Hospital Metrics TAG June 14, 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 • Hospital Committee Meeting Debrief • Presentation: Healthy Families Oregon • Opioid Measurement Draft Specifications 3
Updates 4
Waiver Renewal OHA posted draft waiver renewal application online Public comment was open through June 1, 2016 Based on public comments, OHA will be updating the draft application Submitting to CMS by June 17 th Main Link: http://www.oregon.gov/oha/OHPB/Pages/health-reform/cms-waiver.aspx Appendix C: Measurement Strategy http://www.oregon.gov/oha/OHPB/Documents/Waiver%20Application%20Appendices.pdf (starting on page 39 of PDF) 5
Year 2 Close-Out OHA has completed the review of Year 2 OHA sent summary reports to each hospital on May 12 th OHA sent payment reports to each hospital on June 3 rd The Year 2 report was published on June 9 th http://www.oregon.gov/oha/Metrics/Pages/Hospital-Reports.aspx 6
CMS Update for HTPP Year 3 • CMS approved the STCs for Year 3 extension • OHA does not anticipate any changes from final proposal discussed in April with the Committee: 7
HTPP Year 3 Benchmarks Measure Year 2 Benchmarks Year 3 Benchmarks Year 3 Improvement Target Floor 75 th percentile from 90 th percentile of HTPP SBIRT in the ED – 3 percentage point HTPP baseline (57.0%) brief screen Year 2 performance: improvement from Year 86.4% 2 performance. 90 th percentile of HTPP SBIRT in the ED – Alignment with CCO 3 percentage point benchmark (12%) full screen Year 2 performance: improvement from Year 71.3% 2 performance. 90 th percentile of HTPP Follow-up after National 2014 Medicaid 3 percentage point 90 th percentile (70.0%) hospitalization for Year 2 performance: improvement from Year mental illness 2 performance. 79.3% 90 th percentile for all 90 th percentile of HTPP Hospital-wide all- 3 percent improvement cause hospital types (8.0%) Year 2 performance: from Year 2 readmissions 8.4% performance. 8
Measure Year 2 Year 3 Year 3 Benchmarks Benchmarks Improvement Target Floor Hypoglycemia in 7% or below 5% or below 1 percentage point inpatients receiving improvement from Year insulin 2 performance Excessive 5% or below 3% or below 1 percentage point anticoagulation with improvement from Year Warfarin 2 performance Adverse Drug Events 5% or below 3% or below 1 percentage point due to opioids improvement from Year 2 performance HCAHPS – staff always National 2014 90 th National 2015 90th 2 percentage point explained medicines percentile (72%) percentile (73.0%) improvement from Year 2 performance National 2014 90 th HCAHPS – staff gave National 2015 90th 2 percentage point patient discharge percentile (90%) percentile (91.0%) improvement from Year 2 performance information 9
Measure Year 2 Benchmarks Year 3 Year 3 Benchmarks Improvement Target Floor CLABSI 2010 NHSN 50 th N/A – improvement 3 percent improvement target only percentile from Year 2 performance (0.18 per 1,000 device days) 50 th percentile from CAUTI N/A – improvement 3 percent improvement target only HTPP baseline (1.02 per from Year 2 performance 1,000 catheter days) 75 th percentile from 90 th percentile from Hospitals sharing ED 3 percentage point HTPP baseline (77.4%) visit information with HTPP baseline improvement from Year PCPs (84.4%) 2 performance. 10
HTPP Year 3 Improvement Targets • Year 3 improvement targets could not be calculated until Year 2 data was finalized. • Some Year 2 data may need to be revised (e.g., CLABSI / CAUTI, clarifying SBIRT brief or full screen, etc). If Year 2 data needs to be revised, hospitals have through Friday, July 15 th to notify OHA via metrics.questions@state.or.us • OHA will release Year 3 improvement targets based on Year 2 final / revised data by July 31 st . 11
CLABSI / CAUTI • Year 2 rebase – Revise Jan-Sept 2015 data • Year 3 template 12
HTPP Year 4 Year 4 proposed measures and details are included in Appendix C in draft waiver renewal application and are pending separate CMS approval as part of waiver negotiations. 13
Committee nominations Appointments are pending confirmation from Speaker of House & President of Senate. OHA plans to fill – 2 vacant quality measure expert seats – 2 two hospital representative seats OHA hopes to notify candidates by the end of June. 14
Hospital Committee Meeting Debrief 15
May 20 th Committee Meeting • Committee heard presentation from Helen Bellanca and Erin Deahn on a proposed new metric related to screening for home visiting programs. • Committee heard presentation from David Labby and Lisa Bui on the opioid measure development. • We will review both of these presentations in detail and discuss specifications today. 16
Healthy Families Oregon Proposed Home Visiting Screening Metric Helen Bellanca, Health Share of Oregon Erin Deahn, Early Learning Division 17
OPC Recommendation to HTPP Use the OPC Steering Committee process to prioritize a limited set of measures for the HTPP Perinatal Domain OPC bimonthly meetings occur to facilitate this work OPC to provide a formal recommendation to the HTPP OPC available to review & discuss proposal with the Oregon Hospital Performance Metrics Advisory Committee at future meetings 18 18
MDC Clinical Quality Measures • • • • 3rd & 4th Degree Lacerations Cesarean Section Rate ‐ Nullip, Induction Rate Operative Vaginal Delivery in Vaginal Deliveries ‐ All Term, Singleton, Vertex (PC ‐ 02) • • • 3rd & 4th Degree Lacerations Cesarean Section Rate ‐ • MaternaLength of Stay ‐ Preeclampsia ICU Admissions Vaginal Deliveries in Vaginal Deliveries ‐ Primary (Standard) Instrument Assisted • • • 3rd & 4th Degree Lacerations Cesarean Section Rate ‐ • Maternal Blood Transfusion Preeclampsia Total ICU Days Rate in Vaginal Deliveries ‐ Non Primary, Term, Singleton, Instrument Assisted Vertex • • • 5 Minute APGAR <7 Among Cesarean Section Rate ‐ Maternal ICU Admissions • Severe Morbidity w/Pre ‐ Eclampsia All Deliveries >39 weeks Overall • • 5 Minute APGAR <7 in Early Cesarean Section ‐ • Maternal Long Length of Stay ‐ • Timely Treatment for Severe Cesarean Deliveries HTN (HEN) Term Newborns Uncomplicated (Term, Singleton, Vertex) • • • • Antenatal Steroids (PC ‐ 03) Elective Delivery <39 Weeks Newborn Bilirubin Screening Unexpected Newborn (PC ‐ 01) Prior to Discharge Complication • • • • Appropriate DVT Prophylaxis Episiotomy Rate NTSV No Labor Vaginal Birth After Cesarean in Women Undergoing C ‐ (VBAC) Rate, All (AHRQ IQI Section 34) • • • Birth Trauma Rate Exclusive Breastfeeding (PC ‐ • OB ‐ Hemorrhage: Massive Vaginal Birth After Cesarean 05) Transfusions (HEN, RM) (VBAC) Rate, Uncomplicated (AHRQ IQI 22) • • • Cesarean Section Rate ‐ Exclusive Breastfeeding (PC ‐ • OB ‐ Hemorrhage: Risk Very Low Birth Weight Infant Inductions in Full Term 05a) Assessment on Admission (< 1500 Grams) Not Delivered Multiparas at Level III NICU • • Cesarean Section Rate ‐ Failed Induction • OB ‐ Hemorrhage: Total Inductions in Full Term Transfusions (HEN, RM) per Nulliparas 1000 19
MDC Data Quality Measures Apgar Score of 0 Missing / Inconsistent Birth Weight (among <2500g) Missing 5 Minute Apgar in Newborn Clinical/Birth File Missing Birth Weight in Newborn Clinical Files Missing Delivery Provider in Maternal Clinical Files Missing Gestational Age in Maternal Clinical Files Missing Parity in Maternal Clinical Files Missing/Inconsistent Gestational Age (<37 weeks) in Newborn Discharge Records Missing / Inconsistent Birth Weight (among <2500g) ICU Admission Rate among Severe Morbidity Cases Unlinked Mothers 20
What are “transformative” metrics for hospitals in perinatal care? Transform the way routine care is delivered to significantly improve outcomes Bring something on the radar that hasn’t been there before to re-orient the care: disruptive innovation 21
What is most likely to affect the health of mothers and infants long-term? Whether she had a C-section or a vaginal birth Whether the baby had a NICU stay or not Whether the infant breastfed or not Whether parents are supported in developing a healthy relationship with their child, preventing child abuse and neglect 22
2014 Child Welfare data Factors in child abuse and neglect: 46% alcohol or drugs 31% domestic violence 27% criminal involvement 23
Parenting support in Oregon Home visiting programs Healthy Families Oregon Cacoon Babies First Parenting classes Behavioral health experts in primary care 24
Hospitals are already involved in parenting support! Healthy Families Oregon has screeners who come to the hospitals to screen women right after birth for eligibility in their program. Oregon is moving to a statewide screening and referral system for all home visiting programs 25
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