Medicare Linkage: Quality & Payment Medicare Linkage: Quality & Payment Washington State Hospital Association July 28, 2008.

Medicare Linkage:Medicare Linkage: Quality & Payment Quality & Payment

Washington State Hospital AssociationJuly 28, 2008

Presenters

Washington State Hospital Association Carol Wagner, Vice President, Patient Safety Claudia Sanders, Senior Vice President, Policy Lance Heineccius, Interim Director, Finance Jim Cannon, Executive Director, Health

Information Program

AND, Gloria Kupferman, DataGen

Why This Webcast?

This webcast is designed to:• Provide you with information on current

and future Medicare links between payment and quality

• Provide you with new WSHA tools to improve quality

• Encourage a dialog between finance and quality at each hospital

Preparing for the Future

Links between quality and payment currently apply only to PPS hospitals

It is advisable for hospitals of all sizes to report their measures to Hospital Compare and to ensure that they achieve high scores

Information in Three Stages

Medicare has already started to link quality and payment.

1. CMS is implementing pay for reporting

2. Reporting measures will change; addition of new measures under discussion

3. On the horizon, value based purchasing

Slide Presentation Marked

Likelihood of Medicare policy happening: For sure () Likely (?) Possible (??) Direction is cloudy

Linking Quality and Payment in the Medicare Program

Outpatient Pay for Reporting7 MeasuresMinus 2.0

percentage points

Inpatient Pay for Reporting10 ProcessMeasuresMinus 0.4

percentage points if not

report

Expand Inpatient Pay for Reporting

21MeasuresMinus 2.0

percentage points

Expand Inpatient Pay for

Reporting27 MeasuresAdd Patient

Satisfaction and 30-day Mortality

MeasuresMinus 2.0

percentage points

Hospital Acquired

Conditions(8 conditions)

Potential Payment

Reductions

Value-BasedPurchasing

Pending Congressional

Approval

Linking Quality and Payment

Expand Hospital Pay for Reporting 32 Measures

Minus 2.0 percentage

points

FY 2006 20112009FY 2010200820072005

2011 IPPS Proposed

Quality Measures

?? Measures Minus ??

percentage points

2010 IPPS Proposed

Quality Measures

72 Measures Minus ??

percentage points

2006

Expand Hospital Pay for Reporting

37 Measures( 6 VTE’s)Minus 2.0

percentage points

Candidate Hospital Acquired Conditions

(9 additional conditions)

Medicare Quality Initiatives – Public Reporting

Hospital Compare Twenty four process measures Two risk-adjusted mortality measures Public reporting on the Web

Nursing Home Compare Seventeen measures based on patient condition Public reporting on the Web

Home Health Compare Twelve measures based on patient condition Public reporting on the Web

Physician Voluntary Reporting Program Sixteen process measures Confidential report back to physician

Medicare Payment Update

Reporting hospital quality data for annual payment update

Medicare Modernization Act (MMA) required Prospective Payment System hospitals to submit data on quality beginning in FFY 2005 and linked the update factor to reporting

Data displayed on the CMS Hospital Compare web site

History of “Pay for Reporting”

Inpatient PPS – FFY 2005 and 2006, update factor minus 0.4 percent

for non-compliance FFY 2007, update factor minus 2.0 percent for non-

compliance Outpatient PPS –

CMS delayed adoption of quality measures (including a 2.0 percent for non-compliance)

Reporting in CY 2008 for payment in 2009 Home Health PPS –

CY 2007, update factor minus 2.0 percent for non-compliance

Inpatient PPS MeasuresAcute Myocardial Infarction (AMI)

AMI -1 Aspirin at arrival

Acute Care Inpatient: HQA since 2003 Medicare

payment since FY 2005

AMI -2 Aspirin at discharge

AMI -3 Beta-blocker at arrival

AMI -4 Beta-blocker at discharge

AMI -5

Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD)

AMI -6 Smoking cessation advice/counseling

Acute Care Inpatient: HQA since 2004 Medicare

payment since FY 2007

AMI -7AThrombolytic within 30 minutes of arrival

AMI -8APercutaneous Coronary Intervention (PCI) 90 minutes of arrival

AMI -9 30 day mortality rate Acute Care Inpatient:

Medicare payment since FY 2008

Inpatient PPS MeasuresHeart Failure

HF-1Left ventricular systolic function evaluation Acute Care Inpatient:

HQA since 2003 Medicare payment

since FY 2005HF-2 ACE inhibitor or ARB for LVSD

HF-3 Discharge instructions received Acute Care Inpatient: HQA since 2004


HF-4Smoking cessation advice/counseling

HF 30 day mortality rate Acute Care Inpatient:


Inpatient PPS MeasuresPneumonia

PN-1 Oxygenation assessment

Acute Care Inpatient: HQA since 2003


PN-2 Pneumococcal vaccination

PN-3BBlood culture performed prior to administration of first antibiotics

PN- 4Smoking cessation advice/counseling

Acute Care Inpatient: HQA since 2007


PN-5AInitial antibiotics within 6 hours of arrival

PN-6Received most appropriate antibiotic

PN-7 Influenza vaccination

PN 30 day mortality rate Acute Care Inpatient:

Medicare payment beginning FY 2009

?

Inpatient PPS MeasuresSurgical Care Improvement

SCIP -1Antibiotics one hour before incision Acute Care Inpatient:


since FY 2007SCIP -3Antibiotics stopped within 24 hours after surgery

SCIP -2 Selection of antibiotic Acute Care Inpatient:


since FY 2008

SCIP -VTE1

Prophylaxis to prevent venous thromboembolism ordered

SCIP- VTE2

Prophylaxis to prevent venous thromboembolism received

SCIP -6 Appropriate hair removal Acute Care Inpatient: HQA since 2007


SCIP -Card2

Cardiac surgery patients with controlled 6AM postoperative serum glucose

?

CMS 30-day Mortality Measures

Risk adjustment methodology developed by Yale and Harvard

Based on administrative claims data Takes into account medical care received during

the year prior to patients hospitals admission Patient inpatient, outpatient and physician practice

claims Model uses information adjust for patient mix Patients with comfort care not excluded Patients who are admitted to a hospital and then

transferred are included in the measures

Inpatient PPS MeasuresHCAHPS

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

HCAHPS survey results on patient interaction with doctors, nurses, and hospital staff; cleanliness of the organization; pain control; communication about medicines; and discharge information

Acute Care Inpatient: HQA since

2007 Medicare payment since FY

2008

Hospital Consumer Assessment of Healthcare Providers and Systems

(HCAHPS)

Designed to allow comparison of patients’ perspectives on hospital care based on 27 questions in seven domains Doctor communication Nurse communication Cleanliness and quiet of the hospital environment Responsiveness of hospital staff Pain management Communication about medicines Discharge information

Also includes two questions: overall satisfaction with and willingness to recommend the hospital

Patient Satisfaction

Hospital Environment Items Cleanliness of hospital environment Quietness of hospital environment

Discharge Information Composite Discharge Information

Overall Ratings Overall rating of this hospital Willingness to recommend this hospital

CMS Calculated Performance Measures

Heart Attack Patients Given ACE Inhibitor or ARB for

Left Ventricular Systolic Dysfunction

(LVSD)

Heart Attack Patients Given

Aspirin at Arrival


Aspirin at Discharge

Heart Attack Patients Given Beta

Blocker at Arrival

Heart Attack Patients Given Beta Blocker at

Discharge


Smoking Cessation Advice/Counseling


Fibrinolytic Medication Within

30 Minutes Of Arrival

Heart Attack Patients Given PCI

Within 90 Minutes Of Arrival

Top 10% Performance Level for All United States Hospitals 100% 100% 100% 100% 100% 100% 100% 88%

Average Performance Level for All United States Hospitals 85% 93% 90% 88% 91% 91% 39% 60%

Average Performance Level for All Washington Hospitals 90% 95% 93% 93% 94% 90% 23% 67%

Sample Washington State Hospital

Number of Reported Cases 21 107 124 88 136 38 1 30

Indicator Score 86% 96% 97% 98% 99% 92% 100% 63%

U.S. Decile Rank for Hospitals Reporting More Than 24 Cases (1 is Best) Insufficient Data 7 6 2 2 10 Insufficient Data 6

Ranking out of Washington Hospitals Reporting More Than 24 Cases Insufficient Data 27 out of 38 22 out of 35 10 out of 34 5 out of 35 20 out of 28 Insufficient Data 20 out of 26

State Average Comparisons (Case-weighted)

Washington Average Score - All Hospitals 90% 98% 98% 96% 97% 95% 24% 69%

Washington - Hospitals Reporting < 25 Cases 90% 91% 86% 90% 92% 86% 24% 48%

Washington - Hospitals Reporting > 24 Cases 90% 98% 98% 96% 97% 95% Insufficient Data 70%

All United States Hospitals 99% 100% 100% 100% 100% 100% 91% 88%

Washington 100% 100% 100% 100% 100% 100% Insufficient Data 87%

United States Non-Teaching 100% 100% 100% 100% 100% 100% 84% 88%

Washington Non-Teaching 99% 100% 100% 100% 100% 100% Insufficient Data 87%

United States Urban 99% 100% 100% 100% 100% 100% 92% 88%

Washington Urban 100% 100% 100% 100% 100% 100% Insufficient Data 87%

United States Between 100 and 500 Beds 99% 100% 100% 100% 100% 100% 91% 88%

Washington Between 100 and 500 Beds 99% 100% 100% 100% 100% 100% Insufficient Data 87%500003


Top 10% Performance Level Comparisons (Hospitals Reporting More Than 24 Cases)

Heart Attack (AMI) Care

Heart Attack Care - Hospital vs. Top 10% Performance

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Heart Attack Patients Given ACEInhibitor or ARB for Left

Ventricular Systolic Dysfunction(LVSD)

Heart Attack Patients GivenAspirin at Arrival

Heart Attack Patients GivenAspirin at Discharge

Heart Attack Patients Given BetaBlocker at Arrival

Heart Attack Patients Given BetaBlocker at Discharge

Heart Attack Patients GivenSmoking CessationAdvice/Counseling

Heart Attack Patients GivenFibrinolytic Medication Within 30

Minutes Of Arrival

Heart Attack Patients Given PCIWithin 90 Minutes Of Arrival

Sample Washington State Hospital All United States Hospitals

CMS Release Date:

March 2008

Inpatient Payment Rate

with Full Update

2007 Standard Amount $4,874.492008 Marketbasket Update 3.3%2008 Behavioral Offset Adjustment 0.994 2008 Budget Neutrality Adjustment 0.997096

2008 Standard Amount $4,990.60Seattle Wage Index 1.1363 2008 Wage-Adjusted Standard Amount $5,412.34

Sample Washington State Hospital DSH Adjustment 0.0743 Sample Washington State Hospital IME Adjustment 0.1822

2008 Adjusted Standard Ratefor Sample Washington State Hospital

$6,800.39

Inpatient Payment Rate Reduced by 2.0

2007 Standard Amount $4,874.492008 Marketbasket Update 1.3%2008 Behavioral Offset Adjustment 0.994 2008 Budget Neutrality Adjustment 0.997096

2008 Standard Amount $4,893.98Seattle Wage Index 1.1363 2008 Wage-Adjusted Standard Amount $5,307.55

Sample Washington State Hospital DSH Adjustment 0.0743 Sample Washington State Hospital IME Adjustment 0.1822

2008 Adjusted Standard Ratefor Sample Washington State Hospital

Difference in payment rates (per Medicare patient) ($131.66)

$6,668.73

Proposals for Inpatient in 2009, 2010, 2011 . . .

2009 Inpatient Proposed Quality Measures

CMS requires hospitals to submit data effective with discharges beginning January 1, 2009

Forty-three new measures including: One surgical care Four nursing sensitive Three readmission Five stroke Six venous thromboembolism (VTE) measures

VTE -1: VTE Prophylaxis VTE- 2: VTE Prophylaxis in the ICU VTE- 4: Patients with overlap in anticoagulation therapy VTE - 5/6: (as combined measure) Patients with UFH dosages

and platelet count monitoring and adjustment VTE- 7: Discharge instructions: follow-up, compliance, dietary

restrictions adverse drug reactions VTE- 8: Incidence of preventable VTE

??

2010 Inpatient Proposed Quality Measures (72)

Heart Attack (AMI) - 8 measures Heart Failure (HF) - 4 measures Pneumonia (PN) - 6 measures Surgical Care Improvement Project (SCIP) - 8

measures Mortality Measures - 3 measures Patient’s Experience of Care (HCAHPS) Readmission Measures (Medicare patients) - 3

measures Inpatient Stroke Care - 5 measures

??

2010 Inpatient Proposed Quality Measures (72) continued. . .

DVT Prophylaxis (from proposed 2009) - 6 measures

AHRQ Patient Safety Measures - 4 measures AHRQ Inpatient Quality Indicators – 2

measures AHRQ Composite Measures - 3 measures Nursing Sensitive Measures - 4 measures Cardiac Surgery Measures - 15 measures

??

2011 and Subsequent Years - Inpatient Proposed Measures

Chronic Pulmonary Obstructive Disease Measures - ? measures

Complication of Vascular Surgery - 3 measures Inpatient Diabetes Care Measures - ? measures Healthcare Associated Infection - 2 measures Central Line Associated Blood Stream

Infections/Surgical Site Infections Sexual Assault/Death or Injury Patient or Staff

Assault

??


(continued…)

Timeliness of Emergency Care Measures - 3 measures

Surgical Care Improvement Project (SCIP) - 2 measures

Complication Measures (Medicare Patients) - ? measures

Hospital Inpatient Cancer Care Measures - 5 measures

Average Length of Stay Coupled with Readmission Measure - ? measures

Healthcare Associated Conditions - 3 measures Serious Reportable Events in Healthcare - 24

measures

??

Preventable Hospital Acquired Conditions - 14 measures

Catheter-Associated Urinary Tract Infection (UTI) Vascular Catheter-Associated Infection SSI Following Elective Surgeries:

Total Knee Replacement Laparoscopic Gastric Bypass and Gastroenterostomy Ligation and Stripping of Varicose Veins

Legionnaire’s Disease Glycemic Control Iatrogenic Pneumothorax Delirium Ventilator Associated Pneumonia DVT/PE Staphylococcus Aureus Septicemia C Diff Associated Disease MRSA


(continued…) ??

Hospital Outpatient Quality Data Reporting Program

Emergency Department

Preoperative Care

AMI Aspirin at Arrival X

AMI Median Time to Fibrinolysis X

AMI Fibrinolytic Therapy Received Within 30 Minutes of Arrival X

AMI Median Time to Electrocardiogram X

AMI Median Time to Transfer for Primary PCI X

Timing of Antibiotic Prophylaxis X

Selection of Prophylactic Antibiotic X

?

Outpatient Data Reporting

Start date for hospital outpatient encounters is period from April through June 2008

Outpatient data due to CMS November 1, 2008 Validation will NOT be implemented until CY 2009 Validation will be implemented in CY 2009 beginning with

July 2008 data Delay public reporting until CY 2009 for data submitted

beginning July 2008 Data submitted for July 2008 services and forward will

affect payment determinations for CY 2010

?

Value-Based Purchasing

Medicare Pay for Performance (P4P)

“Better care should be rewarded . . . it is time that we pay for the quality of the health care provided to our beneficiaries, not simply the amount. We are working to apply this in every setting in which Medicare and Medicaid pays for care.”

CMS Administrator Mark McClellan, M.D. Ph.D. January 31, 2005

CMS Report on Value-Based Purchasing

CMS report to Congress released on November 21, 2007

Mandate to implement by October 1, 2008 (Deficit Reduction Act of 2005)

CMS proposes a three-year transition to full payment for performance (P4P) Year 1 – 100 percent pay for reporting Year 2 – 50 percent pay for reporting and 50

percent on P4P Year 3 – 100 percent on P4P

Redistribution in Value-Based Purchasing

Scoring based upon data reported by hospitals in three quality “domains” Clinical process of care, Patients’ perspectives of care, and Outcomes

Pool of incentive money funded via a carve-out from all hospital inpatient payments (2 to 5 percent)

Redistribution of pool dollars dependent upon hospitals’ scores

Measures for Value-Based Purchasing

Process of care data reported since 2004 and publicly available on the CMS Hospital Compare site

HCAHPS Patients’ Perspectives of Care survey required as part of pay for reporting as of FFY 2008 and publicly available since March 2008

Two outcomes measures, 30-day mortality of patients with AMI or heart failure, publicly available since June 2007

Hospital Performance in Value-Based Purchasing

Overall hospital performance will be measured based on an aggregate of the scores in all three domains

Process measures for updates and HCAHPS Indicators Each indicator receives a score between 1

and 10 Each indicator score is the higher of two

measures - attainment or improvement

Hospital Performance in Value-Based Purchasing

The attainment score for an indicator is determined by comparing the hospital’s performance to national benchmark and threshold levels for the indicator The benchmark -- the high performance

measurement The threshold -- the minimum acceptable

performance measurement Each domain will have its own methodology for

setting benchmarks and thresholds The improvement score for an indicator is determined

by comparing the hospital’s performance to its own prior year performance

HCAHPS in Value-Based Purchasing

HCAHPS scoring will include a score (between 0 and 20) for achieving minimum performance across all HCAHPS indicators If all eight of a hospital’s HCAHPS indicator

scores were above their respective 50th percentile (median) value, the hospital would receive the full 20 points

Otherwise, the minimum performance score would be based upon the indicator with the lowest percentile score and points awarded based upon how close that percentile rank is to the median

Scores In Value-Based Purchasing

Each domain’s performance scores are aggregated as a percentage of the maximum possible score

Then the domain aggregates are combined to arrive at one overall VBP Total Performance Score

Combining individual scores into one aggregate percentage allows CMS to compare hospitals on one standardized measure

Questions on Value-Based Purchasing

How will mortality (outcome) measures be scored and incorporated? (Report to Congress makes no mention)

Will indicators with small case counts be included?

How will new indicators be phased in? How will the three domains’ scores be weighted

to arrive at the Total VBP score? What will the withhold percentage be in 2009?

Indicator Benchmark Threshold Case Count Performance Case Count PerformanceAttainment

ScoreImprovement

Score Final Score

Heart Attack Patients Given ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction (LVSD)

90.0% 60.0% 28 79% 21 86% 9 6 9

Heart Attack Patients Given Aspirin at Arrival

90.0% 60.0% 111 97% 107 96% 10 Does Not Apply 10

Heart Attack Patients Given Aspirin at Discharge

90.0% 60.0% 121 97% 124 97% 10 Does Not Apply 10

Heart Attack Patients Given Beta Blocker at Discharge

90.0% 60.0% 141 99% 136 99% 10 Does Not Apply 10

Heart Attack Patients Given PCI Within 120 Minutes Of Arrival

Insufficient Data

Insufficient Data

0 0% 0 Insufficient Data Not Computed

Heart Attack Patients Given Smoking Cessation Advice/Counseling

90.0% 60.0% 37 92% 38 92% 10 Does Not Apply 10

Heart Attack Patients Given Fibrinolytic Medication Within 30 Minutes Of Arrival

85.4% 53.0% 1 100% 1 100% Not Computed Not Computed Not Computed

Heart Failure Patients Given ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction (LVSD)

99.5% 87.0% 56 75% 59 83% 0 3 3

Heart Failure Patients Given Discharge Instructions

97.7% 72.0% 119 59% 120 72% 0 3 3

Heart Failure Patients Given Smoking Cessation Advice/Counseling

90.0% 60.0% 21 81% 20 85% 8 4 8

Pneumonia Patients Assessed and Given Pneumococcal Vaccination

97.6% 80.0% 149 81% 142 84% 2 2 2

Pneumonia Patients Given Smoking Cessation Advice/Counseling

90.0% 60.0% 47 94% 43 95% 10 Does Not Apply 10

Pneumonia Patients Given the Most Appropriate Initial Antibiotic(s)

97.1% 87.0% 116 93% 108 96% 9 7 9

Pneumonia Patients Whose Initial Emergency Room Blood Culture Was Performed Prior To The Administration Of The First Hospital Dose Of Antibiotics

90.0% 60.0% 143 81% 138 85% 8 4 8

Pneumonia Patients Assessed and Given Influenza Vaccination

99.1% 82.0% 48 81% 48 81% 0 0 0

Surgery Patients Who Received Preventative Antibiotic(s) One Hour Before Incision

97.1% 87.0% 360 84% 293 84% 0 0 0

Surgery Patients Whose Preventative Antibiotic(s) are Stopped Within 24 hours After Surgery

97.0% 79.0% 343 87% 279 86% 4 0 4

Hospital - Base Year Hospital - Scoring Year

Overall Score 64%

National

Sample Washington State HospitalValue-Based Purchasing Score Details

Scoring Period: July 2006 - June 2007Base Year: April 2006 - March 2007

500003

Jul 2004 - Jun 2005

Oct 2004 - Sep 2005

Jan 2005 - Dec 2005

Apr 2005 - Mar 2006

Jul 2005 - Jun 2006

Oct 2005 - Sep 2006

Jan 2006 - Dec 2006

Apr 2006 - Mar 2007

Jul 2006 - Jun 2007


April 2004 - March 2005 Base Year 66% 69% 75% 74% 73% 72% 70% 78% 85%

Updated Base Year 74% 63% 64% 64% 71% 64%


Updated Base Year 53% 56% 60% 63% 63% 67% 70% 73% 64%


Updated Base Year 64% 59% 64% 68% 71% 60%

Average Score - Washington Hospitals

Average Score - All United States Hospitals

Reporting Period


Medicare Value-Based Purchasing (VBP) Score Analysis

VBP Score Trend

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jul 2004 - Jun2005

Oct 2004 - Sep2005

Jan 2005 - Dec2005

Apr 2005 - Mar2006

Jul 2005 - Jun2006

Oct 2005 - Sep2006

Jan 2006 - Dec2006

Apr 2006 - Mar2007

Jul 2006 - Jun2007

Reporting Period

VB

P S

co

re

April 2004 - March 2005 Base Year Updated Base Year

Basics of Value-Based Purchasing

Scores will be calculated at the start of each inpatient prospective payment system year

The baseline and measurement period will be April 1 through March 31

FFY 2010 = October 1, 2009 – September 30, 2010 The baseline period for FFY 2010 will be April 1, 2007 –

March 31, 2008 The measurement period for FFY 2010 will be April 1,

2008 – March 31, 2009 Data only be 7 months old at the start of the FFY Hence, hospitals will be submitting data within a tighter

timeframe (60 days from close of quarter plus 30 days to resubmit data, if necessary)

Hospitals’ Scores in Value-Based Purchasing

Overall scores from each of the three domains will be averaged together Process measures will receive the highest weight Current proposal: 70 percent Process, 30 percent

HCAHPS The hospital’s grand total score is entered into an

equation to determine a payment percentage If the maximum payment percentage is 100 percent

of the hospital’s original pool contribution, there will be excess money left in the pool


Washington

64% 68%88% 85%

$985,000 $82,767,000$865,000 $70,215,702($120,000) ($12,551,298)

50000350

Expected Payment from VBP

Curvilinear Payment Function

Net Loss from VBP

Overall VBP ScorePayment Percentage

Dollars Contributed to VBP

Assumes 5% Pool

Sample Washington State HospitalPayment Impact Estimate

Value-Based PurchasingScoring Period: July 2006 - June 2007

Curvilinear Payment Scenario

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Score

Pa

ym

en

t P

erc

en

tag

e

Payment Conversion Curvilinear Function Sample Washington State Hospital

Payments for Value-Based Purchasing

A hospital’s payment percentage will be determined at the start of each payment year

The payment percentage will apply for the whole year

The VBP carve-out and payment percentage will be applied to inpatient prospective payments, excluding IME, DSH, outliers, and capital

Excess Pool Funds in Value-Based Purchasing

Question: What becomes of the excess pool funds? The industry wants assurances that the

entire pool will be distributed MedPAC also recommends that there be no

savings achieved through this program How will distribution of excess dollars be

handled?

Key Factors in Value-Based Purchasing

Hospitals’ P4P scores and payment percentages established prospectively based upon prior performance

Data reported between April 1, 2008 and March 31, 2009 will be the measurement year for FFY 2010 and the base year for FFY 2011

Only top performers will be made whole Once transition to VBP, hospitals still must

participate in reporting of all data to qualify for incentive payments Measures for VBP Measures for public reporting Measures being tested

WSHA Work on Quality and Payment

WSHA Federal Advocacy on Linking Payment and Quality

CMS has proposed inpatient and outpatient rules Inpatient: Comment period closed and final rule

expected by September 1 Outpatient: Comment period open through September

2, 2008 Comment at: http://tinyurl.com/5z33sh

WSHA generally follows AHA lead on national issues

WSHA will be involved if and when value based purchasing is discussed by Congress and next administration

Make sure we understand your concerns on linking payment and quality

WSHA Information on New Payment Changes

HIP will estimate impact of hospital specific proposals

HIP contracts with DataGen to get you this information

You can expect to see: Impact of inpatient final rules Impact of outpatient final rules If adopted, impact of value based purchasing

WSHA Help on Quality Improvement

Washington is helping hospitals to improve the results of Hospital Compare measures through a Safe Table called Safe Practices: Hospital Compare and More A Safe Table is a collaborative in which hospitals

work together to learn best practice and improve care

Quarterly Hospital Compare Reports These color coded reports display how your hospital

is doing as compared to the top 10% of hospitals in the nation and other hospitals in Washington State

Source: Hospital Compare July 2006 – June 2007

Suggested Measures

Measure Group MeasureWA

AverageNational Top 10%

Gap

PCI Within 90 Minutes of Arrival 67% 88% 21%

Smoking Cessation Advice 90% 100% 10%

Antibiotic One Hour Before Surgery 83% 96% 13%

Antibiotic Stopped Within 24 Hours 81% 96% 15%

Discharge Instructions 58% 96% 38%


Influenza Vaccination 67% 98% 31%

Pneumococcal Vaccination 73% 96% 23%


Pneumonia

Surgical Infection Prevention

Heart Attack

Heart Failure

Questions???

Contact Information

Carol Wagner: [email protected]

Claudia Sanders: [email protected]

Jim Cannon: [email protected]

Lance Heineccius: [email protected]

mailto:[email protected]




Medicare Linkage: Quality & Payment Medicare Linkage: Quality & Payment Washington State Hospital Association July 28, 2008.

Documents

reportingreporting measures

quality beginning

addition of new measures

cms hospital

cloudy linking quality

paymentexpand hospital

percentage pointshospital

percentage pointsinpatient