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Vbp cms call 2011 02 10

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  • 1. S p e c ia l Op e n Do o r Fo ru m : Ho s p ita l Va lu e -Ba s e d P u rc h a s in g P ro p o s e d Ru le Ove rvie w fo rFa c ilitie s , P ro vid e rs , a n d S u p p lie rs Th u rs d a y, Fe b ru a ry 10, 2011 1: 30 – 3:30 p .m . ES T
  • 2. Ag e n d a  In tro d u c tio n – Wh a t is th e Ho s p ita l VBP P ro g ra m ?  Wh a t h o s p ita ls a re in c lu d e d in th is p ro g ra m ?  Ho w will h o s p ita ls b e e va lu a te d u n d e r th is p ro g ra m ?  Ho w will p a ym e n ts b e c a lc u la te d ?  Wh a t a re th e lo g is tic s o f th e p ro g ra m ?  Wh a t if I h a ve a p ro b le m with m y e va lu a tio n ?  Ad d itio n a l In fo rm a tio n  Ho w c a n I re a d a n d c o m m e n t o n th e ru le ?  Qu e s tio n s & An s we rs 2
  • 3. In tro d u c tio n : P ro p o s e d Ho s p ita lVa lu e -Ba s e d P u rc h a s in g (VBP ) P ro g ra m  Re q u ire d b y Co n g re s s u n d e r S e c tio n 1886(o ) o f th e S o c ia l S e c u rity Ac t  Ne xt s te p in p ro m o tin g h ig h e r q u a lity c a re fo r Me d ic a re b e n e fic ia rie s  CMS vie ws va lu e -b a s e d p u rc h a s in g a s a n im p o rta n t d rive r in re va m p in g h o w c a re a n d s e rvic e s a re p a id fo r, m o vin g in c re a s in g ly to wa rd re wa rd in g b e tte r va lu e , o u tc o m e s , a n d in n o va tio n s in s te a d o f vo lu m e  Note: Details presented here are proposals and are subject to change in the Final Rule. CMS welcomes public comments. 3
  • 4. Le g is la tive Re q u ire m e n ts  Multiple requirements  Legislation requires that the FY 2013 Hospital VBP program apply to payments for discharges occurring on or after October 1, 2012  Hospital VBP measures must be included on Hospital Compare website for at least one year and specified under the Hospital IQR program  Secretary must establish and announce the performance standards not later than 60 days prior to the beginning of the performance period for FY involved  Performance Period reliability (9 months beginning 7/1/11 proposed)  Regulatory development  CMS anticipates issuing a final rule as soon as possible after close of comment period so it has enough time to calculate performance scores, value-based incentive payments, etc. 4
  • 5. Wh o is Elig ib le fo r th eHo s p ita l VBP P ro g ra m ? (1 o f 3)  Ho w is “h o s p ita l” d e fin e d fo r th is p ro g ra m ? – Hospital VBP Program applies to subsection (d) hospitals  Statutory definition of subsection (d) hospital found in Section 1886(d)(1)(B)  Applies to acute care hospitals in Maryland 5
  • 6. Wh o is Elig ib le fo r th eHo s p ita l VBP P ro g ra m ? (2 o f 3)  Exc lu s io n s u n d e r S e c tio n 1886(o )(1)(C)(ii) – Hospitals subject to payment reductions under Hospital IQR – Hospitals cited for deficiencies during the performance period that pose immediate jeopardy to the health or safety of patients – Hospitals without the minimum number of cases or measures 6
  • 7. Wh o is Elig ib le fo r th eHo s p ita l VBP P ro g ra m ? (3 o f 3)  Clinical Process Clinical Process Clinical Process Clinical Process Clinical Process M easure 1 M easure 2 M easure 3 M easure 4 M easure 17 … – Hospitals with at least 10 cases for at least 4 applicable measures during the performance period receive a Clinical Process of Care score – Hospitals with at least 100 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys during the performance period receive a Patient Experience of Care score 7
  • 8. P ro p o s e d FY 2013 Do m a in s a n dMe a s u re s /Dim e n s io n s 8
  • 9. Me a s u re s P ro p o s e d fo r FY 2014 Ho s p ita l VBP P ro g ra m(1 o f 3) P ro p o s e d Ho s p ita l -Ac q u ire d Co n d itio n Me a s u re s : 1. Fo re ig n Ob je c t Re ta in e d Afte r S u rg e ry 2. Air Em b o lis m 3. Blo o d In c o m p a tib ility 4. P re s s u re Ulc e r S ta g e s III & IV 5. Fa lls a n d Tra u m a : in c lu d e s Fra c tu re , Dis lo c a tio n , In tra c ra n ia l In ju ry, Cru s h in g In ju ry, Bu rn , Ele c tric S h o c k 6. Va s c u la r Ca th e te r-As s o c ia te d In fe c tio n s 7. Ca th e te r-As s o c ia te d Urin a ry Tra c t In fe c tio n (UTI) 8. Ma n ife s ta tio n s o f P o o r Glyc e m ic Co n tro l 9
  • 10. P ro p o s e d Ho s p ita l VBP Me a s u re s fo r FY 2014(2 o f 3) Ag e n c y fo r He a lth c a re Re s e a rc h a n d Qu a lity (AHRQ) P a tie n t S a fe ty In d ic a to rs (P S I), In p a tie n t Qu a lity In d ic a to rs (IQI), a n d Co m p o s ite Me a s u re s : 1. P S I 06 – Ia tro g e n ic P n e u m o th o ra x, a d u lt 2. P S I 11 – P o s t-Op e ra tive Re s p ira to ry Fa ilu re 3. P S I 12 – P o s t-Op e ra tive P u lm o n a ry Em b o li (P E) o r De e p Ve in Th ro m b o s is (DVT) 4. P S I 14 – P o s to p e ra tive Wo u n d De h is c e n c e 5. P S I 15 – Ac c id e n ta l P u n c tu re o r La c e ra tio n 6. IQI 11 – Ab d o m in a l Ao rtic An e u rys m (AAA) Re p a ir Mo rta lity Ra te (with o r with o u t vo lu m e ) 7. IQI 19 – Hip Fra c tu re Mo rta lity Ra te 8. Co m p lic a tio n /P a tie n t S a fe ty fo r S e le c te d In d ic a to rs (c o m p o s ite ) 9. Mo rta lity fo r S e le c te d Me d ic a l Co n d itio n s (c o m p o s ite ) 10
  • 11. Me a s u re s P ro p o s e d fo r FY 2014 Ho s p ita l VBP P ro g ra m(3 o f 3) P ro p o s e d Mo rta lity Me a s u re s : MORT-30-AMI: Ac u te Myo c a rd ia l In fa rc tio n (AMI) 30-Da y Mo rta lity Ra te MORT-30-HF: He a rt Fa ilu re (HF) 30-Da y Mo rta lity Ra te MORT-30-P N: P n e u m o n ia (P N) 30-Da y Mo rta lity Ra te 11
  • 12. Ho s p ita l VBP Me a s u re P ro p o s a l P ro c e s s  P ro p o s e d S u b re g u la to ry P ro c e s s fo r Ad d in g / Re tirin g Me a s u re s – Beginning with the FY 2013 Hospital VBP program, proposed to expedite adding measures beginning FY 2013 – Under proposal, measures could be added to Hospital VBP if measures have been displayed on Hospital Compare for one year and included in Hospital IQR program – Performance periods would begin 1 year after the measure was posted on Hospital Compare – Performance period end dates would be proposed through rulemaking – CMS will confirm the retirement of measures in rulemaking 12
  • 13. P e rfo rm a n c e P e rio d s  Ho s p ita ls will b e s c o re d o n th e ir p e rfo rm a n c e o n q u a lity m e a s u re s d u rin g th e fo llo win g p e rfo rm a n c e p e rio d s : – FY 2013:  Uses a 9-month Performance Period from July 1, 2011 to March 31, 2012 – FY 2014:  Three proposed mortality measures use 18-month Performance Period from July 1, 2011 to December 31, 2012 13
  • 14. Ho w Will Ho s p ita ls Be Eva lu a te d u n d e rth e Ho s p ita l VBP P ro g ra m ?  S u m m a ry fo r Fis c a l Ye a r (FY) 2013 P ro g ra m : – Two domains: Clinical Process of Care (17 measures) and Patient Experience of Care (8 HCAHPS dimensions) – Most hospitals given two scores (Achievement and Improvement) for each measure or dimension, with higher score used – Measure scores summed into Clinical Process of Care domain score – Dimension scores summed with consistency points into Patient Experience of Care domain score – 70% of Total Performance Score based on Clinical Process of Care measures – 30% of Total Performance Score based on Patient Experience of Care measures 14
  • 15. Ho w Will Ho s p ita ls Be Eva lu a te d u n d e rth e Ho s p ita l VBP P ro g ra m ? 15
  • 16. Ho w Will Ho s p ita ls Be Eva lu a te d ?Im p ro ve m e n t vs . Ac h ie ve m e n t 16
  • 17. Ho w Will Ho s p ita ls Be Eva lu a te d ?Im p ro ve m e n t S c o re s  Im p ro ve m e n t p o in ts a re a wa rd e d b y c o m p a rin g a h o s p ita l’s s c o re s d u rin g th e p e rfo rm a n c e p e rio d to th a t s a m e h o s p ita l’s s c o re s fro m th e b a s e lin e p e rio d  Ho w a re im p ro ve m e n t p o in ts a wa rd e d ? – Hospital score above benchmark: 10 achievement points, so no need to calculate improvement – Hospital score ≤ baseline period score: 0 improvement points – If the hospital’s score is between the baseline period score and the benchmark: 0-9 improvement points For example: 17
  • 18. Ho w Will Ho s p ita ls Be Eva lu a te d ?Ac h ie ve m e n t S c o re s  Ac h ie ve m e n t p o in ts a re a wa rd e d b y c o m p a rin g a n in d ivid u a l h o s p ita l’s s c o re s d u rin g th e p e rfo rm a n c e p e rio d with a ll h o s p ita ls ’ s c o re s fro m th e b a s e lin e p e rio d  Ho w a re a c h ie ve m e n t p o in ts a wa rd e d ? – Hospital score above benchmark: 10 achievement points – Hospital score < achievement threshold: 0 points – If the score is equal to or greater than the achievement threshold and less than the benchmark: 1-9 points For example: 18
  • 19. Ho w Will Ho s p ita ls Be Eva lu a te d ?Clin ic a l P ro c e s s o f Ca re Fo rm u la s  Clin ic a l P ro c e s s o f Ca re im p ro ve m e n t s c o re s : 10 * (Hospital performance period score − Hospital baseline score ) − 0.5 (Benchmark − Hospital baseline score )   – Hospitals must score higher than their baseline score in order to receive improvement points  Clin ic a l P ro c e s s o f Ca re a c h ie ve m e n t s c o re s : (Hospital s performance period score − achievement threshold ) 9*  + 0.5  (Benchmark − achievement threshold )  19
  • 20. Ho w Will CMS Ca lc u la te th e Clin ic a lP ro c e s s o f Ca re Do m a in S c o re ?  To ensure comparability between hospitals with different numbers of applicable measures, CMS will norma lize the doma in s core s for Clinica l P roce s s of Ca re . – Each measure is worth up to 10 points – Possible points = Number of applicable measures * 10 – (Scored points / Possible points) * 100 = Clinical Process of Care domain score Ho s p ita l 1 Ho s p ita l 2 Nu m b e r o f Ap p lic a b le Me a s ure s 5 11 S c o re o n Ea c h Me a s u re 9 9 S c o re d P o in t / P o s s ib le P o in ts 45 / 50 99 / 110 Clin ic a l P ro c e s s o f Ca re Do m a in S c o re 90 90 20
  • 21. Clin ic a l P ro c e s s S c o rin g Exa m p le #1:Ho s p ita l B Hospital B earns: 10 achievement points for performance exceeding the benchmark 21
  • 22. Clin ic a l P ro c e s s S c o rin g Exa m p le #2:Ho s p ita l L Hospital L earns: 0 achievement points and 0 improvement points Hospital L scores 0 points on this measure 22
  • 23. Clin ic a l P ro c e s s S c o rin g Exa m p le #3:Ho s p ita l I Hospital I earns: 6 achievement points or 7 improvement points Hospital I scores 7 points on this measure 23
  • 24. Ho w Will CMS Ca lc u la te th e P a tie n tExp e rie n c e o f Ca re (HCAHP S ) S c o re ?  P a tie n t Exp e rie n c e o f Ca re S c o re = (Gre a te r o f im p ro ve m e n t o r a c h ie ve m e n t s c o re s fo r e a c h HCAHP S d im e n s io n ) + Co n s is te n c y s c o re  Up to 20 c o n s is te n c y p o in ts p o s s ib le b a s e d o n th e s in g le lo we s t o f a h o s p ita ls 8 HCAHP S d im e n s io n s c o re s d u rin g th e p e rfo rm a n c e p e rio d c o m p a re d to th e m e d ia n b a s e lin e p e rfo rm a n c e fo r th a t m e a s u re . – Consistency points encourage hospitals to meet or exceed the achievement threshold in all HCAHPS dimensions – 20 points are awarded if all dimension scores ≥ achievement threshold – If any dimension score < achievement threshold, consistency points are awarded in proportion to percentile of the lowest-scoring dimension 24
  • 25. Ho w Will Ho s p ita ls Be Eva lu a te d ?P a tie n t Exp e rie n c e o f Ca re Fo rm u la s  P a tie n t Exp e rie n c e o f Ca re im p ro ve m e n t s c o re s :  (Hospital perf. period score − Hospital baseline period score) − 0.5 10 * (Benchmark − Hospital baseline period score)    – Hospitals must score higher than their baseline score in order to receive improvement points  P a tie n t Exp e rie n c e o f Ca re a c h ie ve m e n t s c o re s :  (Hospital performance period dimension score − 50 )    + 0.5  5  25
  • 26. Ho w will h o s p ita ls b e e va lu a te d ?HCAHP S Co n s is te n c y S c o re s  Ho w a re HCAHP S c o n s is te n c y p o in ts c a lc u la te d ? – If any dimension score ≤ worst-performing hospital dimension score:  0 consistency points – If scores ≥ achievement threshold on all 8 dimensions:  20 consistency points – If dimensions < achievement threshold but > worst-performing hospital’s score:  Consistency points are awarded based on percentile of the lowest dimension score: (2 * (lo we s t p e rc e n tile / 5)) – 0.5  Rounded to nearest whole number between 0-20 26
  • 27. P a tie n t Exp e rie n c e S c o rin g Exa m p le #1:Ho s p ita l B Hospital B earns: 10 achievement points for performance exceeding the benchmark 27
  • 28. P a tie n t Exp e rie n c e S c o rin g Exa m p le #2:Ho s p ita l L Hospital L earns: 0 achievement points and 0 improvement points Hospital L scores 0 points on this measure 28
  • 29. P a tie n t Exp e rie n c e S c o rin g Exa m p le #3:Ho s p ita l I Hospital I earns: 3 achievement points or 4 improvement points Hospital I scores 4 points on this measure 29
  • 30. Ho w Will Ho s p ita ls Be Eva lu a te d ?To ta l P e rfo rm a n c e S c o re s  Do m a in p o in ts e a rn e d a re we ig h te d to d e te rm in e To ta l P e rfo rm a n c e S c o re – CMS considered many factors to develop proposed weighting – FY 2013 domain weighting: (Clinical process of care x 70%) + (Patient experience of care x 30%) – FY 2014 and beyond:  New domains could be added  Domain weighting based on changes in measures will be established in future rulemaking – CMS welcomes public comments on the scoring methodology, weighting, and future proposals 30
  • 31. Th e Exc h a n g e Fu n c tio n  2007 Re p o rt to Co n g re s s in tro d u c e d th e Exc h a n g e Fu n c tio n to tra n s la te th e To ta l P e rfo rm a n c e S c o re s in to va lu e -b a s e d in c e n tive p a ym e n ts  Th e la w re q u ire s th a t th e to ta l a m o u n t o f va lu e -b a s e d in c e n tive p a ym e n ts in a g g re g a te b e e q u a l to th e a m o u n t a va ila b le fo r va lu e - b a s e d in c e n tive p a ym e n ts , a s e s tim a te d b y th e S e c re ta ry  We p ro p o s e d a lin e a r e xc h a n g e fu n c tio n to tra n s la te To ta l P e rfo rm a n c e S c o re s in to va lu e -b a s e d in c e n tive p a ym e n ts 31
  • 32. FY 2013 Ho s p ita l VBPVa lid a tio n Re q u ire m e n ts  CMS will u s e th e Ho s p ita l IQR va lid a tio n p ro c e s s a s o u tlin e d in th e FY 2011 In p a tie n t P ro s p e c tive P a ym e n t S ys te m (IP P S ) Fin a l Ru le fo r FY 2013 Ho s p ita l VBP – Hospitals submit the same data for Hospital IQR and Hospital VBP – No separate medical records requests  En s u re s a c c u ra c y o f Ho s p ita l VBP m e a s u re d a ta 32
  • 33. P ro p o s e d Ho s p ita l No tific a tio na n d Re vie w P ro c e d u re s  No tic e o f a 1% re d u c tio n to FY 2013 b a s e o p e ra tin g d ia g n o s is -re la te d g ro u p (DRG) p a ym e n ts p ro vid e d in th e FY 2013 IP P S ru le  No tific a tio n to h o s p ita ls o f e s tim a te d FY 2013 in c e n tive p a ym e n ts will b e m a d e b y m e a n s o f th e ir Qu a lityNe t a c c o u n ts  Ac tu a l in c e n tive p a ym e n t n o tific a tio n s c h e d u le d to o c c u r b y No ve m b e r 1, 2012 – Claims processing adjustments will be completed by January 2013 33
  • 34. P ro p o s e d Ho s p ita l No tific a tio na n d Re vie w P ro c e d u re s  Ho s p ita l s c o re s will b e p u b lis h e d o n Ho s p ita l Co m p a re : – Measure scores – Condition-specific scores – Domain-specific scores – Total performance scores  Ho s p ita ls will h a ve 30 c a le n d a r d a ys to re vie w a n d s u b m it c o rre c tio n s 34
  • 35. Ho w Will Ap p e a ls o f Ho s p ita l S c o re s b eHa n d le d ?  CMS will p ro p o s e a p p e a ls p ro c e s s in fu tu re ru le m a kin g  Th e fo llo win g to p ic s a re n o t s u b je c t to a d m in is tra tive o r ju d ic ia l re vie w: – Value-based incentive payment determination – Determination of the amount of funding available for incentive payments and payment reduction – Establishment of the performance standards and performance period – Measures specified in the Hospital IQR program or included in Hospital VBP – Methods and calculations for total performance scores – Validation methodology used in the Hospital IQR program  CMS we lc o m e s c o m m e n ts o n m a n a g in g a p p e a ls a n d a re a s o n a b le tim e lin e fo r re s o lu tio n 35
  • 36. Ad d itio n a l In fo rm a tio n  We will m o n ito r a n d e va lu a te th e im p a c t o f th e Ho s p ita l VBP p ro g ra m o n : – Access and quality of care, especially for vulnerable populations – Patterns of care suggesting particular effects on:  Percentage of patients receiving appropriate care for measured conditions  Rates of hospital-acquired conditions – Best practices of high-performing hospitals – Trends in care delivery, access, and quality 36
  • 37. Ho w to Re a d th e Ru le Re a d a n d c o m m e n t o n th e ru le o n lin e a t h ttp ://www.re g u la tio n s .g o v. S e a rc h fo r “CMS -3239-P .” 37
  • 38. Ho w to Co m m e n t o n th e Ru le (1 o f 2) CMS we lc o m e s p u b lic c o m m e n ts o n a ll a s p e c ts o f th e p ro p o s e d ru le , in c lu d in g : – Principles for value-based – Baseline and performance period purchasing selection – Proposed measures – Appropriate domain weighting – Use of structural measures in – Participation in Hospital IQR/ Hospital VBP Hospital VBP – Use of AHRQ PSI, IQI, and Nursing – Scoring hospitals without baseline Sensitive Care measures for FY period data 2014 and beyond – Minimum numbers of cases and – Subregulatory process for adding or measures retiring measures – Exchange function choice – Appropriate measures of efficiency – Appeals process structure and – Achievement and improvement timeline performance standards – Approaches to monitoring and – Performance score methodology evaluation and alternatives – Changes to QIO regulations 38
  • 39. Ho w to Co m m e n t o n th e Ru le (2 o f 2) De ta ils a b o u t s u b m ittin g c o m m e n ts a re in th e ru le Th e re a re two wa ys to s u b m it c o m m e n ts : – Via mail: See the Rule for mailing addresses – Online: Click “Submit a Comment” next to the regulation link P le a s e in c lu d e file c o d e “CMS -3239-P ” in yo u r c o m m e n ts Co m m e n ts a re d u e o n Tu e s d a y, Ma rc h 8, 2011 (b y 5:00 p .m . ES T via m a il a n d 11:59 p .m . ES T o n lin e ) 39
  • 40. Qu e s tio n s ?