Centennial Care Hospital Quality Improvement Incentive Pool - PowerPoint PPT Presentation

Centennial Care Hospital Quality Improvement Incentive Pool Presented by Ellen Interlandi and Beth Landon, NMHA

 HQII – Hospital Quality  HIDD – Hospital Improvement Incentive Pool Inpatient Discharge Data  SNCP – Safety Net Care Pool (or Administrative Data) Hospitals (formerly SCP – Sole patient record level information for all inpatients in non-federal Community Provider Hospitals) hospitals, reported quarterly NM-specific, 29 hospitals  HEN – Hospital  MAD – Medical Assistance Engagement Network a Division , a division of ….. CMS nationally funded initiative for quality outcomes, 30 NM  HSD – NM Human Services hospitals participating; similar Dept quality measures but NOT the same program as HQII  HCAHPs – Hospital Consumer Assessment of Healthcare Providers & AAAA AAAA – American Systems Association Against Acronym Abuse

What is is the HQII? I? ∙ The Hospital Quality Improvement Incentive (HQII) Pool is a component of the Safety Net Care Pool. ∙ It was approved by the Centers for Medicare and Medicaid Services (CMS) as part of the §1115 Waiver – Centennial Care. ∙Calendar year 2014 was “Year 1” for the Waiver, data submission began in Year 2 (2015) ∙The purpose of the HQII is “to incentivize hospitals’ efforts to meaningfully improve the health and quality of care of the Medicaid and uninsured individuals that they serve”.

How wil ill i l it work rk? ∙ The HQII Pool will be distributed to participating “qualified hospitals” that meet certain benchmarks on the designated performance measures ∙ For 2015, there was $2.8 million in the Pool; for 2016 there is about $5.7 million

How Much is is in in the Po Pool? l? • The HQII is a component of the Safety Net Care Pool. • The other component, the Uncompensated Care Pool is a fixed amount ($68.9 million each year). • The amount available for HQII is designed to be the “growth rate” over time and will increase each year, DY 1 DY 2 DY 3 DY 4 DY 5 Total (CY 2014) (CY 2015) (CY 2016) (CY 2017) (CY 2018) UC $68,889,323 $68,889,323 $68,889,323 $68,889,323 $68,889,323 $344,446,615 Pool HQII - $2,824,462 $5,764,727 $8,825,544 $12,011,853 $29,426,586 Pool % UC 100% 96% 92% 89% 85% 92% Pool % n/a 4% 8% 11% 15% 8% HQII $68,889,323 $71,713,785 $74,654,050 $77,714,867 $80,901,176 $373,873,201 Total From the Centennial Care Waiver – Special Terms and Conditions

What is is the HQII I Tim imeli line? ne? • HQII implementation began January 1, 2014 with hospital agreement to participate • Hospitals submitted baseline data for DY2 (Calendar Year 2014) November 2015 • Hospitals will submit new measures for DY3 by October 2016. • Allocation Payment Methodology will be used to determine pool of funds for which each hospital is eligible. Pause se for Questions ions

What t are the Perfor rformance mance Measu sures res The outcome measures are divided into two domains: ∙ Doma main in 1 - Urgent nt Impro provements ements in Care. Critical patient safety and quality measures for areas of widespread need. ∙ Doma main in 2 - Popula ulatio tion-fo focuse cused d Improve provemen ments ts. . Measures of prevention and improved care delivery for the highest burden conditions in the Medicaid and uninsured population

Do Doma main in 1 M Measures sures • Adverse Drug Events • Catheter-Associated Urinary Tract Infections • Central Line Associated Blood Stream Infections • Injuries from Falls and Immobility • Obstetrical Adverse Events • Pressure Ulcers • Surgical Site Infections • Venous Thromboembolism • Ventilator-Associated Pneumonia • All Cause Readmissions

1. Adverse Drug Events DATA COLLECTION METHOD: Self-report A. Hypogly poglyce cemia mia in Inpatien patients Receiv eceivin ing g Insuli sulin Numerator – Hypoglycemia in inpatients receiving insulin or other hypoglycemic agents Denominator - Inpatients receiving insulin or other hypoglycemic agents Rate = Numerator Denominator x 100

1. Adverse Drug Events DATA COLLECTION METHOD: Self-report B. Adverse Drug Events nts due to O Opioids Numerator – number of patients treated with opioids who received naloxone Denominator - number of inpatients who received an opioid agent Rate = Numerator Denominator x 100 patients c. c. Exce cessive ve anticoag oagul ulati ation n with Warfar arin in – Inpatients ients Numerator – Inpatients experiencing excessive anticoagulation with warfarin Denominator - Inpatients receiving warfarin anticoagulation therapy Rate = Numerator Denominator x 100 Resources online at the following link: http://partnershipforpatients.cms.gov/p4p_resources/tspadversedrugeven ts/tooladversedrugeventsade.htm

Asks recently discharged patients about aspects of hospital experience • Random sample of adult inpatients(medical, surgical, maternity) • between 48 hours and six weeks after discharge; not restricted to Medicare patients Can be done by mail, telephone, mail with telephone follow-up or active • interactive voice recognition. Publicly available, hospitals may get soon after end of each quarter Must have at least 300 completed surveys over 4 calendar quarters to • reach statistical reliability Percentage of patients who gave their hospital a rating of 9 o or 1 10 • http://www.hcahpsonline.org/Files/HCAHPS_Fact_Sheet_June_2015.pdf https://www.cms.gov/medicare/quality-initiatives-patient-assessment- instruments/hospitalqualityinits/downloads/hospitalhcahpsfactsheet201007.pdf

2. Cath atheter ter-Assoc Associated iated Urinary nary Tract act In Infe fections(CAUTI) tions(CAUTI) (NHSN) Numerator – total number of observed healthcare associated CAUTI among patients in bedded inpatient locations Denominator - total number of indwelling urinary catheter days for each location under surveillance for CAUTI Rate = Numerator Denominator x 1,000 Specifications available from http://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf

3. Centr ntral al Line Associa ociated ted Blood od Str tream eam In Infe fections tions (CLABSI) ABSI) (NHSN) Numerator – total number of observed healthcare associated CLABSI among patients in bedded inpatient locations Denominator - total number of central line days for each location under surveillance for CLABSI Rate = Numerator Denominator x 1,000 Specifications available from http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf

4. In Inju juries ries fr from Falls lls and d Im Immo mobility/Trauma bility/Trauma HAC 05 CMS (HIDD) Numerator – total number of hospital acquired occurrences of fracture, dislocation, intracranial injury, crushing injury, burn and other injury (codes within the CC/MCC list) Denominator - inpatient discharges Rate = Numerator Denominator x 1,000 https://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/wPOAFactSheet.pdf https://www.cms.gov/Medicare/Medicare-Fee-for- Service-Payment/HospitalAcqCond/Hospital- Acquired_Conditions.html

5. Ob Obstet stetrical rical Ad Adve verse rse Eve vent nts (HIDD) OB Traum auma a – Vagina inal l Deliv iver ery y with th Instr trum umen enta tatio ion PSI 18 Numerator – discharges, among cases meeting the inclusion and exclusion rules for the Denominator, with any listed diagnostic codes for third and fourth degree obstetric trauma Denominator - all vaginal delivery discharges with any procedure code for instrument-assisted delivery Rate = Numerator Denominator x 1,000 Specifications available from http://qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50- ICD10/TechSpecs/PSI%2018%20Obstetric%20Trauma%20Rate%20%E2%80%93 %20Vaginal%20Delivery%20With%20Instrument.pdf

. Ob Obstet tetrical rical Adve verse rse Eve vent nts s (HIDD) 5. OB Traum uma a – Vaginal nal Delivery very witho hout ut Instr trumen umentati ation on PSI 19 Numerator – discharges, among cases meeting the inclusion and exclusion rules for the denominator, with any listed diagnostic codes for third and fourth degree obstetric trauma Denominator - vaginal deliveries identified by DRG or MS-DRG code Rate = Numerator Denominator x 1,000 Specifications available from http://qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50- ICD10/TechSpecs/PSI%2019%20Obstetric%20Trauma%20Rate- Vaginal%20Delivery%20Without%20Instrument.pdf

6. . Pressure & IV rate PSI sure Ul Ulcers St Stage ge III & IV I 3 (HIDD) Numerator - discharges, among cases meeting the inclusion and exclusion rules for the denominator, with any secondary ICD-9-CM or ICD-10-CM diagnosis codes for pressure ulcer and any secondary ICD-9-CM or ICD-10-CM diagnosis codes for pressure ulcer stage III or IV (or unstageable). Denominator – inpatient adult discharges Rate = Numerator Denominator x Specifications available from http://qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50- ICD10/TechSpecs/PSI%2003%20Pressure%20Ulcer%20Rate.pdf Note: update terminology, NPUAP has revised language to describe “pressure injury”