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HCAHPS and Value-Based Purchasing Methods and … · HCAHPS and Value-Based Purchasing Methods and...
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HCAHPS and Value-Based Purchasing
Methods and Measurement
Deb Stargardt, Improvement Services
Darrel Shanbour, Consulting Services
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Acquire new knowledge pertaining to:
A. Hospital CAHPS Survey and Scoring Methodology
(Top Box)
B. The Impact of Social Media and Transparency on
Consumer Assessment
C. Value-Based Purchasing Evolution and Impact on
Reimbursement
Today’s Learning Objectives
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Consider the key words – “Consumer Assessment”
How do consumers assess their
patient experience?
Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS)
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5 © 2012 Press Ganey Associates, Inc.
Linking Values to Behaviors
Compassion
“What does it look like?”
Being Responsive
Respect
“What does it look like?”
Providing Explanations
Teamwork
“What does it look like?”
Coordinating Care
6 © 2012 Press Ganey Associates, Inc.
Standards of Behavior
Courteous
Authentic
Competent
Cooperative
Solutions-Oriented
High Achiever
Top Performer
Team Player
Time Manager
Financial Steward
Goal-oriented
Professional
Friendly
7 © 2012 Press Ganey Associates, Inc.
Leadership Challenge - Connecting the Dots
Standards of Behavior
HCAHPS
Organizational Values
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Consumer Assessment of Healthcare Providers and Systems
• Produce comparable data for public reporting
• Create incentives to improve
• Enhance public accountability and transparency
Hospital CAHPS
Home Health Care CAHPS
In-Center Hemodialysis CAHPS
Clinician and Group CAHPS
Family Evaluation of Hospice Care
Health Plan CAHPS
Ambulatory Surgery CAHPS (under CMS consideration)
Outpatient Diagnostic CAHPS (under CMS consideration)
The CAHPS Family of Surveys
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10 © 2012 Press Ganey Associates, Inc.
Linking Mission to Margin with HCAHPS
Mission Margin
Mission Measures Points Scores Payments Margin
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Think about it…
We usually give
our patients the
correct
medication. We usually pull
the right patient
chart.
We probably get the correct
label on the tube.
Your doctor will usually come by
to talk to you.
We usually
respect your
privacy.
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Top Box is…
Top box is the percent of highest ranked answers on the survey:
Percent of “Always” Responses
Percent of “Yes” Responses
Percent of “9” and “10” Responses
Percent of “Strongly Agree”
Percent of “Definitely”
All other responses are irrelevant.
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Only the Highest Rank Counts
Evaluative Questions
Screening Questions
Global Rating Questions
Top Box
Top Box
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Calculating question scores
Each response scored “top box” (1) or zero (0)
Question top-box score is calculated as the total number of
“top box responses divided by the total number of questions
answered.
Calculating HCAHPS Scores Sample
Nurses treat with courtesy/respect
Patient 1 Always (top box)
Patient 2 Usually
Patient 3 Usually
Patient 4 Never
Patient 5 Sometimes
Patient 6 Always (top box)
Patient 7 Usually
Patient 8 Sometimes
Patient 9 Always (top box)
Patient 10 Sometimes
3 top box responses
10 total responses
For “Nurses treat with
courtesy/respect” the
Top box score is 30%
© 2012 Press Ganey Associates, Inc.
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Calculating Domain scores
Each question has a top box percentage.
The top box percentages are added and divided by the number
of questions (not the number of responses) in each domain.
Calculating HCAHPS scores
Question
Nursing
Domain
Nurses treated you with
courtesy/respect 30%
Nurses listen carefully to you 70%
Nurses explained in way you
understand 80%
(30+70+80) = 180 = 60
3 3
The Nursing Domain
score is 60% *note: Domain scores are not
weighted
© 2012 Press Ganey Associates, Inc.
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• Five new questions
– Three care transitions questions
– Two demographic questions
– Voluntary use beginning with July 1 discharges
– Likely required in 2013
– Unlikely to affect VBP for several years
Proposed New HCAHPS Dimensions
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Why More Questions?
The new questions CMS must find ways to save money associated with readmissions and has funded initiatives that are taking a community level approach to improving the transition of adult care through various interventional models – notably Dr. Eric Coleman’s work.
Going public with data Today, CMS is sharing Information on 30-day readmission rates for Medicare patients experiencing heart attack, heart failure or pneumonia on Hospital Compare as above average, average or below average compared to other hospitals nationally.
Questions with a different scale Three of the new questions come directly from Dr. Coleman’s Care Transitions Measure©, a copyrighted measurement tool with considerable benchmarked data associated with the response methodology he adopted when the survey was developed. The two “about you” questions provide some demographic information about the patient that will be helpful in looking at the broader patient experience, i.e., admitted through ER and patient perception of mental health status.
Looking forward
Every day, 10,000 Baby Boomers (born between 1946 – 1964) reach the age of 65 and this will continue for the next 19 years (25% of U.S. population).
According to the Medicare Payment Advisory Commission, the government spends an estimated $12 billion a year on “potentially preventable” readmissions for Medicare patients alone.
This will be an era of accountability during which CMS will attempt to hold hospital’s to the HHS definition of health care quality – “getting the right care to the right patient at the right time – every time.”
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So, how are you really doing?
Discharge Communication and Spending Ratio – is there a connection?
Consider a Patient Experience timeline that starts 3 days before hospital stay and extends until 30 days after discharge from the hospital.
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Collaborations Across the Nation
Introduction to the Triple Aim
In October 2007 the Institute for Healthcare Improvement (IHI) launched the
Triple Aim initiative, designed to help health care organizations improve the
health of a population patients' experience of care (including quality,
access, and reliability) while lowering—or at least reducing the rate of
increase in—the per capita cost of care. Pursuing these three objectives
at once allows health care organizations to identify and fix problems such as
poor coordination of care and overuse of medical services. It also helps them
focus attention on and redirect resources to activities that have the greatest
impact on health.
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Rounding Enables Communication
What would you like to
understand?
Medication Communication
Rounding
What are your
concerns?
Discharge Communication
Rounding
What is your story?
Demographics
Rounding
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Linking Values through Discharge Calls
High-performing organizations
commit time and resources to post-
discharge phone calls.
Reassures patient
Identifies service concerns
Provides insights for WOW!
moments
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Be Proactive
Anchor all improvement efforts to organizational mission, vision,
values and standards of behavior.
Recruit, coach, and train to behavior standards – require
compliance; inspire commitment.
The goal is to improve the perception of care through sound
business structure, efficient processes, and rigorous behavior
standards that lead to great outcomes.
Be proactive in understanding the where, why and when of CMS
to better understand how to utilize your survey results.
http://www.innovations.cms.gov/
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-
Assessment-Instruments/hospital-value-based-
purchasing/index.html?redirect=/Hospital-Value-Based-
Purchasing/
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Our Transparent World
More than 25 billion pieces of content (web links, news stories, blog posts, notes, photo albums, etc.) are shared on Facebook each month.
Twitter gets more than 300,000 new users every day.
80% of companies use LinkedIn as a recruitment tool.
You would need to live for around 1,000 years to watch all the videos currently on YouTube.
77% of Internet users read blogs
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Consumers Assessing Care
What do you know about you?
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January 2011 –
CMS launches
Physician Compare
www.medicare.gov/find-a-
doctor
Provider Comparison
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2011 2012 2013 2014 2015
1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
Physician Quality
Reporting
System (PQRS)
Data Collection
for Public
Reporting
Payment
Modification for
those Impacted
by Physician
VBP
Physician
Compare
Launched
Physician Compare
Public Reporting of
PQRS
Increased Transparency and Measurement
© 2012 Press Ganey Associates, Inc.
CGCAHPS
PCMH / CA / MN
Initial launch
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Hospital Acquired Conditions (Nonpayment)
2010 2011 2012 2013 2014 2015 2016 2017
Readmission Reduction Program
HAC Reduction Program
Meaningful Use of EHR
Value-based Purchasing (VBP)
Inpatient Quality Reporting Requirement (IQR, formerly RHQDAPU) 2% of APU
1-3%
1%
1-2%
CMS-sponsored Quality Performance Programs
Outpatient Quality Reporting Requirement (OQR, formerly HOPQDRP) 2% of APU
Medicare Shared Savings: ACO (MSSP)
PQRS Phys. Quality Reporting System
Meaningful Use 1%
PQRS 1.5-2%
2-3+%
Voluntary Incentive Penalty
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Example of Potential Hospital Impact
Dollars subject to Medicare P4P programs
at a 146-bed hospital in Florida
Using MedPar 2010 data
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Example of Potential Hospital Impact
Dollars subject to Medicare Pay-for-Performance programs at a 541-bed hospital in New Jersey
Using MedPar 2010 data
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Incentive/Penalty 1% of Base DRG operating payment in FY13, rising to 2% in FY17
Measurement Areas of Interest
FFY 2013 Core Measures
Patient Experience
AMI, HF, PN, SCIP
HCAHPS
FFY 2014 Core Measures
HCAHPS
Outcomes
(Largely unchanged)
(Unchanged)
30d risk- adjusted mortality AMI, HF, PN
FFY 2015 (proposed)
Core Measures
Patient Experience
Outcomes
Efficiency of Care
(Largely unchanged)
(Unchanged)
Adding AHRQ PSI composite and CLABSI
Average spending per M/care Beneficiary
FFY 2016 (proposed)
Clinical Care Person & Caregiver Experience & Outcomes Safety Efficiency & Cost Reduction Care Coordination Community/Population Health
Considerations Domain weighting for score calculation changes as new domains added
Measures within domains subject to change (additions, deletions)
Proposal for FY16 is a realignment of all measures
Value-based Purchasing (VBP): The Race to Top Box
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Threshold and Benchmark
Established with data from the baseline period
Benchmark (Mean of Top Decile) Achievement
threshold (Median)
Lower scores Higher scores
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2014 Baseline & Performance Periods
Each domain has its own baseline and performance period
and the periods are not aligned across domains
2009 2010 2011 2012 2013
1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
Clinical
Baseline
Clinical
Performance
HCAHPS
Baseline
HCAHPS
Performance
Mortality
Baseline
Mortality
Performance
Payments affected
Oct. 1, 2013 – Sept. 30, 2014
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FFY15 (Possible): Four domains Addition of Efficiency Domain (Spending per Medicare
Beneficiary)
New measures added to Outcomes Domain: AHRQ and HAC composite measures added to Outcomes Domain
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On the Horizon…
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Clinical Performance
Misses on 7 patients,
Loss $102,493
Misses on 4 patients,
Loss $102,493 Misses on 11 patients,
Loss $102,493 Misses on 4 patients,
Loss $71,745
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Satisfaction Performance
What you don’t see: 19% responded Usually
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Dr. Donald Berwick’s Words…
“The problems do not lie in any failure of good will, benign
intentions or skills of our doctors, nurses, health care
managers or staffs. With rare exceptions, they are doing their
best. The problems lie in the design of the care systems in
which they work, systems never built for the levels of reliability,
safety, patient centeredness, efficiency or equity that we owe to
ourselves and our neighbors.”