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VALUE BASED PERFORMANCE: UNDERSTAND YOUR SCORECARD AND BOOST YOUR REIMBURSEMENT. MARCH 06, 2013. INTRODUCTIONS. ROBIN KISH Vice President +1 813.220.6868 [email protected] SUZANNE HOLBACH Vice President +1 865.274.9729 [email protected]

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Introductions
INTRODUCTIONS YOUR REIMBURSEMENT

ROBIN KISHVice President+1 813.220.6868 [email protected]

SUZANNE HOLBACHVice President+1 [email protected]

DONNA JENNINGSSenior Vice President+1 [email protected]


Agenda
AGENDA YOUR REIMBURSEMENT

  • VBP and Its Impact

  • Healthcheck-2014 and Beyond

  • Risk & Finance: Impact Points

  • Unhealthy Hospitals (Collateral Risks)

  • “Healthy Hospital Solutions”


VBP AND ITS IMPACT YOUR REIMBURSEMENT


Vbp and its impact what is vbp
VBP AND ITS IMPACT YOUR REIMBURSEMENTWHAT IS VBP?


Vbp and its impact what is vbp1
VBP AND ITS IMPACT YOUR REIMBURSEMENTWHAT IS VBP?

Incentive for quality outcomes and efficiency:

  • Required by the Affordable Care Act.

  • Quality incentive program built on the Hospital Inpatient Quality Reporting (IQR) measure reporting infrastructure.

  • Next step in promoting higher quality care for Medicare; pays for care that rewards better value and patient outcomes, instead of just volume of services.

  • Funded by a 1% reduction from participating hospitals’ base operating diagnosis-related group (DRG) payments for FY 2013, increasing to 2% by FY 2017.

  • Uses measures that have been specified under the Hospital IQR Program and results published on Hospital Compare for at least one year.


Vbp and its impact what is vbp2
VBP AND ITS IMPACT YOUR REIMBURSEMENTWHAT IS VBP?

Incentive for quality outcomes and efficiency:

  • The VBP program design includes:

    • Measuring Quality Performance and Patient Experience

      • Total Performance Score (TPS)

      • 20 performance measures for FY 2013

      • 24 performance measures for FY 2014

    • Reimbursement based on Quality Outcomes

    • Funded by withholding 1% of the CMS reimbursement

    • Reimbursement is based on performance scores

Pay for Performance vs. Pay for Reporting


Vbp and its impact fy 2013 measures

8 Patient Experience of YOUR REIMBURSEMENTCare Dimensions

12 Clinical Process of Care Measures

  • AMI-7a Fibrinolytic Therapy received within 30 minutes of hospital arrival.

  • AMI-8 primary PCI recevied with 90 minutes of hospital arrival.

  • HF-1 discharge instructions.

  • PN-3b blood cultures performed in the ED prior to initial antibiotic received in hospital.

  • PN-6 initial antibiotic selection for CAP in immunocompetent patient.

  • SCIP-Inf-1 prophylactic antibiotic received within one hour prior to surgical incision.

  • SCIP-Inf-2 prophylactic antibiotic selection for surgical patients.

  • SCIP-Inf-3 prophylactic antibiotics discontinued within 24 hours after surgery.

  • SCIP-Inf-4 cardiac surgery patients with controlled 6AM postoperative serum glucose.

  • SCIP-Card-2 surgery patients on a beta blocker prior to arrival that received a beta blocker during the perioperative period.

  • SCIP-VTE-1 surgery patients with recommended venous thromboembolism prophylaxis ordered.

  • SCIP-VTE-2 surgery patients who received appropriate venous thromboembolism prophylaxis within 24 hours.

  • Nurse communication.

  • Doctor communication.

  • Hospital staff responsiveness.

  • Pain management.

  • Medicine communication.

  • Hospital cleanliness and quietness.

  • Discharge information.

  • Overall hospital rating.

VBP AND ITS IMPACTFY 2013 MEASURES

30%

70%

Source: CMS official VBP web site.


Vbp and its impact vbp 2013
VBP AND ITS IMPACT YOUR REIMBURSEMENTVBP 2013


Vbp and its impact how are hospitals evaluated
VBP AND ITS IMPACT YOUR REIMBURSEMENTHOW ARE HOSPITALS EVALUATED?

  • Hospitals are awarded points for Achievement and Improvement for each measure or dimension, with the greater set of points used.

  • Points are added across all measures to reach the Clinical Process of Care and Outcome domain scores.

  • Points are added across all dimensions and are added to the Consistency Points to reach the Patient Experience of Care domain score.

Source: CMS official VBP web site.


Vbp and its impact how are hospitals evaluated1

Achievement YOUR REIMBURSEMENTThreshold

Benchmark

All Hospitals’ Baseline

SCORE0.70

One Hospital’s Performance

1

2

3

4

5

6

7

8

9

10

Achievement Range

All Hospitals

Me!

Time

VBP AND ITS IMPACTHOW ARE HOSPITALS EVALUATED?

  • Achievement points: awarded by comparing an individual hospital's rates during the performance period with all hospitals’ rates from the baseline period.

    • Rate at or above the benchmark: 10 points.

    • Rate less than the achievement threshold: 0 points.

    • Rate equal to or greater than the achievement.

    • Threshold and less than the benchmark: 1-10 points.

Source: CMS official VBP web site.


Vbp and its impact how are hospitals evaluated2

Achievement YOUR REIMBURSEMENTThreshold

SCORE0.21

Benchmark

One Hospital’s Baseline

SCORE0.70

One Hospital’s Performance

Achievement Range

1

2

3

4

5

6

7

8

9

10

0

1

2

3

4

5

6

7

8

9

Me!

Me!

Improvement Range

Time

VBP AND ITS IMPACTHOW ARE HOSPITALS EVALUATED?

  • Improvement points: awarded by comparing a hospital's rates during the performance period to that same hospital's rates from the baseline period.

    • Rate at or above the benchmark: 9 points

    • Rate less than or equal to baseline period rate: 0 points

    • Rate between the baseline period rate and the benchmark: 0-9 points

Source: CMS official VBP web site.


Vbp and its impact average vbp scores ownership
VBP AND ITS IMPACT YOUR REIMBURSEMENTAVERAGE VBP SCORES – OWNERSHIP

Source: CMS official VBP web site.


Vbp and its impact quality measures healthcheck
VBP AND ITS IMPACT YOUR REIMBURSEMENTQUALITY MEASURES HEALTHCHECK

Source: iVantage


Vbp and its impact hcahps healthcheck
VBP AND ITS IMPACT YOUR REIMBURSEMENTHCAHPS HEALTHCHECK

Source: iVantage


Vbp and its impact what is the financial impact of vbp
VBP AND ITS IMPACT YOUR REIMBURSEMENTWHAT IS THE FINANCIAL IMPACT OF VBP?

Withholding CMS reimbursement

  • The VBP initiative is funded by withholding reimbursement from participating hospitals’ Diagnosis Related Group (DRG) payments

    • FY 2013 - 1.0%

    • FY 2014 - 1.25%

    • FY 2015 - 1.5%

    • FY 2016 - 1.75%

    • FY 2017 – 2.0%

  • CMS estimates that in FY 2013, 50% of participating hospitals will receive a net increase in payments and 50% will receive a net decrease in payments

  • 1% of DRG payments withheld from eligible hospitals is estimated at $850 million.


HEALTHCHECK-2014 AND BEYOND YOUR REIMBURSEMENT


Healthcheck 2014 and beyond fy 2014 measures and its impact

13 Clinical Process of Care Measures YOUR REIMBURSEMENT

8 Patient Experience of Care Dimensions

  • AMI-7a Fibrinolytic Therapy received within 30 minutes of hospital arrival.

  • AMI-8 primary PCI received with 90 minutes of hospital arrival.

  • HF-1 discharge instructions.

  • PN-3b blood cultures performed in the ED prior to initial antibiotic received in hospital.

  • PN-6 initial antibiotic selection for CAP in immunocompetent patient.

  • SCIP-Inf-1 prophylactic antibiotic received within one hour prior to surgical incision.

  • SCIP-Inf-2 prophylactic antibiotic selection for surgical patients.

  • SCIP-Inf-3 prophylactic antibiotics discontinued within 24 hours after surgery.

  • SCIP-Inf-4 cardiac surgery patients with controlled 6AM postoperative serum glucose.

  • SCIP-Inf-9 postoperative urinary catheter removal on postoperative day 1 or 2.

  • SCIP-Card-2 surgery patients on a beta blocker prior to arrival that received a beta blocker during the perioperative period.

  • SCIP-VTE-1 surgery patients with recommended venous thromboembolism prophylaxis ordered.

  • SCIP-VTE-2 surgery patients who received appropriate venous thromboembolism prophylaxis within 24 hours.

  • Nurse communication.

  • Doctor communication.

  • Hospital staff responsiveness.

  • Pain management.

  • Medicine communication.

  • Hospital cleanliness and quietness.

  • Discharge information.

  • Overall hospital rating.

3 Mortality Measures

  • MORT-30-AMI Acute Myocardial Infarction (AMI) 30-day mortality rate.

  • MORT-30-HF Heart Failure (HF) 30-day mortality rate.

  • MORT-30-PN Pneumonia (PN) 30-day mortality rate.

Represents a new measure for the FY 2014 program not in the FY 2013 program.

HEALTHCHECK-2014 AND BEYONDFY 2014 MEASURES AND ITS IMPACT

25%

45%

30%

Source: CMS official VBP web site.


Healthcheck 2014 and beyond vbp 2014
HEALTHCHECK-2014 AND BEYOND YOUR REIMBURSEMENTVBP 2014


Healthcheck 2014 and beyond ed quality indicators
HEALTHCHECK-2014 AND BEYOND YOUR REIMBURSEMENTED QUALITY INDICATORS

  • Data collection began January 2012

    • ED-1: Median time from ED arrival to ED departure for admitted ED patients

    • ED-2: Admit decision time to ED departure time for admitted patients

  • For more information on the ED Measures, go to: http://medicare.gov/hospitalcompare/Data/emergency-wait-times.aspx

    Reimbursement Impact!

Source: CMS Specifications Manual 4.0c


Healthcheck 2014 and beyond coming soon to an ed near you
HEALTHCHECK-2014 AND BEYOND YOUR REIMBURSEMENTCOMING SOON TO AN ED NEAR YOU

"A patient's experience in an emergency department is an essential component of their overall healthcare experience in a hospital, and we believe that a patient survey evaluating such care will further support the HHS's goals and priorities.“ - CMS statement on patient satisfaction surveys

  • December 10, 2012

    • Pain control

    • Wait Times

    • Communication with Provider

Source: Fierce Healthcare. ED Patient Satisfaction. The Future of Reimbursement.


RISK & FINANCE: IMPACT POINTS YOUR REIMBURSEMENT


Risk finance impact points what is the vbp connection
RISK & FINANCE: IMPACT POINTS YOUR REIMBURSEMENTWHAT IS THE VBP CONNECTION?

  • Patient throughput and flow issues

  • Medication reconciliation

  • Patient complaints

  • Efficiencies of Ancillary Departments (lab, pharmacy)

  • Individualization of patient care/treatment plans, including discharge plan and education

  • Rapid Response and Emergency Care

  • Claims & Liability

  • Medical Errors, Reporting, & Disclosure

  • Health Information Management (EMR, HIPAA, HI-TECH)

  • ER Efficiencies and Turn Around Times

  • Transition of Care Delays

  • Readmissions (Preventable)

  • Hospital Acquired Conditions

  • Sentinel Events

  • Patient Complications

  • Regulatory Audits/Surveys/Sanctions

  • Mortality Review

  • Medical Record Gaps or Lack of Documented Medical Necessity


Risk finance impact points staying strong in the midst of reform
RISK & FINANCE: IMPACT POINTS YOUR REIMBURSEMENTSTAYING STRONG IN THE MIDST OF REFORM



Unhealthy hospitals collateral risks
UNHEALTHY HOSPITALS “COLLATERAL RISKS” YOUR REIMBURSEMENT

  • Financial Risks (Noted Previously)

  • Operational and Reputational Risks

  • Medical Malpractice/Litigation

  • Underwriter / Carrier Issues

  • Regulatory and Accreditation Impact

  • Public Consumer Opinions

  • Adverse Events/Mandatory Reportable Events

  • Mortality and Morbidity

  • Employees, Physicians, Residents, Students Satisfaction Scores

  • Impact on Managed Care Contracting, Hospital Rating & Business Partner Relationships


HEALTHY HOSPITAL SOLUTIONS YOUR REIMBURSEMENT


Healthy hospital solutions
HEALTHY HOSPITAL SOLUTIONS YOUR REIMBURSEMENT

  • Value Based Purchasing Solutions

  • ED throughput

  • Readmissions reduction and management

  • Revenue cycle and clinical documentation improvement Programs


Healthy hospital solutions clinical healthcare consulting services

Customer Service – Door to Departure YOUR REIMBURSEMENT

Arrival, Registration and Triage

Waiting

Test and Treat

Observation, Reassessment and Admission or Discharge

ED Intake

ED Throughput

ED Output

  • Quick Registration

  • Triage

    • Bypass

    • Protocols

    • Med Reconciliation

  • MSE

  • D2D

  • Waiting Room

    • Rounding

  • MSE

  • Testing – Radiology/Laboratory

  • Case Management

  • Diversions

  • Direct Admits

  • Barriers to A/D/T

  • Consultants

  • Orders

  • Boarders

  • Diversions

HEALTHY HOSPITAL SOLUTIONS CLINICAL HEALTHCARE CONSULTING SERVICES


Healthy hospital solutions clinical healthcare consulting programs
HEALTHY HOSPITAL SOLUTIONS YOUR REIMBURSEMENTCLINICAL HEALTHCARE CONSULTING PROGRAMS

Readmissions Reduction and Management

The last readmission group is considered as preventable – or avoidable – readmission. There is a great potential to reduce the number of this type of readmission by identifying causes and developing preventable strategies in hospitals and community settings.

Source: CMS official VBP web site.


Healthy hospital solutions readmissions reduction management strategies
HEALTHY HOSPITAL SOLUTIONS YOUR REIMBURSEMENTREADMISSIONS REDUCTION & MANAGEMENT STRATEGIES

  • Facility and provider practice risk impact analysis

  • Technology

  • Pre-admission

  • Hospital admission

  • Care transition coordination


Healthy hospital solutions clinical healthcare consulting programs1
HEALTHY HOSPITAL SOLUTIONS YOUR REIMBURSEMENTCLINICAL HEALTHCARE CONSULTING PROGRAMS

  • Revenue Cycle and Clinical Documentation Improvement Programs

    • Operations Review

    • ED Case Management

    • ED Throughput

    • Denial Management

    • Billing, Coding and Clinical Documentation Improvement

    • RACS/MICS/ZPICS/Medical Necessity


QUESTIONS YOUR REIMBURSEMENT


Vbp resources
VBP RESOURCES YOUR REIMBURSEMENT

  • CMS official VBP web site: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html

  • CMS VBP fact sheet: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/Downloads/FY-2013-Program-Frequently-Asked-Questions-about-Hospital-VBP-3-9-12.pdf

  • Refer to the Hospital VBP Final Rule for more information on the Hospital VBP quality measures: http://www.gpo.gov/fdsys/pkg/FR-2011-05-06/pdf/2011-10568.pdf.

  • For detailed information on the Hospital VBP program, refer to: http://www.cms.gov/Hospital-Value-Based-Purchasing.

  • For further details about scoring for the FY 2013 Hospital VBP program, refer to the July 2011 Open Door Forum: http://www.cms.gov/Hospital-Value-Based-Purchasing/Downloads/HospVBP_ODF_072711.pdf.


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