Hospital Metrics TAG March 8, 2016
Welcome and Introductions 2
Agenda Overview • Updates • Presentation: HTPP Evaluation Plan • Continued discussion: opioid measure • Future agenda items • Wrap-up 3
Updates • Year 3 CMS Discussions • HTPP Committee – Feb 26 th meeting debrief – March HTPP Committee meeting cancelled. • CCO Committee – Feb 26 th meeting debrief 4
HTPP Committee Nominations • Currently seeking nominations for HTPP Committee: – Hospital representatives – Measurement experts • Applications due Friday, March 18 th • Interest form online at www.oregon.gov/oha/analytics/Pages/Hospital- Performance-Metrics.aspx 5
Other updates or questions? 6
Hospital Transformation Performance Program Evaluation DATE: MARCH 8, 2016 PRESENTED BY: JOHN MCCONNELL, CENTER FOR HEALTH SYSTEMS EFFECTIVENESS
Overview • Evaluation team • Key HTPP questions • Analytic approach • Survey – Development, Questions, Logistics • Getting your help on survey response • Timeline
Evaluation team OHSU Center for Health Providence Center for Outcomes Systems Effectiveness (CHSE) Research and Education (CORE) • John McConnell • Bill Wright • Hyunjee Kim • Lauren Broffman • Jenny Young • Natalie Royal • Ruth Rowland • Maggie Weller
Key HTPP Questions 1. How have hospitals performed on HTPP metrics, compared to baseline? 2. How have hospitals performed on metrics that are also CCO metrics? (primarily follow-up after hospitalization for mental illness ; potentially considered: sharing ED visit information; SBIRT ) 3. What contributed to the success of those hospitals successfully meeting the HTPP measurement goals? 4. What barriers prevented the success of any hospitals not meeting HTPP measurement goals? 5. What changes in hospital practice have been made as a result of HTPP? 6. What quality improvements/investments have hospitals made as a result of receiving the HTPP incentive payments? 7. What, if any, changes to the incentive structure for the CCOs by the state and by the CCOs for the providers is the state considering, as a result of lessons learned from HTPP?
Analytic Approach (I) 1. How have hospitals performed on HTPP metrics, compared to baseline? 2. How have hospitals performed on metrics that are also CCO metrics? (primarily follow-up after hospitalization for mental illness ; potentially considered: sharing ED visit information; SBIRT ) These questions will be answered primarily through statistical analyses of HTPP metric data, relying on pre-post comparisons for all measures, and extending the analyses to include comparison groups where possible (e.g., all cause readmissions & hospital discharge data).
Analytic Approach (II) 3. What contributed to the success of those hospitals successfully meeting the HTPP measurement goals? 4. What barriers prevented the success of any hospitals not meeting HTPP measurement goals? 5. What changes in hospital practice have been made as a result of HTPP? 6. What quality improvements/investments have hospitals made as a result of receiving the HTPP incentive payments? 7. What, if any, changes to the incentive structure for the CCOs by the state and by the CCOs for the providers is the state considering, as a result of lessons learned from HTPP? These questions will be answered primarily through a survey.
Survey Development • In progress • Currently conducting interviews with stakeholders across small number of hospitals and hospital systems
Possible survey questions • Did your hospital(s) carry out specific activities to improve performance on specific HTPP measures? • If no, why not? (E.g. measure specifications changed; measure too hard to meet) • If yes, what activities did you carry out? (E.g., hiring new staff, assembling teams, changing workflows, training staff, new collaborations, new data tools) • How engaged were leadership, clinicians, data teams? • How many FTE were allocated to work on HTPP efforts?
Survey logistics • Anticipate about 20-30 questions – Some questions will ask about activities across all 11 metrics • Assuming that the respondent had all the information, filling out the survey should take 15 minutes • Obtaining information will probably require coordination with – Quality improvement teams – Data teams – Financial/budget personnel • Assuming coordination/cooperation from your staff, we think these questions could be answered in a week
Getting responses to the survey • Hospital responses are vitally important to the evaluation efforts! • We would like each hospital (or hospital system) to identify a single point of contact. – That person will serve as the liaison; we anticipate that they may have to coordinate with multiple parties internally to obtain answers to all of the questions. – Please provide your contact name by 3/18 to Sarah Bartelmann at metrics.questions@state.or.us • If questions about the survey, please contact CORE: Maggie.Weller@providence.org
Timeline Milestone Date Survey instrument finalized March 25, 2016 Survey fielded (in field and follow-up through April 1, 2016 May 15) Survey fielding ended May 15, 2016 Draft evaluation report OHA June 2, 2016 Final evaluation report due to OHA June 23, 2016
And…Questions? Thank You!
Measure Development 19
Opioid Recap • At February H-TAG meeting, we discussed an alternative opioid measure: Total number of opioid pills dispensed over X time, as a rate per 1000 (or some such) ED visits. • Alternate measure was presented to the Committee in February as part of a bundled measure: – ED must have opioid prescribing policy in place that is consistent with best practices – Rate of pills dispensed / Rx per 1,000 ED visits • Committee is also interested in looking at MED per 1,000 ED visits. 20
Feedback: Technical Ability to Report Goal: to assess whether or not hospitals have the technical ability to report on these measures from your EMRs. • Yes, a report can be developed, but will take time / pending EHR upgrade this summer. • Yes, a report can be pulled. • “Opioids” is not a normal drug classification so pharmacy records are not set up this way – will require more definition to build report. 21
Feedback: Concerns with Measure Since last TAG and Committee meeting, additional concerns around the alternate measure have been raised: • Counting the number of pills, regardless of dosage. • Dispensing methods other than “pills.” • Defining an appropriate baseline (all ED visits? Prior year where opioids were dispensed? Other?). • Is the goal of the measure to reduce opioid Rx for abusers / frequent fliers, or to reduce the overall quantity of prescribed opioids to have fewer amounts given to any single patient at a time? • Defining excluded populations. 22
Opioid Prescribing Guidelines Taskforce As part of it’s opioid initiative, OHA will be facilitating a statewide taskforce to develop prescribing guidelines (including ED prescribing). • The taskforce will convene in April and meet for ~6 months (monthly meetings). • OHA is seeking at least one hospital representative to participate. If interested, please contact Lisa.M.Shields@state.or.us by March 21 th . 23
Thoughts? 24
Future H-TAG Agenda Items • April – CLABSI / CAUTI Year 3 specifications, reporting process – Continue opioid measure development • Ideas for future meetings: – Barriers & strategies for improvement on specific measures (any requested measures to start?) 25
Wrap-up • Next meeting – Tuesday, April 12, 10am – 12pm • H-TAG webpage (for meeting materials, future meeting dates, etc.) www.oregon.gov/oha/analytics/Pages/Hospital-Metrics- Technical-Advisory-Group.aspx • OHA contact details for all HTPP related questions: - metrics.questions@state.or.us 26
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