Hospital Metrics TAG April 11, 2017 PLEASE DO NOT PUT YOUR PHONE ON - PowerPoint PPT Presentation

Hospital Metrics TAG April 11, 2017 PLEASE DO NOT PUT YOUR PHONE ON HOLD: IT IS BETTER TO HANG UP AND CALL BACK IN IF NEEDED

Welcome and Introductions 2

Agenda Overview • Updates • EDIE-sourced measure • CLA BSI / CAUTI NHSN Rebase and QA on Internal Validation • Voluntary ED Opioid Prescribing Metric (exclusions discussion) 3

Updates 4

CCO Metrics & Scoring Committee Updates • Met on March 17 th : – Had presentations on alternative patient experience measures from the CAHPS survey and on dental metrics • Next meets on April 21 st , to discuss: – The mid-year CCO metrics report – Begin high level discussions to narrow down the list of potential 2018 CCO incentive measures • Committee meeting materials are available here: http://www.oregon.gov/oha/analytics/Pages/Metrics- Scoring-Committee.aspx 5

Hospital Performance Metrics Advisory Committee • Met by phone on March 16, 2017 – Reviewed written public testimony on the voluntary opioid metric and the incentivized EDIE metric – Discussed Year 4 as approved by CMS – On hiatus until July (may meet earlier as needed). – Subject to consultation with the President of the Senate and the Speaker of the House, all committee members’ terms will be extended by one year – Minutes available on the Committee’s webpage: http://www.oregon.gov/oha/analytics/Pages/Hospital- Performance-Metrics.aspx 6

HTPP Year 4 Incentive Measures • Reminder that the Year 4 incentive measures eligible for payment remain the same as in Year 3 – All-cause readmissions – Hypoglycemia with insulin – Excessive anticoagulation with warfarin – ADEs with opioids – CLABSI (switch to SIR) – CAUTI (switch to SIR) – Follow-up after hospitalization for mental illness – SBIRT – EDIE (switch to revisit measure) – HCAHPS – discharge instructions – HCAHPS – explain medication • Official Year 4 improvement targets from OHA will be sent in August (allowing time for review and any corrections to Year 3 data 7

HTPP Year 4 Voluntary Measures – not eligible for payment / not required submissions • C-sections; opioid prescribing in the ED; c-difficile • Voluntarily submitted data will be used to assist in benchmarking (and baseline) for possible future quality incentives • Hospitals choosing to report on these metrics will do so directly to OHA (not via the Apprise reporting platform) • OHA will send out directions for reporting data in the spring (OHA anticipates asking for two data submissions – one in approximately June, and another towards the end of the Year 4 measurement period) 8

HTPP Year 3 Data Submission (1/2) • OHA has already received official submissions from hospitals for the measures below. • OHA is reviewing, and may contact hospitals with questions regarding the data submitted. • Hospitals must be able to provide documentation of data submitted should it be requested. Measure Data Source Readmissions Hypoglycemia with insulin ADEs with opioids Apprise Excessive anticoagulation with warfarin HCAHPS – discharge info HCAHPS – medication SBIRT EDIE-sourced measure CMT Follow-up after hospitalization for mental illness OHA (claims) 9

HTPP Year 3 Data Submission (2/2) • OHA is awaiting data for CLABSI and CAUTI. • After internal validation is complete, these data will be pulled directly from NHSN by the state’s HAI Program and provided to the OHA Office of Health Analytics on April 28, 2017. 10

SBIRT – Counting Brief Interventions • At the March H-TAG office hour, hospitals on the call requested that OHA consider allowing metric credit for brief interventions that are not conducted face-to-face (i.e., over the telephone). • OHA is still reviewing the literature and consulting with billing and other experts before making a decision. • In the interim, hospitals should continue adhering to the current measure specifications, for which brief interventions conducted via telephone are not eligible for metric credit. 11

Year 4 EDIE Measure 12

Year 4 EDIE Measure Discussion Overview • Review current Year 4 measure • Proposed specification changes to existing Year 4 metric • Proposed process to ensure patients who LWOBS and AMA are excluded • Proposal for measure change (heard by Committee) 13

Recap of Current Year 4 Measure (1/3) • Revised, outcome focused metric developed by OHA in partnership with the OHLC, OAHHS, and with consultation from the H-TAG. • Aim to reduce ED revisits for patients frequently treated at the same facility. • Measures the number of patients readmitted to the ED within 30 days of their fifth visit to the same facility in 12 months. 14

Recap of Current Year 4 Measure (2/3) • Notes: – Count of events, specifically the fifth visit in 12 months. – A patient on their 40 th visit will not show up on the report – Intent is to focus on high utilizers before they become super utilizers 15

Recap of Current Year 4 Measure (3/3) • CMT uses discharge disposition “discharge to home or self- care” to identify whether the visit is counted in the metric. • However, this field is sometimes blank, and some hospitals do not share this field with CMT. If there is no discharge disposition, CMT: 1. Reviews the discharge date. If visit < 12 hours , it is not counted. 2. If neither discharge disposition or date, CMT looks for evidence of in-hospital transfer. Such visits are not counted. 16

Concerns About Exclusions Related to Current Measure – LWBS / AMA (1/2) • Some hospitals (mainly Epic) reported inconsistencies between EDIE report and what is displayed in Epic for discharge disposition. • This can occasionally result in a Left Without Being Seen (LWBS) or Left Against Medical Advice (AMA) coming through to CMT as a discharge to home/self-care • Potential fix: adding ED discharge disposition field to the existing ADT field 17

Concerns About Exclusions Related to Current Measure (LWBS / AMA 2/2) • If a hospital has concerns that this is an issue, the hospital can send CMT files with such patient visits identified, and CMT will exclude them. • This would happen twice: once in Spring 2017 (this month) for use in baseline, and in early 2018 (for final 2017 results). • OHA will send instructions in late April. 18

Concerns About Exclusions Related to Current Measure (inpatients – 1/2) • Some hospitals have reported visits that led to an inpatient stay being included in an EDIE report. • This is generally explained by a missing message/ADT data point from the hospital to CMT indicating that an inpatient admission or transfer occurred. • One way to address this broadly is to amend the specifications and exclude any patients with an ED visit of >12 hours 19

Concerns About Exclusions Related to Current Measure (inpatients 2/2) • CMT has provided test data showing how the 12- hour limit would impact hospitals in terms of aggregate counts ( see packet materials) • Imperfect solution: Will result in some legitimate ED patients with visits >12 hours being excluded from the denominator • Thoughts? 20

Public Testimony to Change Year 4 Metric • See full testimony in materials • Concern that hospitals that make efforts to target high utilizers very early in the process may limit the number of patients who reach five visits in 12 months to those who are most difficult to serve. • As the denominator shrinks to the more difficult to serve population, it may be harder for the hospital to achieve the benchmark. • Benchmark would remain the 90 th percentile (of HTPP Year 2 performance on these revised specification) 21

Proposed EDIE Metric Shift Emergency Department Information Exchange April 11, 2017 Justin Keller, Director of Network Operations Larry Finch, HTPP Report Writer

HTPP Measure – Potential Shift • Current measure is focused on actionable outcome of reducing the high utilizer population: – Focuses on just the 5 th visit at the same facility for the denominator – Focuses on just the 6 th “revisit” within 30 days of the denominator visit • Potential shift would focus on the proportion of a hospital’s full patient volume that are “5 in 12” high utilizers – Denominator would be all unique patients who visit the ED at least once during the performance year – Numerator would be all patients who visit 5 or more times during the performance year – Outstanding question: unclear from proposal whether it would be 5 or more times at the same facility or just any facility

Initial Data • Performance Year 2 and Year 3 data was pulled • Two sets of numbers: taken with and without the criteria that the 5+ visits had to occur at the same facility • Data looks at all HTPP-participating hospitals

Data Highlights – Same Facility • Denominator range: Year 2 5,574 62,736 Year 3 4,941 65,317 • Numerator range: Year 2 129 2,827 Year 3 102 3,103 • Proportion range: Year 2 2.16% 6.07% Year 3 2.06% 6.4%

Data Highlights – Any Facility • Denominator range: Year 2 5,574 62,736 Year 3 4,941 65,317 • Numerator range: Year 2 672 5,890 Year 3 600 6,235 • Proportion range: Year 2 4.82% 17.41% Year 3 5.78% 16.75%