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Discussions related to Hospital Measures. Medicaid RCO Quality Committee. Key decision points. In assessing the performance of the RCO, the draft principles suggest selecting measures that address: Access to care Coordination of care Population health and clinical care Patient satisfaction.

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Discussions related to hospital measures

Discussions related to Hospital Measures

Medicaid RCO Quality Committee

Key decision points
Key decision points

  • In assessing the performance of the RCO, the draft principles suggest selecting measures that address:

    • Access to care

    • Coordination of care

    • Population health and clinical care

    • Patient satisfaction

Critical parameters
Critical parameters

  • Measures must be important in that they are evidenced-based and could have a significant impact on a large number of people (i.e., a serious event)

  • Initial measures should be simple, clear and should be a measure for which the RCO would have the ability to affect the outcome.

  • RCOs should be measured on both improvement and performance, and there should be a data gathering period prior to establishing benchmarks.

Critical parameters cont
Critical parameters (cont.)

  • Data measurement baselines should be adjusted to reflect the varying demographics of the RCOs.

  • Measures must have an impact on the populations being served.

  • Consideration should be given as to whether the measure applies to where the recipient lives or where he/she received care (may be different depending on the measure)

Types of hospital measures
Types of Hospital Measures

  • Inpatient Measures Collected and Submitted by Hospital

    • Acute Myocardial Infarction

    • Emergency Department/ Immunization

    • Heart Failure/Pneumonia/Stroke Surgical Care Improvement

    • VTE/ Perinatal Care/Pediatric

    • NHSN Measures/Structural/Patient Experience of Care

Inpatient cont
Inpatient (cont.)

  • Inpatient Claims Based Measures Calculated by CMS

    • Mortality/Readmissions/Surgical Complications/AHRQ

    • AHRQ/Nursing Sensitive/HACs/Cost Efficiency

Outpatient measures
Outpatient Measures

  • Outpatient Measures Collected and Submitted by Hospital

    • Cardiac Care/ED /Pain Management/Stroke/Surgery/Other/NHSN

    • Structural Measures

  • Claims Based Measures Calculated by CMS (Outpatient)

    • Imaging Efficiency

Psychiatric hospital measures
Psychiatric Hospital Measures

  • Inpatient Psychiatric Facility Measures Collected and Submitted by Hospital

    • HBIPS/Substance Use/Other

  • Claims Based Measures Calculated by CMS (IPF)

    • Clinical Quality of Care Measures

Brief review of medicaid data
Brief Review of Medicaid Data

  • Highest costs by age:

    • Under 1

    • 1 – 12 years old

  • Highest cost by aid category:

    • SOBRA maternity

    • SOBRA child

Diagnosis categories
Diagnosis Categories

  • Top three ED claims categories in terms of cost were for conditions that might could have been treated in a primary care setting

    • Acute upper respiratory infections of unspecified

    • Unspecified otitis media

    • Fever, unspecified

  • By far, the most costly category of medications was antipsychotics - $51 million for 29,000 recipients (medication costs represent all settings)

Diagnosis categories for paid claims
Diagnosis Categories for Paid Claims

  • Total costs by claims category:

    • Single births $71.4 million

    • Preterm births $21.4 million

    • Next several categories:

      • Twin mate live born - $9.6 million

      • Pneumonia - $9.6 million

      • Respiratory distress in newborn - $6.5 million

      • Affective psychosis - $6.5 million

      • Acute bronchiolitis due to respiratory stress - $6.2 million

First suggested measures
First Suggested Measures

  • Access to care:

    • Ability to refer to a specialist

    • Access to primary care

      We are not sure there is a hospital-specific measure for this category. The points listed are examples of the types of issues that would impact hospital care, but are not being tracked currently by hospitals.

Coordination of care
Coordination of Care

  • Post discharge continuing care plan transmitted to next level of care provider upon discharge – part of inpatient psychiatric core measures

  • All cause, 30-day readmission rates

    The first measure would help address the coordination of antipsychotic medications; it only applies to those providing psych services. The second would address continuity of inpatient and post-acute care and would apply to all acute care hospitals. Both are already begin collected and reported.

Health of the population
Health of the Population

  • Early elective deliveries without a medical indication.

  • Providing interconception care immediately following delivery to decrease unintended births (50% currently).

    Both measures have long-term implications for both the health of the mother and the baby and are issues that the hospital and physician together can address. In addition, since about half of all deliveries are Medicaid, the existing measures would be significant.

Patient satisfaction
Patient satisfaction

  • Use questions from HCAPHS survey:

    • Overall rating of hospital

    • When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.

      The HCAPHS survey would cover all patients, but would likely be a good proxy for measuring Medicaid satisfaction. It is already being collected and reported.