010;3:188-195.
Improvement Achievement
The greater of the two
scores will be used for each
Core Measure
Achievement – Improvement Process of Care & Outcomes Scoring
Note: Implementation FY 2014 Source: OPPS VBP Final rule 11.1.11
New 2014
update
More in Store
1% 1.25% 1. 5% 1. 75% 2%
1% 2% 3% 3% 3%
HCAHPS & Readmissions
For all three clinical areas (AMI, HF, PN),HCAHPS
performance was more predictive of readmission
rates “than the objective clinical performance
measures often used to assess the quality of hospital
care.”
Source: Boulding W et al. Relationship between Patient Satisfaction with Inpatient Care
and Hospital Readmissions Within 30 Days, Am J Manag Care. 2011; 17(1): 41-48.