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Hospital Transformation Performance Program (HTPP ) Funding Allocation Methodology Elyssa Tran February 7, 2014

Hospital Transformation Performance Program (HTPP ) Funding Allocation Methodology Elyssa Tran February 7, 2014. BACKGROUND. Under Oregon’s Triple Aim, portion of the transformation savings will come from reduced utilization of hospital services

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Hospital Transformation Performance Program (HTPP ) Funding Allocation Methodology Elyssa Tran February 7, 2014

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  1. Hospital Transformation Performance Program (HTPP)Funding Allocation MethodologyElyssa TranFebruary 7, 2014

  2. BACKGROUND • Under Oregon’s Triple Aim, portion of the transformation savings will come from reduced utilization of hospital services • Oregon hospitals will need to pursue new models of care and business structures • 2013-2015 OHA Budget created a new hospital incentive pool, the Hospital Transformation Performance Program (HTPP)

  3. HTPP FUNDING • Funding is from the Federal equivalent value of the funds available from a 1% additional tax rate • Requires CMS approval • Available to DRG hospitals that are subjected to provider tax assessment • Must meet specific performance goals set by OHA and approved by CMS

  4. ALLOCATION METHODOLOGY • Established basis for determining the level of incentive funds available to earn for each hospital • Example: Available funds is $100 million • Hosp A = $40 mil • Hosp B = $30 mil • Hosp C = $20 mil • Hosp D = $10 mil

  5. ALLOCATION METHODOLOGY • Different from “What performance criteria and targets must a hospital meet in order to earn its share of the pie?” • Answer to this question is based on the recommendations of this OHA-led workgroup

  6. ALLOCATION METHODOLOGY • OAHHS workgroup • Drew on expertise of the Provider Tax Advisory Committee • Drew on guidance from CMS expert consultants • Recommendation include: • A base/minimum amount for each DRG hospital • Remaining amount • 50% based on share of total Medicaid discharges • 50% based on share of total Medicaid inpatient days • Shared and accepted by the OHA • Hospitals must meet performance benchmarks or improvement targets to receive payment

  7. ALLOCATION METHODOLOGY • All funds would be distributed each year (no carryover) • Data source for calculations is Hospital Inpatient Discharge Data collected by OHPR • Funds not distributed in the first round would go to a “challenge pool”

  8. ALLOCATION METHODOLOGY Challenge Pool • Only those hospitals that received distributions in the first round are eligible • Part of the committee’s work is to recommend measures for the challenge pool • Earnings from the challenge pool could potentially be based on fewer and/or different measures from the first round

  9. Hospital Performance Potential MeasuresDiane WaldoFebruary 7, 2014

  10. BACKGROUND • OAHHS formed a workgroup of hospital representatives to brainstorm a possible measure approach • Workgroup reviewed lists of possible measures – similar to what the Advisory Group will do today • Workgroup included multi-disciplinary representation from member hospitals • Work group met twice during April 2013 and created a measure approach for consideration

  11. MEASURES FOR CONSIDERATION • Early Elective Deliveries • Preventable Readmissions • Stage 1 Meaningful Use

  12. MEASURES FOR CONSIDERATION • Early Elective Deliveries • Description/definition • Patients with elective vaginal or elective C/S at greater than or equal to 37 and less than 39 weeks completed gestation (Joint Commission definition) • Alignment with CCO • Important patient safety effort • Cost savings

  13. MEASURES FOR CONSIDERATION • Preventable Readmissions • Description/definition • Reducing preventable readmissions has value as an indicator of quality; may reflect poor coordination of services and transitions of care at discharge or in the immediate post discharge period • Potentially preventable readmissions (PPR) as calculated by Apprise Health Insights, using 3M software

  14. MEASURES FOR CONSIDERATION • Stage 1 Meaningful Use • Hospitals that achieved Stage 1 meaningful use (attested and received payment)

  15. OTHER POTENTIAL MEASURES • Falls with injury • All documented patient falls with an injury level of minor or greater (NQF measure) • Catheter-Associated Urinary Tract Infection (CAUTI) • Rate of patients with catheter-associated urinary tract infections per 1000 urinary catheter days-all tracked units

  16. SUMMARY • Collective thinking of the hospital work group • Align with current work now being done in hospitals • Believe that this measure approach reflects transformative potential in alignment with the Triple Aim • Recognize that this is a starting point for discussion with the Advisory Committee

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