Hospital Metrics TAG July 1, 2015
Welcome and Introductions 2
Group Charter and Membership 3
Introduction to Hospital Transformation Performance Program and Year 2 Measures and Benchmarks 4
Background • Incentive measure program for DRG hospitals in Oregon • Mandated by Oregon’s 2013 HB 2216 and 2015 HB 2395 – Established Hospital Metrics Advisory Committee (analogous committee for CCO measures is the CCO Metrics & Scoring Committee) • Approved through OHA’s 1115 Medicaid waiver 5
Timing • Initially approved by CMS for two years – Recently approved for four more years by Oregon legislature • CMS must approve additional years • Baseline (Year 1): October 2013 – September 2014 – Report published and payments distributed April 2015 • Performance Year (Year 2): October 2014 – September 2015 – Payments distributed June 2016 (report to follow) 6
Funding • Funding is provided by the Hospital Provider Assessment • In first two years, equal to 1% of federal financial participation (capped at $150 million per year) • In subsequent years, equal to 0.5% of federal financial participation 7
Incentive Payments • Payment in the baseline year was for reporting • Payment in the second year is contingent upon meeting benchmarks or improvement targets • In years 1 and 2 hospitals achieving 75% of the measures for which they are eligible receive a floor payment of $500,000 • The remaining funds are distributed based upon performance on individual measures 8
Hospital Performance Metrics Advisory Committee • Charged with identifying measure and targets – Initial list of measures had to be approved by CMS – Should align with goals of Health System Transformation and CCOs • Charter dictates that the committee meet at least four times each year 9
Hospital Performance Metrics Advisory Committee • Hospital representatives (four representatives): – Manny Berman, CEO, Tuality – Doug Koekkoek, MD: Chief Medical Officer, Providence Health & Services – Janet O’Hallaran, Kaiser – Pam Steinke, Chief Nurse Executive, St. Charles Healthcare • CCO representatives (two representatives): – Maggie Bennington Davis, MD, Health Share, Chair of CCO Metrics & Scoring Committee. – Ken House, Pacific Source, Director of Health Analytics at Mosaic Health. • Quality experts (three representatives): – Steve Gordon, MD: Physician Executive, Salem Hospital – Jeff Luck, PhD, Oregon State University – Vacant 10
Year 2 Measures and Benchmarks - 1 • Per CMS agreement, the HTPP measures are divided into two focus areas: hospital-focused and hospital-CCO coordination focused • ons Improvement Domains Measures Benchmark Target 1. CLABSI in all tracked units (modified NQF 0.18 per 1,000 device days (2010 3 percent 0139) NHSN Data Summary Report 50 th 1. Healthcare percentile) Associated 2. CAUTI in all tracked units (modified NQF 1.13 per 1,000 catheter days (50 th 3 percent Infections 0754) percentile from HTPP baseline) 3. Hypoglycemia in inpatients receiving insulin 7% or below 1 percentage point 2. Medication 4. Excessive anticoagulation with Warfarin 5% or below 1 percentage point Safety 5. Adverse drug events due to opioids 5% or below 1 percentage point 72% (national 90 th percentile) 6. HCAHPS, Staff always explained medicines 2 percentage points (NQF 0166) 7. HCAHPS, Staff gave patient discharge Shriners benchmark: 92.7% (90 th 2 percentage points information (NQF 0166) (for all hospitals, 3. Patient percentile, all PG database peer Experience group) including Shriners) All others: 90% (national 90 th percentile) 8.0% (state 90 th percentile for 8. Hospital-wide all-cause readmission 3 percent 4. Readmissions DRG hospitals) 11
Year 2 Measures and Benchmarks - 2 • The hospital-CCO coordination focused measures are below:On Improvement Domains Measures Benchmark Target 70.0% (national Medicaid 90 th 9. Follow-up after 3 percentage hospitalization for mental percentile, aligned with 2015 CCO points illness (modified NQF 0576) measure) Brief Screen: 67.8% (75 th percentile 10. SBIRT Brief Screen: 3 5. Behavioral from HTPP baseline) percentage points Health Full Screen: 12.0% (alignment with Full Screen: 3 CCO full screen benchmark) percentage points *No benchmark for brief intervention rate, which is reporting only 78.7% (75 th percentile from HTPP 11. Hospitals share ED visit 3 percentage information with primary baseline) points 6. Sharing ED care providers and other *Benchmark for notification to primary Visit Info hospitals to reduce care only; care guideline rate is unnecessary ED visits reporting only 12
Year 2 – Current Progress 13
Year 2 Progress Report Summary (data aggregated across first 6 months of Year 2) – 1 *Note data are preliminary and subject to change Statewide Progress – Baseline to Domains Measures Year 2 (first 6 months) 1. CLABSI in all tracked units 0.80 to 0.63; 1. (modified NQF 0139) 13 better than benchmark Healthcare 2. CAUTI in all tracked units 1.56 to 1.15; Associated (modified NQF 0754) 24 better than benchmark Infections 3. Hypoglycemia in inpatients 3.9% to 3.7%; receiving insulin 25 better than benchmark 2. 4. Excessive anticoagulation with 1.5% to 1.4%; Medication Warfarin 27 better than benchmark Safety 5. Adverse drug events due to steady at 0.5%; opioids 28 better than benchmark 14
Year 2 Progress Report Summary (data aggregated across first 6 months of Year 2) – 2 *Note data are preliminary and subject to change Statewide Progress – Baseline to Year 2 Domains Measures (first 6 months) 6. HCAHPS, Staff always 63.6% to 63.2%; explained medicines (NQF 0 hospitals performing better than 0166) benchmark 3. Patient Experience 7. HCAHPS, Staff gave 88.8% to 89.2%; patient discharge 8 performing better than benchmark information (NQF 0166) 8. Hospital-wide all-cause steady at 10.9%; 4. readmission 3 performing better than benchmark Readmissions 15
Year 2 Progress Report Summary (data aggregated across first 6 months of Year 2) – 3 *Note data are preliminary and subject to change Statewide Progress – Baseline to Domains Measures Year 2 (first 6 months) 9. Follow-up after hospitalization steady at 72.2%; for mental illness (modified NQF 10 of 14 performing better than 0576) benchmark 5. Behavioral Health 10. SBIRT 5 of 17 reporting hospitals performing better than relevant benchmark 11. Hospitals share ED visit TBD 6. Sharing ED information with primary care providers and other hospitals to Visit Info reduce unnecessary ED visits 16
Year 2 Q & A 17
CMS Negotiations – National Context (1) • Oregon’s negotiations with CMS must be seen in light of the broader context of hospital incentive programs nationally. • CMS has currently approved six Delivery System Reform Incentive Payment (DSRIP) programs (CA, KS, MA, NJ, NY, and TX). • These programs are elements of Section 1115 Medicaid/CHIP demonstrations. • A recent NASHP report includes profiles of these programs, as well as two ‘DSRIP-like’ programs: HTPP and a program in New Mexico. The full report is available at https://www.macpac.gov/wp- content/uploads/2015/06/State-Experiences-Designing- DSRIP-Pools.pdf. 18
CMS Negotiations – National Context (2) • DSRIP programs are designed to support the triple aim. • They have the following types of metrics (though Oregon and New Mexico don’t have the first): 1. Implementation milestones and metrics (aimed at measuring progress on specific delivery system reform projects) 2. Pay-for-reporting metrics (this can be extensive; NJ has 45 such measures) 3. Pay-for-performance metrics • New York State is the most recently approved DSRIP. To receive payment, NYS hospitals must reduce the gap between the baseline and the benchmark (all at 90 th percentile) by 10%. 19
CMS Waiver Negotiations – Local Context • CMS will be looking toward DSRIP program requirements • OHA will propose a program structure that bridges the current program with CMS expectations • CMS will be expecting closer coordination with CCOs and the Coordinated Care Model 20
Potential Program Structure Changes (1) • Instituting a challenge pool • Changing Year 3 benchmarks where appropriate and continuing to monitor benchmarks annually • Retiring measures that do not foster continuous improvement • Including additional hospital-CCO coordination measures • Coordinating more closely with CCO Metrics & Scoring Committee in future years • CMS will likely push for 75 th and 90 th percentile benchmarks 21
Potential Program Structure Changes (2) • Look to DSRIP programs • Provide menu of measures – must meet performance benchmark or improvement target on x measures? • Institute of Medicine Core Measures • OHA tasked with bringing a proposal along these lines to next committee meeting 22
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