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9/25/2017
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NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Value Based Purchasing (VBP) & the EHR
D’Andre T. Carpenter, DNP, MS-ISM, RN-BCCorporate Director, Clinical Informatics
BaylorScott&White All Saints Medical CenterBaylorScott&White Andrews Women’s Hospital
Making Sense of Alphabet Soup!
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
BaylorScott&White
• Largest Integrated Delivery Network in TX
• Over 900 access points
• 5.1 patient encounter annually
• 48 Hospitals and 900+ Patient Care Site
• 40,000+ employee organization
• Internationally known for Quality STEEEP Program
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Course Objectives
By the end of this session, you will understand:• The main concepts of VBP • 21 measures associated with the FY17 program• 4 different domains: Clinical Care, Patient Exp,
Efficiency, Safety• How to incorporate performance improvement (PI)
leveraging the EHR• Data overview to track performance overtime
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NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Why Are We Here?
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Transition: FFS to Value Based Care
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Transition: FFS to Value Based Care
• Over 65% of payers and providers have already switched
• US Department of Health and Human Services set a goal to shift 85% medicare FFS to Value Base care by 2016
• Some private payer sources have started to shift towards value based care.
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NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Shifting Revenue Mix
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Precision Nursing
• Patient centered, highly reliable, evidence based and personalized nursing practice across the continuum of care that supports:– Quality outcomes
– Safety
– Decreased Costs
– Efficiency
– Nurse Satisfaction
– Length of Stay
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Triple Aim: Value Based Care
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NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Measure Based Model
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Current State: Quality MetricsPROGRAMS
Meaningful Use (MU)Medicare Value Based
PurchasingMedicare Readmission Reduction
ProgramMedicare Healthcare Acquired
Conditions (HAC's)Medicaid Potentially
Preventable Events (PPE)State-based initiatives
MEASURES
Data Capture and sharing, advanced clinical
processes, improved outcomes
Patient Experience, Core Measures,
Outcomes, Efficiency of Care FY17: Mortality,
Safety
AMI, HF, PNE, THA/TKA, and COPD 30-day readmissions
HAI: CAUTI, CLABSI, & Patient Saftey Indicators (PSI 90)
Readmission Based on APR DRG's (not those from
medicare)
Example: Texas DHSH Medicaid PPC program
RISK (Incentive vs. Penalty)
Incentive payouts & Penalties
Incentive payouts & Penalties
Penalty (All medicare payments to "affected" hospital will be reduced)
Penalty (Reimbursement affected for hospital services)
Penalty Based State Specific
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Value Based Care FY 17
• Effective for discharges from October 1, 2016 – September 30, 2017
• Program Includes a total of 21 measures
• Represented in 4 domains
– Clinical Care
– Patient Experience of Care (HCAHPS)
– Efficiency
– Safety
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NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Value Based Care FY 17
• The Diagnosis-related groups (DRGs) based operating payments increase from 1.75 to cap 2.00 percent
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Clinical Care
• 30% of the score for reimbursement is based on Clinical Care measures
• FY 2017 - Clinical Care is broken into two categories
– Process (5 percent weight)
– Outcomes (25 percent weight)
– Totaling 30%
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NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Clinical Care
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Clinical Care
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Patient Experience
• Patient Experience of Care (HCAHPS) survey will determine 25 percent of reimbursement in FY 2017
• The 25 percent weight remains unchanged from FY 2016 to FY 2017
• A total of eight measures and scores
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NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Patient Experience
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Safety
SAFETY FORMULA = PATIENT SAFETY INDICATORS + HEALTHCARE ASSOCIATED INFECTIONS • The Safety domain was added in FY 2017• includes Patient Safety Indicators (PSIs)• Healthcare-Associated Infections (HAI) measures• The Safety domain accounts for 20% of
reimbursement
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
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NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Efficiency
• Efficiency domain was added in FY 2015
• Remains in FY 2017
• Proposed by CMS to examine all Medicare (Part A and Part B) spending
• Measures begins three days prior to admission through 30 days after discharge.
• 25% of the score that determines reimbursement will be based on efficiency
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Efficiency
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NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Shift of Weighted Measures
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Shift: Value Based Measures & HAC
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
More Than Meeting the Measure
• EHR Goals that impact Value Based Care
– Standardization
– Quality
– Compliance
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NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
Connecting VBP w/ the EHR
Improves:
• Safety, Quality, & Convenience
• Accuracy of Diagnosis & Health
Outcomes
• Overall Care Coordination &
Continuum of Care
• Accuracy in reimbursement practices
& required documentation
• Organizational process efficiencies
resulting in cost savings
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
VBP & EHR
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
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NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
NMC 2017 – Las Vegas
VBP & EHR Alphabet Soup
D’Andre T. Carpenter, DNP, MS-ISM, RN-BCCorporate Director, Clinical Informatics
BaylorScott&White All Saints Medical CenterBaylorScott&White Andrews Women’s Hospital
[email protected]: 804-502-2151