Hospital Metrics TAG April 12, 2016 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 • Year 2: CAUTI / CLABSI • Year 4: Measure Development - Opioids • Year 4: Measure Development - EDIE 3
Year 3 Updates • Verbal Approval from CMS – Having a Year 3 – Measurement period • Continuation of FFY, October 2015 – September 2016 • Will propose switch to CY for Year 4 • Still Pending with CMS – Readmission measure – Benchmarks – Final, written approval for Year 3 4
Hospital Committee Nominations • OHA received applications from 11 individuals. • Applications are being reviewed by OHA and a recommendation will then be sent to the Speaker of the House and the President of the Senate for confirmation. • OHA hopes to notify applicants by mid-June. 5
Hospital Committee • The Committee next meets on April 22 nd from 1-4 pm in Wilsonville. • Agenda items include: – Year 3 / CMS Updates – Presentation from Oregon Perinatal Collaborative on future measure options for the Maternal and Child Health Domain – Year 4 program structure and measure development (EDIE, Opioid Rx). http://www.oregon.gov/oha/analytics/Pages/Hospital-Performance- Metrics.aspx 6
CCO Metrics & Scoring Committee • The Committee next meetings on April 22 nd , from 9 – noon in Wilsonville. • The agenda will focus on disparities in current performance data and ways to measure disparities. http://www.oregon.gov/oha/analytics/Pages/Metrics-Scoring- Committee.aspx 7
Evaluation • HTPP Evaluation Survey launched April 4 th – thanks to those of you who have already started! • Survey will remain in the field through May 15 th . • If questions about survey, please contact CORE at Maggie.Weller@providence.org 8
Opioid Prescribing Guidelines Taskforce • OHA heard from a number of hospitals interested in participating on the taskforce – thank you! • First taskforce meeting will be Friday, April 29 th . • Meeting will be public (can sign up for notifications) https://public.health.oregon.gov/PreventionWellness/Sub stanceUse/Opioids/Pages/index.aspx 9
Year 2 Close Out • OHA has received hospital Year 2 data submissions from OAHHS and is beginning review. • OHA intends to send summary reports to each hospital on May 12 th for final hospital review prior to processing payments and populating the year 2 public report. • OHA / OAHHS may contact hospitals with questions between now and May 12 th . 10
Other updates or questions? 11
CAUTI / CLABSI Potential Year 2 Resubmission 12
Issues (1) • Hospitals are not all tracking the same units, leading to unequal comparison of performance. • OHA is accepting the already-submitted Year 2 data as is for Year 2 payment. • However, for equal comparison and more accurate data (and improvement targets) for Year 3, OHA is considering re-calculating Year 2. 13
Issues (2) • Hospital Committee is considering dropping CLABSI for Year 4 – is it worth re-submitting Year 2 for Year 3 comparison if the measure is going away soon? • Given CMS approval for FFY as the measurement period, Year 2 recalculation of CAUTI will only cover 9 months. • New template (all tracked units) available for reporting. However, hospitals have already submitted 6 months of data for Year 3. Should we still re-base Year 2 / Year 3? 14
Year 4 Measure Development Safe Opioid Prescribing in the ED EDIE 15
Opioid Recap • February H-TAG meeting, we discussed alternative opioid measure: Total number of opioid pills dispensed over x time, as a rate per 1,000 ED visits . • Alternate measure presented to Committee in March as part of bundled measure. Committee interested in: MED per 1,000 ED visits • March H-TAG meeting, discussed technical ability to report on this type of measure. H-TAG suggested third option: Total number of pills per 1,000 ED visits. • March discussion also noted concerns re: prescribing policies, given upcoming taskforce work. Current measure development will focus on the rate, not the policy component. 16
Revised Draft Opioid Specifications: Denominator • Total number of emergency department visits in the measurement period. • Exclude: – ED visits resulting in admissions – Neoplasm-related pain, end-of-life care, palliative care, or hospice care 17
Revised Draft Opioid Specifications: Numerator Options 1 Total number of opioid pills dispensed in the measurement period 2 Morphine equivalent doses dispensed in the measurement period MED = drug strength * (quantity / days’ supply) * conversion factor 3 Total number of Rx for opioids written in the measurement period All options would use all drugs in the “narcotic analgesics” therapeutic class (standard code 40). 18
Opioid Questions 1. Ages to include in the denominator (12+ or 18+)? 2. Any suggested changes to the exclusions? 3. Option 3: prescriptions written or prescriptions filled? 4. Measurement period full 12 months? 5. Which of the numerator options would be the best to focus on, striking the right balance between feasibility of reporting and improving patient care? 19
EDIE Recap • Initial EDIE measure focuses on process: care guidelines created and outreach notifications sent to primary care providers for ED “frequent flyers” • Original proposal for Year 3 EDIE measure would create bundled measure with three components: – Notifications – Care guidelines – ED revisit rates among those with care guidelines. 20
Transition to Outcome Measure Given widespread use of EDIE and PreManage tools and unintended consequences of original process measure… …Oregon Health Leadership Council will be proposing an outcome measure to the Committee on April 22: Percentage of individuals who have 5 qualifying ED visits at the same facility, who subsequently re-visit the same ED within 30 days of the 5 th visit. 21
Draft EDIE Specifications Denominator • Count of patients with at least 5 emergency department visits in 12 months (5/12) at the same facility. • Exclude patients who die, visits resulting in admissions, and patients who left AMA or without being seen. Numerator • Of those patients, count of those who return to the same ED within 30 days after their 5 th ED visit. 22
Test Data # of visits Hospital Range Hospital Range Hospital Range (denominator n) (30 day rate) (60 day rate) 4 in 12 63 – 4,390 22.21 – 29.03% 32.65 – 44.44% 5 in 12 208 – 2,663 25.48 – 40.00% 37.57 – 73.33% 7 in 12 85 – 1,227 0.00 – 48.42% 0.00 – 65.45% 10 in 12 26 – 535 38.46 – 61.31% 53.85 – 75.91% 23
Test Data: 5/12/30 days Hospitals 5 in 12 30 day 30 day rate 1 208 53 25.48% 2 525 162 30.86% 3 559 150 26.83% 4 577 151 26.17% 5 630 199 31.59% 6 665 230 34.59% 7 685 222 32.41% 8 771 226 29.31% 9 843 281 33.33% 10 875 248 28.34% 11 886 250 28.22% 12 933 254 27.22% 13 941 275 29.22% 14 984 271 27.54% 24
Test Data: 5/12/30 days Hospitals 5 in 12 30 day 30 day rate 15 1038 334 32.18% 16 1073 312 29.08% 17 1097 316 28.81% 18 1133 335 29.57% 19 1136 313 27.55% 20 1146 321 28.01% 21 1162 312 26.85% 22 1280 376 29.38% 23 1457 427 29.31% 24 1475 377 25.56% 25 1896 565 29.80% 26 2442 788 32.27% 27 2663 854 32.07% 25
EDIE Questions 1. 30 days versus 60 days? 2. Individuals who qualify for the denominator multiple times during the measurement year? 26
Wrap-up • Next meeting: Tuesday, May 10 th , 10 am – noon • H-TAG webpage www.oregon.gov/oha/analytics/Pages/Hospital-Metrics- Technical-Advisory-Group.aspx • OHA contact for all HTPP related questions: metrics.questions@state.or.us 27
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