Centennial Care Hospital Quality Improvement Incentive … presentation for SNCP... · HQII –Hospital Quality Improvement Incentive Pool SNCP –Safety Net Care Pool Hospitals (formerly

Centennial CareHospital Quality

Improvement Incentive Pool

Presented by Ellen Interlandi and Beth Landon, NMHA

HQII – Hospital Quality Improvement Incentive Pool

SNCP – Safety Net Care Pool Hospitals (formerly SCP – Sole

Community Provider Hospitals)

NM-specific, 29 hospitals

MAD – Medical Assistance Division, a division of …..

HSD – NM Human Services Dept

HCAHPs – Hospital Consumer Assessment of Healthcare Providers & Systems

HIDD – Hospital Inpatient Discharge Data (or Administrative Data) patient record level information for all inpatients in non-federal hospitals, reported quarterly

HEN – Hospital Engagement Network a CMS nationally funded initiative for quality outcomes, 30 NM hospitals participating; similar quality measures but NOT the same program as HQII

AAAA – American

Association Against Acronym Abuse

What is the HQII?∙The Hospital Quality Improvement Incentive (HQII) Pool is a component of the Safety Net Care Pool.∙It was approved by the Centers for Medicare and Medicaid Services (CMS) as part of the §1115 Waiver – Centennial Care.∙Calendar year 2014 was “Year 1” for the Waiver, data submission began in Year 2 (2015)∙The purpose of the HQII is “to incentivize hospitals’ efforts to meaningfully improve the health and quality of care of the Medicaid and uninsured individuals that they serve”.

How will it work?

∙The HQII Pool will be distributed to participating “qualified hospitals” that meet certain benchmarks on the designated performance measures∙For 2015, there was $2.8 million in the Pool; for 2016 there is about $5.7 million

DY 1

(CY 2014)

DY 2

(CY 2015)

DY 3

(CY 2016)

DY 4

(CY 2017)

DY 5

(CY 2018)Total

UC

Pool $68,889,323 $68,889,323 $68,889,323 $68,889,323 $68,889,323 $344,446,615

HQII

Pool - $2,824,462 $5,764,727 $8,825,544 $12,011,853 $29,426,586

% UC

Pool 100% 96% 92% 89% 85% 92%

%

HQIIn/a 4% 8% 11% 15% 8%

Total $68,889,323 $71,713,785 $74,654,050 $77,714,867 $80,901,176 $373,873,201

How Much is in the Pool?•The HQII is a component of the Safety Net Care Pool.•The other component, the Uncompensated Care Pool is a fixed amount ($68.9 million each year).•The amount available for HQII is designed to be the “growth rate” over time and will increase each year,

From the Centennial Care Waiver – Special Terms and Conditions

What is the HQII Timeline?

•HQII implementation began January 1, 2014 with hospital agreement to participate•Hospitals submitted baseline data for DY2 (Calendar Year 2014) November 2015•Hospitals will submit new measures for DY3 by October 2016.•Allocation Payment Methodology will be used to determine pool of funds for which each hospital is eligible.

Pause for Questions

What are the Performance Measures

The outcome measures are divided into two domains: ∙Domain 1 - Urgent Improvements in Care. Critical patient safety and quality measures for areas of widespread need.∙Domain 2 - Population-focused Improvements. Measures of prevention and improved care delivery for the highest burden conditions in the Medicaid and uninsured population

Domain 1 Measures

• Adverse Drug Events• Catheter-Associated Urinary Tract Infections• Central Line Associated Blood Stream Infections• Injuries from Falls and Immobility• Obstetrical Adverse Events• Pressure Ulcers• Surgical Site Infections• Venous Thromboembolism •Ventilator-Associated Pneumonia• All Cause Readmissions

1. Adverse Drug EventsDATA COLLECTION METHOD: Self-report

A. Hypoglycemia in Inpatients Receiving Insulin Numerator – Hypoglycemia in inpatients receiving insulin or other hypoglycemic agentsDenominator - Inpatients receiving insulin or other hypoglycemic agents

Rate = NumeratorDenominator x 100

1. Adverse Drug EventsDATA COLLECTION METHOD: Self-report

B. Adverse Drug Events due to OpioidsNumerator – number of patients treated with opioids who received

naloxoneDenominator - number of inpatients who received an opioid agent

Rate = NumeratorDenominator x 100 patients

c. Excessive anticoagulation with Warfarin – Inpatients Numerator – Inpatients experiencing excessive anticoagulation with warfarinDenominator - Inpatients receiving warfarin anticoagulation therapy

Rate = NumeratorDenominator x 100

Resources online at the following link:

http://partnershipforpatients.cms.gov/p4p_resources/tspadversedrugeven

ts/tooladversedrugeventsade.htm

http://www.hcahpsonline.org/Files/HCAHPS_Fact_Sheet_June_2015.pdf

https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/hospitalqualityinits/downloads/hospitalhcahpsfactsheet201007.pdf

• Asks recently discharged patients about aspects of hospital experience• Random sample of adult inpatients(medical, surgical, maternity)

between 48 hours and six weeks after discharge; not restricted to Medicare patients

• Can be done by mail, telephone, mail with telephone follow-up or active interactive voice recognition. Publicly available, hospitals may get soon after end of each quarter

• Must have at least 300 completed surveys over 4 calendar quarters to reach statistical reliability

• Percentage of patients who gave their hospital a rating of 9 or 10

2. Catheter-Associated Urinary Tract Infections(CAUTI) (NHSN)

Numerator – total number of observed healthcare associated CAUTI among patients in bedded inpatient locationsDenominator - total number of indwelling urinary catheter days for each location under surveillance for CAUTI

Rate = NumeratorDenominator x 1,000

Specifications available from http://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf

3. Central Line Associated Blood Stream Infections (CLABSI) (NHSN)

Numerator – total number of observed healthcare associated CLABSI among patients in bedded inpatient locationsDenominator - total number of central line days for each location under surveillance for CLABSI

Rate = NumeratorDenominator x 1,000

Specifications available fromhttp://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf

4. Injuries from Falls and Immobility/Trauma HAC 05 CMS (HIDD)

Numerator – total number of hospital acquired occurrences of fracture, dislocation, intracranial injury, crushing injury, burn and other injury (codes within the CC/MCC list)Denominator - inpatient discharges Rate = Numerator

Denominator x 1,000

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/wPOAFactSheet.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html

5. Obstetrical Adverse Events (HIDD)

OB Trauma – Vaginal Delivery with Instrumentation PSI 18Numerator – discharges, among cases meeting the inclusion and exclusion rules for the Denominator, with any listed diagnostic codes for third and fourth degree obstetric traumaDenominator - all vaginal delivery discharges with any procedure code for instrument-assisted delivery

Rate = NumeratorDenominator x 1,000

Specifications available fromhttp://qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50-ICD10/TechSpecs/PSI%2018%20Obstetric%20Trauma%20Rate%20%E2%80%93%20Vaginal%20Delivery%20With%20Instrument.pdf

5. Obstetrical Adverse Events (HIDD)

OB Trauma – Vaginal Delivery without Instrumentation PSI 19Numerator – discharges, among cases meeting the inclusion and exclusion rules for the denominator, with any listed diagnostic codes for third and fourth degree obstetric traumaDenominator - vaginal deliveries identified by DRG or MS-DRG code

Rate = NumeratorDenominator x 1,000

Specifications available fromhttp://qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50-ICD10/TechSpecs/PSI%2019%20Obstetric%20Trauma%20Rate-Vaginal%20Delivery%20Without%20Instrument.pdf

6. Pressure Ulcers Stage III & IV rate PSI 3 (HIDD)

Numerator - discharges, among cases meeting the inclusion and exclusion rules for the denominator, with any secondary ICD-9-CM or ICD-10-CM diagnosis codes for pressure ulcer and any secondary ICD-9-CM or ICD-10-CM diagnosis codes for pressure ulcer stage III or IV (or unstageable).Denominator – inpatient adult discharges

Rate = NumeratorDenominator x

Specifications available from

http://qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50-

ICD10/TechSpecs/PSI%2003%20Pressure%20Ulcer%20Rate.pdf

Note: update terminology, NPUAP has revised

language to describe “pressure injury”

7. Surgical Site Infections (NHSN)

Colon, abdominal hysterectomy, total knee replacement, or total hip replacementsNumerator – total number surgical site infections based on CDC NHSN definitionDenominator - all patients having any of the procedures included in the selected NHSN operative procedures category(s)

Rate = NumeratorDenominator X 100

Specifications available from http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf

8. Venous Thromboembolism (VTE) post-operative PSI 12 (HIDD)

Numerator – Discharges, among cases meeting the inclusion and exclusion rules for the denominator, with a secondary ICD-9-CM diagnosis code for deep vein thrombosis or a secondary ICD-9-CM diagnosis code for pulmonary embolism. Denominator - all patients having any of the procedures included in the selected NHSN operative procedures category(s)

Rate = NumeratorDenominator X 1,000

Specifications available from http://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50/TechSpecs/PSI_12_Perioperative_Pulmonary_Embolism_or_Deep_Vein_Thrombosis_Rate.pdf

9. Ventilator –Associated Pneumonia (VAP) (NHSN)

Ventilator Associated Condition (VAC)Numerator – number of events that meet the criteria of VAC; including those that meet the criteria for infection-related ventilator associated complication (IVAC) and possible/probable ventilator-associated pneumonia (VAP)Denominator - number of ventilator days

Rate = NumeratorDenominator X 1,000 vent days

Infection-Related Ventilator Associated Complication (IVAC)Numerator – number of events that meet the criteria of infection-related ventilator-associated condition (IVAC); including those that meet the criteria for possible/probable ventilator-associated pneumonia (VAP)Denominator - number of ventilator days

Rate = NumeratorDenominator X 1,000

Resources available from http://www.cdc.gov/nhsn/PDFs/pscManual/10-VAE_FINAL.pdf

NOTE: VAE is currently not included in CMS Hospital Inpatient Quality Reporting. Current NHSN recommendations for “appropriate public reporting” include Overall VAE rate = rate of all events meeting at least the VAC definition “IVAC –plus” rate = rate of ALL events meeting at least the IVAC definitionAccording to NHSN, only 44% of the experts can correctly identify a VAE/IVAC/VAC, PVAP

10. All Cause Preventable Readmissions (NQF 1789) (HIDD)

Numerator - inpatient admission to any acute care

facility which occurs within 30 days of the

discharge date of an eligible index admission. All

readmissions are counted as outcomes except

those that are considered planned.Denominator – adult admissions to acute care facility (minus Denominator exclusions)

Rate = NumeratorDenominator X 100

Resource available from: http://www.qualityforum.org/Projects/NQF_All-Cause_Readmissions_Project.aspx

1. Diabetes Short-term Complications Admissions Rate (PQI 01)

2. Diabetes Long-term Complications Admission Rate (PQI 03)

3. COPD or Asthma in Older Adults Admission Rate (PQI 05)

4. Heart Failure Admission Rate (PQI08)

5. Bacterial Pneumonia Admission Rate (PQI 11)

6. Angina without Procedure Admission Rate (PQI13)

7. Uncontrolled Diabetes Admission Rate (PQI14)

8. Asthma in Younger Adults Admission Rate (PQI 15)

1. Diabetes Short-term Complications Admissions Rate (PQI 01)

Numerator - Discharges, for patients ages 18 years and older, with a principal ICD-9-CM diagnosis code for diabetes short-term complications (ketoacidosis, hyperosmolarity, or coma).

Denominator – Patient discharges

2. Diabetes Long-term Complications Admission Rate (PQI 03)

3. COPD or Asthma in Older Adults Admission Rate (PQI 05)

4. Heart Failure Admission Rate (PQI08)

5. Bacterial Pneumonia (PQI 11)

6. Angina without Procedure Admission Rate (PQI13)

7. Uncontrolled Diabetes Admission Rate (PQI14)

8. Asthma in Younger Adults Admission Rate (PQI 15)

References for Domain 2 measures at: http://www.qualityindicators.ahrq.gov/modules/pqi_resources.aspx

Pause for Questions

http://nmhanet.org/quality.html

http://www.qualityindicators.ahrq.gov/Modules/PQI_TechSpec.aspx

What Do Hospitals Have to Do?

Pause for Questions

Outstanding Questions and Issues

What if hospitals submitted different data numerator/denominators in DY2?

To be determined

Do all hospitals need to meet benchmarks on all measures?

No. Hospitals with fewer than 100 beds will only be evaluated on 6 of the 10 domain 1 measures.

Will hospitals be penalized for not submitting data for services they do not provide?

This is not the State’s intent and is why we limited the number of measures for hospitals with <100 beds.

Is there a minimum denominator to be statistically significant?

Denominator less than 10 for most measures; HCAHPs measure is 300 min surveys in a calendar year

How should collected data be submitted to HSD?

How will the dollars be allocated? To be determined

Ellen Interlandi [email protected]

Beth [email protected]

505-343-0010