Preparing Critical Access Hospitals (CAHs) for the New World of Hospital Measurement

1. Preparing Critical Access Hospitals (CAHs) for the New World of Hospital Measurement Session #1: The Basics of Minnesota’s Health Reform Initiative and Its Implications for Rural Hospitals October 8, 2009 Jennifer P. Lundblad, PhD, MBA Stratis Health

2. Welcome to the Program! • A 6-part program, in the form of a conference call series, that leads Minnesota rural/CAH leaders through the basics of data collection, validation, types of data, and public reporting • Goal is to assure that Minnesota CAHs understand the CMS Value Based Purchasing Program and Minnesota’s Health Reform Initiative and the anticipated data reporting requirements and can build or strengthen their capacity to meet the requirements • Developed and led by Stratis Health; funded by MDH Office of Rural Health and Primary Care

3. Program Overview • Session 1: The Basics of Minnesota’s Health Reform Initiative and Its Implications for Rural Hospitals • Session 2: Building Data Collection Capacity at a CAH • Sessions 3 & 4: Measure-specific Data Collection Training • Sessions 5 & 6: Using Data for Improvement

4. Today’s session The Basics of Minnesota’s Health Reform Initiative and Its Implications for Rural Hospitals • In both 2007 and 2008, the state legislature passed and Governor Pawlenty signed significant health care reform legislation into law • You can follow the details and sign up for email alerts at: • http://www.health.state.mn.us/healthreform/

5. Minnesota Health Care Reform Initiative • Statewide Health Improvement Program (SHIP) • Health Care Homes • Payment reform, quality measurement, and cost/quality transparency • Insurance coverage and affordability • eHealth

6. Minnesota:SHIP • SHIP will improve health and reduce demands on the health care system by decreasing the percentage of Minnesotans who are obese or overweight or use tobacco

7. Minnesota:Health Care Homes • Minnesotans with complex or chronic conditions will receive coordinated care through health care homes • These “homes” are not facilities; they are systems that promote coordinated care from a team of health care providers focusing on common goals

8. Minnesota:Reporting and Incentives • These parts of the health reform bill are aimed at making sure the right financial incentives are in place to encourage changes in health care that reduce cost and improve quality • The reforms will make available more information for consumers on health care cost and quality and begin to change the way health care providers are paid

9. Minnesota:Coverage and Affordability • The bill makes it easier for people to get information about state health care programs, promotes the use of Section 125 plans for employees to buy health insurance with pre-tax money, and requires reports to the Legislature on subsidies for employer-based health insurance coverage and value-based benefit sets

10. Minnesota:eHealth • Legislates a state mandate that all health care providers have interoperableelectronic health records by 2015, establish uniform health data standards by 2009, develop a statewide plan to meet the 2015 mandate, and have an electronic prescription drug program by January 2011

11. What are the implications for rural and Critical Access Hospitals?

12. Mandate: New Quality Measurement System • The Minnesota Statewide Quality Reporting and Measurement System proposed rule and technical appendices were published in the September 8, 2009, edition of the State Register, and the public comment period closed October 7, 2009 • The new system includes required reporting by all Minnesota hospitals: • Measures proposed are predominantly either CMS/Joint Commission chart review measures or AHRQ measures derived from claims • As of Quarter 4, 2008, 66 of 79 (83.5%) MN CAHs were participating in the CMS data collection and submission process

13. Mandate: New Quality Measurement System (2010) • Measures Required for Reporting Beginning in January 2010 (2009 Dates of Service) and Every Year Thereafter • From the CMS/Joint Commission core measures: • AMI (measures 1, 2, 3, 4, 5, 7a, 8a, 9) • Heart Failure (measures 1, 2, 3, 4) • Pneumonia (measures 2, 3b, 4, 5c, 6, 7) • Surgical Care Improvement Project (measures SCIP-Inf 1, 2, 3, 4, 6, 7, plus Card 2, VTE 1, 2)

14. Mandate: New Quality Measurement System (2010) • Measures Required for Reporting Beginning in January 2010 (2009 Dates of Service) and Every Year Thereafter (cont.) • From the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators (IQI) • Abdominal aortic aneurysm volume and mortality (IQI4, IQI11) • CABG volume and mortality (IQI 5, IQI 12) • PTCA volume and mortality (IQI 6, ISI 30) • Hip fracture mortality (IQI 19) • A composite mortality measure based on six conditions

15. Mandate: New Quality Measurement System (2010) • Measures Required for Reporting Beginning in January 2010 (2009 Dates of Service) and Every Year Thereafter (cont.) • From the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSI) • Pressure ulcers (PSI 3) • Deaths from surgical complications (PSI 4) • Postoperative PE or DVT (PSI 12) • Obstetric trauma (PSI 18, 19) • Composite measure of preventable adverse events based on eight measures

16. Mandate: New Quality Measurement System (2010) • Measures Required for Reporting Beginning in January 2010 (2009 Dates of Service) and Every Year Thereafter (cont.) • From the Agency for Healthcare Research and Quality (AHRQ) Pediatric Patient Safety Indicators (PDI) • Composite measure of preventable adverse events based on six measures • A newly created HIT measure • Hospital’s adoption and use of Health Information Technology (HIT) in its clinical practice

17. Mandate: New Quality Measurement System (2011) • Measures Required for Reporting Beginning in January 2011 (2010 Dates of Service) and Every Year Thereafter • From the CMS/Joint Commission core measures: • Outpatient (ED) AMI/chest pain (measures OP 1, 2, 3, 4, 5) • Outpatient surgery measures (measures OP 6, 7) • Patient experience –Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) (This measure is not required for hospitals with fewer than 500 admissions in the previous calendar year.)

18. Mandate: Health Information Technology • 2011 e-Prescribing: Any person or organization involved in prescribing, filling prescriptions or paying for prescriptions, including communicating or transmitting formulary or benefit information, must do so electronically using specified standards by January 1, 2011 • 2015 EHR: All hospitals and health care providers to have "an interoperable electronic health records system within their hospital system or clinical practice setting" by January 1, 2015 • http://www.health.state.mn.us/e-health/

19. Opportunity: Health Care Homes • As of September 2009, the health care home certification process is open at MDH to health care providers • Clinics and physicians are eligible to be certified and must meet a set of standards and criteria in order to be designated as a health care home in Minnesota • Since the criteria and focus of health care homes include care coordination (including to/from the hospital), management of complex clinical conditions, and comprehensive care planning, how can your hospital coordinate with certified health care homes in your community?

20. Opportunity: SHIP • In August 2009, MDH awarded grants to Minnesota communities to help lower the number of Minnesotans who use or are exposed to tobacco or who are obese or overweight: • 39 grants • Include 86 of Minnesota's 87 counties and eight of 11 tribal governments • Total funds of $47 million • Are there opportunities for your hospital to participate, support, or leverage these funds in your community?

21. Opportunity: Baskets of Care • Baskets of Care are collections of health care services designed to treat particular health conditions or episodes of care • The Baskets of Care Steering Committee has identified seven initial baskets of care: Asthma (children’s) Preventive care (adults) Diabetes Preventive care (children) Low back pain Total knee replacement Obstetric care • Will your hospital opt to participate in one or more of the baskets of care?

22. Contact Information Jennifer P. Lundblad, PhD, MBAPresident and CEO Jlundblad@stratishealth.org

23. Stratis Health is a nonprofit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities.