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What’s Hot & What’s Not in the Core Measure Field B RENDA B ARTKOWSKI , C M A , C C A , B S H PA M A N AG E R , C L I N I C A L D ATA A B ST R AC T I O N A MY W IRTH S A L ES E X EC U T I V E J U LY 1 7 , 2 0 1 3 © 2013 Amphion Medical Solutions 1 What’s Hot & What’s Not DISCLAIMER: This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference. This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents. © 2013 Amphion Medical Solutions 2 What’s Value-Based Purchasing (VBP) What is hospital value-based purchasing? A Centers for Medicare & Medicaid Services (CMS) initiative Rewards acute-care hospitals for quality of care to Medicare recipients © 2013 Amphion Medical Solutions 3 What’s Value-Based Purchasing (VBP) Why? Rewards based on following best clinical practices How well hospitals enhance patients’ experiences of care Patients receive higher quality care © 2013 Amphion Medical Solutions 4 What’s Value-Based Purchasing (VBP) How? Must report on minimum of 4 Hospital VBP measures Minimum of 10 cases per measure © 2013 Amphion Medical Solutions 5 What’s Value-Based Purchasing (VBP) When? Began with FY2013 Participating hospitals already receiving incentive payments © 2013 Amphion Medical Solutions 6 What’s FY 2015 Finalized Domains and Measures/Dimensions This information on Hospital Value Based Purchasing was retrieved from the National Provider Call on HVBPg from March 14, 2013. © 2013 Amphion Medical Solutions 7 What’s 12 Clinical Process of Care Measures 1 2 3 4 5 6 7 8 9 10 11 12 AMI-7a Fibrinolytic Therapy Received within 30 Minutes of Hospital Arrival AMI-8 Primary PCI Received within 90 Minutes of Hospital Arrival HF-1 Discharge Instructions PN-3b Blood Cultures Performed in the ED Prior to Initial Antibiotic Received in Hospital PN-6 Initial Antibiotic Selection for CAP in Immunocompetent Patient SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour Prior to Surgical Incision SCIP-Inf 2 Prophylactic Antibiotic Selection for Surgical Patients SCIP-Inf-3 Prophylactic Antibiotics Discontinued within 24 Hours After Surgery SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m. Postoperative Serum Glucose SCIP-Inf-9 Postoperative Urinary Catheter Removal on Postoperative Day 1 or 2 SCIP-Card-2 Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the Perioperative Period SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis within 24 Hours © 2013 Amphion Medical Solutions 8 What’s 8 Patient Experience of Care Dimensions 1 2 3 4 5 6 7 8 Nurse Communication Doctor Communication Hospital Staff Responsiveness Pain Management Medicine Communication Hospital Cleanliness & Quietness Discharge Information Overall Hospital Rating © 2013 Amphion Medical Solutions 9 What’s 5 Outcome Measures 1 2 3 4 5 MORT-30-AMI – Acute Myocardial Infarction (AMI) 30-day mortality rate MORT-30-HF – Heart Failure (HF) 30-day mortality rate MORT-30-PN – Pneumonia (PN) 30-day mortality rate PSI-90 – Patient safety for selected indicators (composite) CLABSI – Central Line-Associated Bloodstream Infection 1 Efficiency Measure 1 MSPB-1 Medicare Spending per Beneficiary measure Measure / Dimension Clinical Process of Care Measures Patient Experience of Care Dimensions Mortality Measures (Survivability) Rate Higher is better Higher is better Higher is better Represents a new measure for the FY 2015 program that was not in the FY 2014 program. © 2013 Amphion Medical Solutions 10 What’s How will hospitals be evaluated? Achievement Points Awarded by comparing an individual hospital’s rates during the performance period with all hospitals’ rates from the baseline period. Improvement Points Awarded by comparing an individual hospital’s rates during the performance period to that same individual hospital’s rates from the baseline period. © 2013 Amphion Medical Solutions 11 What’s Proposed Weights VBP Measure Process of Care Patient Experience Outcome Efficiency Safety 2015 20% 30% 30% 20% 2016 10% 25% 40% 25% © 2013 Amphion Medical Solutions 2017 10% 25% 50% 25% 15% 12 What’s EPs that began participation in 2011 or 2012 EPs that began participation this year (2013) EPs that plan to begin participation in 2014 © 2013 Amphion Medical Solutions 13 What’s © 2013 Amphion Medical Solutions 14 What’s ▪ MU Stages 1 & 2 Comparisons ▫ Must meet 19 objectives in Stage 1 ▫ Clinical Quality Measure Reporting (CQM) required ▫ No incentive payment if any of the objectives are not met ▪ Timelines ▫ MU Stage 1 Final Rule = July 2010 ▫ MU Stage 2 Final Rule = August 2012 ▫ MU Stage 2 Final Rule Effective FY 2014 = October 1, 2013 © 2013 Amphion Medical Solutions 15 What’s ▪ Clinical Quality Measures for Stage 1 ▫ ED = 2 ▫ STK = 7 ▫ VTE = 6 ▪ Clinical Quality Measures for Stage 2 ▫ ED = 3 ▫ PN = 1 ▫ STK = 7 ▫ SCIP = 3 ▫ VTE = 6 ▫ PC = 2 ▫ AMI = 4 ▫ Early Hearing Detection = 1 ▫ Healthy Newborn = 1 © 2013 Amphion Medical Solutions 16 What’s ▪ Highlights of MU Stage 2 Objectives ▫ Use CPOE ▫ Record demographics ▫ Record/chart changes ▫ Record smoking status ▫ Use clinical decision support ▫ Provide patients access to their info ▫ Protect electronic health info ▫ Import lab results ▫ Generate lists ▫ Use certified HER technology ▫ Medication reconciliation and summary of care ▫ Submit electronic data ▫ Automatically track medications © 2013 Amphion Medical Solutions 17 What’s Not Medicare EPs: How to Avoid Payment Adjustments ▫ ▫ ▫ ▫ Mandated to begin January 1, 2015 Based on MU data submitted prior to 2015 Applied to Medicare physician fee schedule amount Will increase if MU is not demonstrated in subsequent years © 2013 Amphion Medical Solutions 18 What’s Not © 2013 Amphion Medical Solutions 19 What’s Not Measure Suspension ▫ ▫ ▫ ▫ AMI – 1 AMI – 3 AMI – 5 SCIP-Inf-6 ▪ Measure Refinement ▫ SCIP-Inf-4 ▪ Measure Retirement ▫ AMI ▫ IMM ○ AMI-2 ○ IMM-1 ○ AMI-10 ▫ SCIP ▫ PN ○ SCIP-Inf-10 ○ PN-3b ▫ HF ○ HF-1 ○ HF-3 © 2013 Amphion Medical Solutions 20 What’s Not HBIPS ▫ CMS is not collecting data on HBIPS1 ▫ CMS is collecting data on HBIPS-2, 3, 4, 5, 6, 7 ○ HBIPS-2 – 7 are required ○ HBIPS-2, 3 are event measures ○ HBIPS-4 – 7 are discharge measures ○ No validation for HBIPS data © 2013 Amphion Medical Solutions 21 What’s Not Validation ▫ ED ▫ STK / VTE ▫ Quarterly Appeals © 2013 Amphion Medical Solutions 22 What’s Not Hospital Readmissions Reduction Program ◊ ◊ ◊ Affordable Care Act October 1, 2012 ADDITIONAL penalty from CMS ▫ Up to 1% ▫ Grows to 3% by October 1, 2014 © 2013 Amphion Medical Solutions 23 What’s Not Readmission Measures ▫ ▫ ▫ ▫ ▫ Defined readmission Adopted readmission measures Established methodology to calculate Established policy of using the risk adjustment methodology Established an applicable period ○ For FY 2013 ○ For FY 2014 ▪ Readmissions Adjustment Factor ▫ FY 2013 – the higher of the Ratio or 0.99 (1% reduction) ▫ FY 2014 – the higher of the Ratio or 0.98 (2% reduction) ▫ FY 2015 – the higher of the Ratio or 0.97 (3% reduction) © 2013 Amphion Medical Solutions 24 Resources Medicare’s Hospital VBP Scores are now available: http://www.medicare.gov/hospitalcompare/data/VBP/hospital-vbp.aspx Details on how to calculate MSPB measure scores, and more on VBP, please view The Official Website for the Medicare Hospital Value-based Purchasing Program: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html?redirect=/HospitalValue-Based-Purchasing/ OR https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1228772039937 Medicare’s “Hospital Compare”: http://www.hospitalcompare.hhs.gov/hospital-search.aspx?AspxAutoDetectCookieSupport CMS’s readmissions reduction program: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html and https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1228772412458 Proposed Rule Site: http://www.ofr.gov/OFRUpload/OFRData/2013-16555_PI.pdf Comment Site: http://www.regulations.gov/#!submitComment;D=CMS-2013-0154-0001 NFQ Website: http://www.qualityforum.org/Home.aspx © 2013 Amphion Medical Solutions 25 Amphion’s Core Measures Solutions What’s right now? Outsourcing Core Measures! What’s Not? Overworked hospital staff © 2013 Amphion Medical Solutions 26 Thank you for the opportunity to speak with you today F o r m o r e i n f o r m a t i o n o n A m p h i o n ’s s o l u t i o n s , contact Amy Wirth at 888-830-2644 x1634 or A m y.W i r t h @ a m p h i o n m e d i c a l . c o m © 2013 Amphion Medical Solutions 27