Quality Reporting: Why IT Matters

1. Quality Reporting: Why IT Matters September 25, 2012 Presenter: Kimberly Rask, MD PhD Medical Director

2. Driving Improvement BETTER CARE AFFORDABLE CARE BETTER HEALTH FOR POPULATIONS • CMS contracts with QIOs to improve health and health care for Medicare beneficiaries • Largest federal network dedicated to improving health quality at the community level • QIOs based in all 50 states

3. Joint Letter of Cooperation

4. It’s not just about the numbers

5. 2011 Senior Softball World Championships in Phoenix, Arizona • 5 for 5 in playoff game • 2 doubles • and a triple!

6. Coordinated Federal Focus on Quality • National Quality Strategy • DHHS Action Plan • Partnership for Patients • CMS Quality Improvement Organization (QIO) program priorities

7. Partnership for Patients National Campaign to Align Priorities and Resources Two Goals • Decrease by 40 percent preventable hospital-acquired conditions (HACs) by 2013  60,000 lives saved, 1.8 million fewer injuries to patients and $20 billion in health care costs avoided • Reduce 30-day hospital readmissions by 20 percent by 2013  1.6 million fewer readmissions and $15 billion in health care costs avoided

8. Multiple Quality Reporting Programs Impact the Bottom Line

9. Hospitals Paid to Report Quality Data

10. “Pay for Reporting” Programs Participation is “voluntary” and hospitals are not required to participate. • Those who choose NOT to participate will receive a reduction of 2 percent for each program in their Medicare Annual Payment Update for the following CMS fiscal year (FY)

11. What data is collected? • 2004: Hospitals voluntarily report 10 measures and agree to have the data reported publicly to receive an incentive payment (Annual Payment Update) • 2005-2012: New measures added yearly • AMI patients, congestive heart failure patients, pneumonia patients • Surgical patients (Surgical Care Improvement Project or SCIP) • Children’s asthma • 2007: Added mortality rates • 2008: Added patient satisfaction survey • 2009: Added readmission rates • 2011: Added hospital acquired infection rates • 2012:Composite patient safety measure • 2013: Elective deliveries

12. Quality Measures Reporting • Each measure’s specific data can be collected either retrospectively or concurrently • The same data is submitted to The Joint Commission and CMS – used for quality improvement and public reporting • Quarterly • Hospital Compare website • Validation

13. Quality Reporting

14. Processes of Care

15. Mortality Rates

16. Patient Satisfaction

17. Emergency Department (ED) Measures

18. Healthcare-Associated Infections (HAI) • Data is submitted to the CDC’s National Healthcare Safety Network (NHSN) • Central-Line Associated Bloodstream Infection (CLABSI) • Surgical Site Infection (SSI) • Catheter-Associated Urinary Tract Infection (CAUTI)

19. Pay for Performance

20. Value-based Purchasing • Moving from Pay for Reportingto Pay for Performance • Authorized under the Affordable Care Act • Funded by a 1 percent withhold from hospital DRG payments • Minimum of 10 cases for process and outcome measures over 9 month performance period • Minimum of 100 satisfaction surveys

21. Hospital Total Performance 70% 30% 12 Clinical processes of care • 2 AMI measures • 1 HF measure • 2 pneumonia measures • 7 SCIP measures • Antibiotic selection, given within 1 hour, discontinued • Controlled 6 a.m. glucose • Beta blocker continued • VTE prophylaxis ordered and given 8 Patient experience measures • Nurse communication • Doctor communication • Staff responsiveness • Pain management • Medication communication • Cleanliness and quiet • Discharge information • Overall hospital rating

22. How will hospitals be evaluated? Achievement Current hospital performance compared to All Hospitals baseline rates Improvement Current hospital performance compared to own baseline rates • Minimum threshold rates to receive any points • Benchmark rates to receive full points

23. Incentive or Penalty? • Program will be budget neutral overall • Some hospitals will not earn back everything that they had withheld for the pool and some hospitals will earn back more than what they had withheld • Projected that 2 percent of hospitals will earn bonus of more than 0.5 percent • While 2 percent will lose more than 0.5 percent • Penalty or incentive applied to base operating DRG payment for each discharge

24. And looking forward to the next year…

25. Penalty for Excess Readmissions

26. CMS Implementation • Selected 3 conditions • Acute Myocardial Infarction (AMI) • Heart Failure (HF) • Pneumonia (PN) • Calculated “Excess Readmission Ratios” using the National Quality Forum (NQF)-endorsed 30-day risk-standardized readmission methodology • Set a 3-year rolling time period for measurement with a minimum of 25 discharges • For October 1, 2012 penalty determination, the measurement period was July 2008 to June 2011

27. Excess Readmission Ratio • The ratio compares Actual number of risk-adjusted readmissions from Hospital XX to the Expected number of risk-adjusted admissions from Hospital XX based upon the national averages for similar patients • Ratio >1 means more than expected readmissions <1 means fewer than expected readmissions

28. Applying the Penalty • Applied to base-DRG payment for all fee-for-service Medicare discharges during the fiscal year (FY) • Not revenue neutral, no bonus for excellent performance • For FY 2013, maximum penalty is 1 percent • Impacting more than 2000 hospitals nationally • Expected to cost hospitals $280 million or 0.3 percent of the total Medicare revenue to hospitals • Excess Standardized Readmission Ratio (SRR) will be public

29. Impact of Reporting on Bottom Line

30. Hospital-acquired Conditions (HAC) or “Never Events” CMS identified conditions that:   • Were high cost, high volume or both • Result in the assignment to a DRG that has a higher payment when present as a secondary diagnosis • “Could reasonably have been prevented through application of evidence‑based guidelines”

31. HAC Definition Changing • Most individual HACs have been removed from public reporting • Section 3008 of Affordable Care Act requires public reporting of HACs • CMS is proposing an all-cause harm measure with potential to “drill down” on Hospital Compare • Section 3008 creates payment reduction for lowest performing hospitals based upon HAC rates by 2015 • Reduction applied to hospitals in the top quartile of hospital acquired conditions using “an appropriate” risk-adjustment methodology • Those hospitals will have payments reduced to 99 percent of the amount that would otherwise apply to such discharges

32. IT Capabilities are Critical! • Managing and organizing a growing body of clinical quality information (data) • Coordination with HITECH • Evaluating measures with electronic specifications • Anticipate EHR direct reporting by FY 2015 • From documentation to usable information – forms/screens that allow queries • Real-time data capabilities

33. It’s not just about “the numbers” • You can impact patient outcomes • Patients hold us accountable and “the numbers” are critical to document good work! This material was prepared by Alliant | GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 10SOW-GA-IIPC-12-226