Why core measures abstraction matters to ceos cfos
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Why Core Measures Abstraction Matters to CEOs/CFOs. June 21, 2012. Objectives. Participants will understand: Quality and financial impacts of clinical process of care measures Critical issues related to clinical process of care reporting outcomes

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Why core measures abstraction matters to ceos cfos

Why Core Measures Abstraction Matters to CEOs/CFOs

June 21, 2012


Objectives

Objectives

Participants will understand:

  • Quality and financial impacts of clinical process of care measures

  • Critical issues related to clinical process of care reporting outcomes

  • Staffing issues related to retrospective abstraction of clinical process of care measures


Course summary

Course Summary

  • Hospital Inpatient/Outpatient Core Measures

    • Background

    • Current

  • Quality Impact

  • Financial Impact

  • Critical Issues

  • What Next? Strategy and Staffing


Hospital inpatient outpatient core measures background

Hospital Inpatient/Outpatient Core Measures Background

  • Origins

  • Purpose

  • Players

  • Reporting


Hospital inpatient outpatient core measures current

Hospital Inpatient/Outpatient Core MeasuresCurrent

  • Value-Based Purchasing (VBP)

  • Annual Payment Update (APU)

  • TJC “Improving America’s Hospitals”

  • Medicare Hospital Compare


Process of care measures quality impact

Process of Care MeasuresQuality Impact

  • Data Collection Approach

  • Data Accuracy

  • Measure Analysis Suggestions

  • Sampling

  • Data Reported As:

  • Selected References

  • Flow Chart

    • Visual

    • Written

  • Measure Set

  • Set Measure ID#

  • Performance Measure Name

  • Description

  • Rationale

  • Type of Measure

  • Improvement Noted As:

  • Numerator Statement

  • Denominator Statement


Process of care measures quality impact1

Process of Care Measures Quality Impact

  • Measure Set: Surgical Care Improvement Project (SCIP)

  • Set Measure ID#: SCIP-VTE-2

  • Performance Measure Name: Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery

  • Description: Surgery patients who received appropriate Venous Thromboembolism (VTE) prophylaxis within 24 hours prior to Anesthesia Start Time to 24 hours after Anesthesia End Time.

    Specifications Manual – Measure Information Form - 22 pages

    50 decisions points


Process of care measures quality impact scip vte 2 decision points

Process of Care MeasuresQuality Impact - SCIP-VTE-2 Decision Points

  • Excluded Populations:

    • Patients whose total surgery time is less than or equal to 60 minutes

    • Patients who stay less than two nights

    • Patients who expire perioperatively

    • Patients with reasons for not administering both mechanical and pharmacological prophylaxis

    • Patients who did not receive VTE Prophylaxis (as defined in the Data Dictionary)

  • Excluded Populations:

    • Patients less than 18 years of age

    • Patients who have a Length of Stay greater than 120 days

    • Burn patients (as defined in Appendix A, Table 5.14 for ICD-9-CM codes)

    • Patients enrolled in clinical trials

    • Patients who are on oral anticoagulation therapy prior to admission

    • Patients whose ICD-9-CM principal procedure occurred prior to the date of admission


Process of care measures quality impact scip vte 2 scoring

Process of Care MeasuresQuality Impact - SCIP-VTE-2 Scoring

  • VBP Achievement Threshold

    • FY 2013 – 93.07%

    • FY 2014 – 94.92%

  • VBP Benchmark

  • FY 2013 – 99.85%

  • FY 2014 – 99.83%

  • National Averages

    • 2008-2009 – 86%

    • 2009-2010 – 92%

    • 2010-2011 – 94%


Process of care measures financial impact

Process of Care MeasuresFinancial Impact

  • FY 2013 Value-Based Purchasing Program

    • 1% IPPS Base Operating DRG withhold

    • Clinical Process of Care (CPC) Domain

      • 12 measures

    • Patient Experience of Care (PEC) Domain

      • 8 dimensions

    • Higher of Achievement and Improvement score used for each measure/dimension

    • Measure scores summed into CPC Domain score

    • Dimension scores summed into PEC Domain score

    • CPC Domain score weighted 70%

    • PEC Domain score weighted 30%


Process of care measures financial impact1

Process of Care MeasuresFinancial Impact

  • FY 2014 Value-Based Purchasing Program

    • 1.25% IPPS Base Operating DRG withhold

    • Clinical Process of Care (CPC) Domain

      • 70% to 45%

    • Patient Experience of Care (PEC) Domain

      • Remains 30%

    • Mortality Domain (Outcomes) – 25%


Process of care measures financial impact scip vte 2 achievement improvement fy 2013

.1000

.9500

.9000

.8500

Process of Care MeasuresFinancial ImpactSCIP-VTE-2 Achievement/Improvement FY 2013

.9985

Benchmark

.9307

Achievement Threshold

Achievement Range

Baseline

5 – Achievement Points

6 – Improvement Points

.9000

.1000

.9500

.8500

.8950

Achievement Range

Performance

.1000

.8500

.9500

.9000

Improvement Range

.9600


Process of care measures financial impact scip vte 2 achievement improvement fy 2014

Process of Care MeasuresFinancial ImpactSCIP-VTE-2 Achievement/Improvement FY 2014

FY 2013 Achievement Threshold

FY 2014 Achievement Threshold

.9000

.1000

.9492

.9307

.9983 Benchmark

Achievement Range

.1000

.9000

FY 2013 Performance

.9600

6– Achievement Points

4 – Improvement Points

.9000

.1000

FY 2014 Performance

Achievement Range

.9750

Improvement Range


Process of care measures vbp financial risk

Process of Care MeasuresVBP Financial Risk


Critical issues value based purchasing

Critical IssuesValue-Based Purchasing

  • Reporting Period Lag

    • FY 2013 (begins 10/1/12)

      • Baseline period – 7/1/09 to 3/31/10

      • Performance period – 7/1/11 to 3/31/12

      • Estimated payment – 8/12

      • Exact payment – 10/12


Critical issues value based purchasing1

Critical IssuesValue-Based Purchasing

  • Reporting Period Lag

    • FY 2014 (begins 10/1/13)

      • CPC and PEC

        • Baseline period – 4/1/10 to 12/31/10

        • Performance period – 4/1/12 to 12/31/12

      • Outcomes

        • Baseline period – 7/1/09 to 6/30/10

        • Performance period – 7/1/11 to 6/30/12


Critical issues value based purchasing2

Critical IssuesValue-Based Purchasing

  • Measure Cycling

    • “Topped out” measures discontinued

      • FY 2011 – 45 measures reported

      • FY 2013 final rule – 8 measures discontinued


Critical issues apu updates

Critical IssuesAPU Updates

  • Measure Cycling

    • FY 2014 Inpatient Quality Reporting

      • Retire 4 measures

      • Suspend data collection for 4 measures

      • Add 1 HAI measure

      • Add Stroke and VTE chart-abstracted measures

    • FY 2014 Outpatient Quality Reporting

      • Add 1 HAI measure

      • Add 6 chart-abstracted measures


Critical issues number and complexity of measures

Critical IssuesNumber and Complexity of Measures

  • Inpatient Quality Reporting – APU payment determination

    • FY 2014 – 55 measures

    • FY 2015 - 72 measures

    • Complexity – VTE-1

    • “…assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission.”


Critical issues cdac validation

Critical IssuesCDAC Validation

  • Clinical Data Abstraction Center (CDAC) verifies hospital-abstracted data for Hospital IQR Program is consistent and reproducible

  • Randomly assigned hospitals + previously failed hospitals

  • 12 cases per quarter

  • 75% validation rate per quarter (9 of 12 cases)

  • Interrater reliability

  • APU update


Critical issues concurrent review

Critical IssuesConcurrent Review

  • Identifying patients

  • Rounding

  • Care provided meets standards

  • Care documented appropriately

  • Care not given can’t be documented

  • Prospective rather than retrospective


Critical issues meaningful use overview

Critical IssuesMeaningful Use - Overview

  • Goal: achieve significant improvements in care through adoption and “meaningful use” of electronic health record and clinical decision support tools

  • Stage 1

    • Implement 14 core objectives and 5 of 10 menu objectives

    • Implement 15 clinical quality measures

  • Stage 2 (Proposed)

    • Implement 16 core objectives and 3 of 5 remaining menu objectives

    • Implement 24 clinical quality measures


Critical issues meaningful use implications

Critical IssuesMeaningful Use - Implications

  • Less retrospective abstraction

  • Continued verification of clinical documentation processes

  • Process failure – measure fall-out

  • Automotive industry parallel – changing nature of work


What next

What Next?

  • Determine your quality strategy

  • What role does retrospective core measures abstraction play in that strategy?

  • Staffing to the strategy

    • Staffing issues

    • Staffing tactics


Staffing issues

Staffing Issues

  • Training/education

  • Economies of scale / scattered resources

  • Succession issues

  • Reporting lag


Staffing to the strategy

Staffing To The Strategy

  • Turtle tactic – stretch current staff

  • Grasshopper tactic – find more fixed FTEs and increase training/education

  • Comparative Advantage tactic – external experts

    • Validation audits

    • Short-term staffing

    • Long-term outsourcing


Staffing to the strategy1

Staffing To The Strategy

  • If outsourcing, issues to address with vendors:

    • Experience

    • Quality control

    • Privacy

    • Outcomes – validation / interrater reliability

    • Reporting

    • Level of Collaboration

  • Opportunity costs


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