Continued Momentum for Transparency: How Do CAHs Fit?

1. Continued Momentum for Transparency: How Do CAHs Fit? Indiana Rural Health Conference August 20, 2009 Jennifer P. Lundblad, PhD, MBA

2. Session Goals • Remind ourselves of what focused QI action can achieve in CAHs • Review data collection and reporting rationale • Become familiar with measurement options, including new federal requirements • Start planning for action

3. Who is Stratis Health? • Independent, nonprofit, community-based Minnesota organization founded in 1971 • Mission: Lead collaboration and innovation in health care quality and safety, and serve as a trusted expert in facilitating improvement for people and communities • Funded by federal and state contracts, corporate and foundation grants • Serves as Medicare QIO for Minnesota • Co-leads the Patient Safety QIO Support Center (QIOSC)

4. A Look Back at QIO Rural Hospital Efforts (2005-2008) • Help non-reporting CAHs to submit data to QualityNetExchange Results: As of Quarter 3 (Q3) 2007, 77% of CAHs nationally were submitting data on at least one measure • Support reporting CAHs in improving care in selected areas Results: See next slide • Improve organizational patient safety culture in a selected group of rural PPS hospitals and/or CAHs Results: Median Relative Improvement: 8.2%; on average, 61% of hospitals saw positive improvement

5. CAH Clinical Quality Improvement Baseline

6. Rationale for Collecting and Reporting Quality Measures • Demonstrates your organization’s commitment to quality and transparency • Keeps you and the CAH community “at the table” in a value-based purchasing environment …Even though Medicare doesn’t yet pay for performance for CAHs • Helps you to meet the new EHR meaningful use standards and earn additional Medicare and Medicaid $$$

7. Your Menu of Measure Options Publicly Reported Measure Sets: • CMS/Joint Commission core measures (AMI, HF, PNE, SCIP) • Patient experience of care (HCAHPS) • Outpatient Emergency Department (5 chest pain/AMI measures) Plus: • Health plan-specific measures • State-mandated measures • Internally-focused measures

8. CMS/Joint Commission Core Measures • Heart Attack (AMI) Care • 8 measures (7 process measures, plus mortality and readmission rates) • Heart Failure Care • 5 measures (4 process measures, plus mortality and readmission rates) • Pneumonia Care • 8 measures (7 process measures, plus mortality and readmission rates) • Surgical Care: • 7 measures (all process measures)

9. Patient Experience of Care • Patient experience of care measure • Measured by HCAHPS • CAHs not required to submit but can choose to, and can publicly report if HQA pledge is signed • www.hcahpsonline.org • Arizona QIO is HCAHPS support contractor: hcahps@azqio.sdps.org1-888-884-4007

10. Outpatient ED Measures • Rural Sensitive Emergency Department measures • ED measures for chest pain/AMI now part of CMS Hospital Outpatient Quality Data Reporting Program (HOP QDRP) measures set • CMS Abstraction and Reporting Tool (CART) released 2008 • CAHs able to submit measures into the Clinical Warehouse in November 2008 • Florida QIO as HOP QDRP support contractor: hopqdrp@fmqai.com1-866-800-8756

11. Additional options • Health plan-specific measures • What do health plans serving Indiana require or have as options? • State-mandated measures • Does Indiana require reporting of certain measures? • Internally-focused measures • Staff satisfaction • Safety measures (e.g., falls, pressure ulcers, hospital acquired infections) • Safety culture (e.g., AHRQ survey)

12. Health Reform: Implications for Rural and Critical Access Hospitals • ARRA HITECH Act • CAHs must become meaningful EHR users between 2011 and 2015 to qualify for bonus structure and avoid penalties • For CAHs that qualify, new and un-depreciated “certified EHR costs” will get a roughly 40-50% increase in Medicare Reimbursement (with 100% Maximum)

13. ARRA HITECH Act (cont.) • Critical Access Hospitals • CAHs that are meaningful users by 2011 are eligible for 4 years of enhanced Medicare payments • CAH range expected to be $350,000-$450,000 per hospital • Penalties for non-users start in 2015 (in 2015, 100.66% of cost reimbursement instead of 101%, which decreases to 100% by 2017) • Definition of “Meaningful Use” will ultimately determine whether the incentive is reasonably attainable by rural providers

14. What is “Meaningful Use”? • ARRA Language for Hospitals • Use of CCHIT-certified vendors • Participation in Information Exchange • Quality reporting participation • Meet function and reporting requirements as determined by ONC and ultimately CMS • Requirements phased in: • CPOE in use by 2011 • Evidence based order sets and clinical documentation in use by 2013 • Advanced clinical decision support by 2015

15. Actions You Can Take Your quality leadership role: • Determine which measures make the most sense strategically, financially, and in your community to collect, submit, and report • And figure out how the measures fit into your overall quality management approach (e.g., Balanced Scorecard, Baldrige) • Engage your Board of Directors in a discussion about quality measures • Help ensure resources and support for action on improving the measures

16. Actions You Can Take Assess whether you are using a certified EHR vendor? http://www.cchit.org/choose/inpatient/2007/ http://www.cchit.org/choose/ambulatory/08/ • If yes, will that vendor likely provide us with a migration path to meaningful use? • Determine what vendor modules needed by 2011 • Begin assessing workflow and change goals • If no, convene an HIT Planning Workgroup • Set goals and develop a high level HIT strategic plan • Identify regional collaborative opportunities • Begin vendor evaluation and/or selection process • Begin assessing workflow and change goals