Presented by: Richard Schirmer, MBA, FACHE July 2012 Quality Reporting: Initiatives at the Federal and State Level.

Presented by:

Richard Schirmer, MBA, FACHE

July 2012

Quality Reporting: Initiatives at the Federal and State Level

THA – Who We Are

The Texas Hospital Association is a nonprofit trade association representing Texas hospitals and health systems. In addition to providing a unified voice for health care, THA serves its 500+ members with timely information, data analysis, education on essential operational requirements, networking and leadership opportunities.

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THA – What We Do

Since its founding in 1930, THA has grown and evolved with the hospital industry itself. Today, THA is the leading advocacy organization for Texas hospitals. The Association’s staff is committed to helping hospitals navigate the complex, ever-changing legislative and regulatory environment, while working toward common solutions for better health care policy at the state and federal levels.

THA also serves as a resource for the State of Texas in the areas of disaster planning and response, data services and regulatory development.

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Executive Summary…..

Plethora of Quality Initiatives

pleth·o·ra noun 1. overabundance; excess: a plethora of

advice and a paucity of assistance. 2. Pathology Archaic . a morbid condition due

to excess of red corpuscles in the blood or increase in the quantity of blood.

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Impact of Quality Initiatives

Improving quality helps bottom line– Venous Thromboembolism Prophylaxis

– Beta Blockers for AMI

– Prophylactic antibiotics prior to surgery

Improving quality worsens bottom line

– Eliminating 39 weeks elective deliveries

Let’s do what is best for the PATIENT-we ALL have a vested interest!!!!!!

Steve Berkowitz MD 6

Federal Initiatives: Affordable Care Act

ACA

HAC

Readmissions ACOs

Bundled PaymentVBP

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Federal Quality Based Payment Reforms

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Federal Initiatives: Readmissions

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ACA

HAC

ReadmissionsACOs Bundled

Payment

VBP

Federal Initiatives: Readmissions

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• Y1 - CMS proposes existing 30-day readmissions measures (over 3 yrs)

Heart attack, heart failure, pneumonia

• Hospitals with “excess” readmissions penalized up to 1% in FY 2013 on all Medicare discharges

• ACA: exclude unrelated, planned. CMS’ proposal fails to do so.

• CMS proposes that hospitals with fewer than 25 discharges for each condition be excluded

Federal Initiatives: Readmissions

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Patient Compliance Is Never An Issue

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What Happens If You Remove Cost From The Equation?

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Federal Initiatives: Value Based Purchasing

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ACA

HAC

Readmissions

ACOs Bundled Paymen

t

VBP

VBP Quality Measures: 2013

For FY 2013, CMS finalized 13 total measures– 13 process measures

– HCAHPS patient satisfactions-8 measures

– Patient outcomes-2014-3 measures

For FY 2013, performance measured

July 1, 2011 – March 31, 2012

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Scoring Hospitals’ VBP Performance

Hospitals will receive the higher of their attainment or improvement score on each measure

Score on each domain equals points earned out of total possible points

FY 2013 payment based on:

FY 2014 payment based on:

Payment details next year

HCAHPS 30% Process 70%

Efficiency0% (20%)

HCAHPS 30%Outcomes 25%

(30%)Process

45% (20%)

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Federal Initiatives: Hospital Acquired Conditions

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ACA

HAC

ReadmissionsACOs Bundled

Payment

VBP

Hospital Acquired Conditions

ACA imposes financial penalties on hospitals with high HAC rate.

Current-Reduced payments to hospital where one of 8 HACs was not present on admission.

VBP Policy-Proposed for October 2013. Recently withdrawn

HAC Policy-Beginning October 2014, hospitals with HAC rate in bottom quartile of national average (i.e. high rate) will suffer a 1% payment reduction for ALL Medicare inpatient DRGs.

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Preventable Hospital Acquired Conditions

Foreign Object After Surgery Air Embolism Blood Incompatibility Pressure Ulcers (Stage III and IV) Falls and Trauma Vascular Catheter Associated Infections Catheter Associated UTI Poor Glycemic Control

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State Initiatives

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Texas

Patient Identification

System

HAI ReportingTx Institute for

Quality and Patient Safety

PPR/PPC

State Initiatives: HAI Reporting

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Texas

Patient Identification

System

HAI ReportingTx Institute for

Quality and Patient Safety

PPR/PPC

Mandatory State Reporting of Healthcare-associated Infections

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Who must report?

Long-term acute care hospitals that have an adult or neonatal intensive care unit (ICU) or critical care unit (CCU)

Critical access hospitals with ICU/CCU/NICU and/or that perform National Healthcare Safety Network (NHSN) surgical procedures

General hospitals (adult, pediatric, adolescent) with ICU/CCU/NICU and/or that perform National Healthcare Safety Network (NHSN) surgical procedures

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Reporting of HAIs

Central line-associated bloodstream infections in hospital special care settings

Surgical site infections– Adult general hospitals and ASCs: colon surgeries, hip

& knee arthroplasties, abdominal & vaginal hysterectomies, vascular procedures, and coronary artery bypass grafts

– Pediatric/adolescent general hospitals: ventriculoperitoneal shunt procedures (including revisions and removal), cardiac procedures 9excluding thoracic) and spinal surgeries with instrumentation

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Public Access to Data

Compile and make available to the public a summary, by health care facility

Publish the summary at least annually and place on website

Allow health care facilities to submit concise written comments

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Phased In Reporting

Phase in reporting beginning in October of 2011– All facilities report: central line-associated

bloodstream infections– Surgical centers and general hospitals report:

knee arthroplasties Knee arthroplasties ICD-9th Revision codes. Knee prosthesis – 00.80-00.84, 81.54 and

81.55

– Pediatric/adolescent hospitals report: ventricularoperitoneal shunts Ventriculoperitoneal shunts ICD-9th Revision codes. Ventriculoperitoneal shunts including

revision and removal of shunt – 02.2, 02.32-02.35, 02.39, 02.42, 04.43 and 54.95

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Phased In Reporting

Beginning in January 2012– Surgical centers and general hospitals report:

hip arthroplasties and coronary artery bypass grafts

– Pediatric/adolescent hospitals report: cardiac procedures

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Phased In Reporting

Beginning January 2013– Surgical centers and general hospitals report:

abdominal & vaginal hysterectomies, colon surgeries, and vascular procedures

– Pediatric/adolescent hospitals report: spinal surgeries with instrumentation

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How to Report

National Healthcare Safety Network (NHSN) developed and sustained by the Centers for Disease Control & Prevention will be the designated reporting system.

§200.3(e). Facilities shall report HAI data on patients who are admitted to the facility for inpatient treatment of a surgical site infections associated with a procedure listed in §200.4 of this title within 30 calendar days of the procedure or within 1 year of the procedure if the procedure involved an implant.

§200.3(e)(2). If the facility treating the patient did not perform the surgery, the treating facility shall notify the facility that performed, document the notification, and maintain this documentation for audit proposes.

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Future Activities

What will be implemented at a later date– Reporting of respiratory syncytial virus

– Receiving reports from the public

– Reporting of preventable adverse events (PAE) An event included in the list of serious events identified

by the National Quality Forum

An event or condition for which the Medicare program will not provide additional payment to the facility.

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State Initiatives: Patient Identification System

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Texas

Patient Identification

System

HAI ReportingTx Institute for

Quality and Patient Safety

PPR/PPC

Patient Identification System

Texas DSHS is required to develop a statewide standardized patient risk identification system that will allow hospital personnel to readily identify a patient with a specific medical risk.

Each hospital will be required to implement the state identification system unless they are allowed an exemption because the hospital adopts a different identification system that is evidenced based. SB 7 (82nd Session). May potentially include colored wristband ID initiative developed by SA Hospital Council several years ago.

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Patient Identification System

Three mandatory colors (AHA’s Alert Colors)– Red-Allergies

– Yellow-Fall Risk

– Purple-DNR

Two optional colors– Green-Latex Allergy

– Pink-Restricted Extremity

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Coming Attractions-MD Related

MD feedback reports (200+ MDs)-2010 MD feedback reports (Iowa, Kansas,

Missouri, Nebraska) – all MDs Most of claims based measures depend on

patient compliance to some degree (fill prescription or keep appointment)

Implementation of value modifier in 2015 may increase participation in 2012 (payment impact)

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In Conclusion……..

Questions?

Richard Schirmer, MBA, FACHE

Vice President, Health Care Policy Analysis

Texas Hospital Association

[email protected]

512/465-1056

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