The Changing LandscapeValue Based P h iV l B      d Purchasing, R i b                         Reimbursement and it        ...
How Did We Get Here? Hospital payments account for the largest share of Medicare spending Medicare is the largest single p...
Health Care Reform
CMS Value Based Purchasing Affordable Care Act, Section 3001 ◦ The Secretary of HHS is required to establish a hospital va...
CMS Immediate Jeopardy Triggers Failure to protect from: ◦ Ab   Abuse, neglect, psychological h             l t       h l ...
CMS Value-Based Purchasing:        Value-  Linking Federal Reimbursement to Clinical        g  PerformanceOver the next fi...
CMS Value Based PurchasingAffordable Care Act, Section 3001◦ CMS funds the VBP program by reducing the base operating DRG ...
CMS Value Based PurchasingProposed rule released Jan. 7, 2011; Final rule released April 29, 20112 Domains◦ Process (core)...
Incentive Payment Calculations ◦ CMS will notify each hospital of their   estimated amount via QualityNet account   at lea...
Linear Exchange CurveVBP payments are based upon the slope of the linear exchangeline. The slope of the linear exchange is...
Core Measure Selection
FY 2013 Clinical Process Measures                                20
FY 2013 HCAHPS Measures Nurse Communication Composite Doctor Communication Composite Cleanliness and Quietness Composite (...
HCAHPS Scoring Achievement ◦ Scoring is done at the individual measure level      Hospital performance: Equal to or greate...
HCAHPS Scoring Example
VBP MetricsHeavilyyInfluenced byNursing Care
FY 2014 VBP RevisedNov 1, 2011◦ CMS will NOT include the following:    OUTCOME MEASURES      HACs      AHRQ composites    ...
AHRQ is     is….. The health services research arm of the U.S. Department of Health and Human Services (HHS), complementin...
AHRQ Indicators The Patient Safety Indicators are part of a set of software modules of the Agency for Healthcare Research ...
AHRQ Inpatient Quality IndicatorsInpatient Quality Indicators   Can be used to help hospitals identify potential problem a...
AHRQ Inpatient Quality Indicators     Hospital-level procedure utilization rates        • Cesarean section delivery       ...
AHRQ Patient SafetyIndicatorsPatient Safety Indicators  Can be used to help hospitals and health care organizations assess...
AHRQ Patient SafetyIndicatorsindicators  Hospital-level   Death in low-mortality diagnosis-related groups   Pressure ulcer...
AHRQ Patient Safety and Inpatient Quality Indicators Hospital                                                             ...
AHRQ StrategiesAHRQ Strategies Individual case review Professional peer review Validate use of evidenced based practices Q...
Potential Future Measures andChangesCh In 2013, hospitals will receive a payment reduction if they have excess 30-day read...
CMS Physician Quality Reporting System(PQRS)  Formerly known as PQRI (initiative)  Established by 2006 Tax Relief & Health...
PQRI Financial Incentives/Penalties for participation ◦ Incentives: 1.0% in 2011, 0.5% in 2012-                           ...
PQR Eligible Professionals1. Medicare physicians  ◦   Doctor of Medicine  ◦   Doctor of Osteopathy  ◦   Doctor of Podiatri...
PQR Eligible Professionals3. Therapists        p ◦ Physical Therapist ◦ Occupational Therapist        p             p ◦ Qu...
2011 PQR Measures List
2012 PQR Group Measures
CMS Public Reporting Metrics
Future Public Measure Changes
2012 and beyond….looking ahead…. Four primary buckets of quality metrics: ◦ CMS VBP measures ◦ CMS HQA IPPS measures ◦ CMS...
CMS HQA Measures: Current/Future Public Reporting per OPPS 2011 Final Rule1Measures   collected in one year are used to de...
Joint CommissionCore MC     Measure R              Requirements                  i     t Hospitals are only required to su...
TJC Accountability Measures Accountability measures are now used by TJC to identify their Top Performers on JC Key Quality...
Managed Care VBP Engaging in P4P initiatives ◦ Appropriate use of Surgical Safety   Checklists Monitoring hospital public ...
First Do No Harm…….. “It may seem a strange        y              gprinciple to enunciate as       the very first         ...
CMS Hospital-Acquired Conditions    Hospital-(HAC) Proposed rule released Feb 17, 2011 Final rule released June 1 2011    ...
CMS Hospital-Acquired Conditions    Hospital-(HAC) OPPC gives states leeway to add additional preventable conditions to th...
Public Perception
HAC Top Performer 5ThemesFacilities with zero (or the fewest) HACs based on10 quarters of coding data1.1 Engaged leadershi...
ChallengesRapid expansion of           Growth in hospital andmeasures                     physician P4P programsCombinatio...
Building a Culture“We must stop putting silos around the various facets of healthcare.”“The ti t“Th patient experience i n...
Interdisciplinary Ownership                    Everyone at every level needs to                    “own” the quality agend...
As a result……………     result Priorities/Initiatives…………must be directly li k d to: di    l linked ◦ building a culture of p...
Questions/Comments
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica D...
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica D...
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica D...
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica D...
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica D...
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica D...
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica D...
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica D...
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica D...
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica D...
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica D...
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica D...
The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica D...
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The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica Division

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Troy Trosclair, HCA MidAmerica Division - Speaker at the marcus evans National Healthcare CNO Summit, held in Hollywood, FL, April 26-28, 2012, delivered his presentation entitled The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing

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The Changing Landscape: Value-Based Purchasing, Reimbursement and its Impact on Nursing - Troy Trosclair, HCA MidAmerica Division

  1. 1. The Changing LandscapeValue Based P h iV l B d Purchasing, R i b Reimbursement and it t d itsImpact on NursingTroy A Trosclair, RN, DNS, CPHRMVice President Clinical Services President,HCA MidAmerica Division
  2. 2. How Did We Get Here? Hospital payments account for the largest share of Medicare spending Medicare is the largest single payer for hospital services. In 2009 I 2009, > 7M M di Medicare b beneficiaries h d > 12 4M IP fi i i had 12.4M hospitalizations One in seven Medicare patients will experience some “adverse” p p event (preventable illness or injury) while in the hospital. One in three Medicare patients who leave the hospital will have a readmission within one month. ◦ In 2009, readmissions cost Medicare $26 billion Every year, >98,000 Americans die from errors in hospital care ◦ In 2009, Medicare spent $ $4.4 billion for patients harmed in hospitals
  3. 3. Health Care Reform
  4. 4. CMS Value Based Purchasing Affordable Care Act, Section 3001 ◦ The Secretary of HHS is required to establish a hospital value- value based purchasing program ◦ Effective with discharges of Oct. 1, 2012 ◦ Applies to short term, general, acute care hospitals Hospitals excluded from the VBP program include: ◦ Psych, rehab, LTC, Children’s, Cancer ,and Critical Access hospitals. ◦ Hospitals without data in at least four process measures with a minimum of 10 cases in each measure measure. ◦ Hospitals without at least 100 completed HCAHPS surveys during the Performance Period ◦ Hospital without at least 10 cases for each of at least 4 applicable clinical measures during the Performance Period ◦ Hospitals cited for deficiencies during the Performance Period that p p g pose IMMEDIATE JEOPARDY to the health or safety of patients (results in immediate suspension from VBP for 12 months). The application of this exclusion is under further discussion by CMS due to several posed concerns; CMS clarification to follow in the future.
  5. 5. CMS Immediate Jeopardy Triggers Failure to protect from: ◦ Ab Abuse, neglect, psychological h l t h l i l harm, undued adverse medication consequences, widespread hospital-acquired infections Failure to provide: ◦ Adequate nutrition & hydration ◦ Safety from fire, smoke, and environment fire smoke hazards ◦ Initial medical screening, stabilization and safe transfers of patients with emergenc ith emergency medical conditions (EMTALA) Failure to correctly identify p y y patients Failure to safely administer blood products
  6. 6. CMS Value-Based Purchasing: Value- Linking Federal Reimbursement to Clinical g PerformanceOver the next five years, approximately 6% of inpatient Medicarereimbursements to hospitals will be linked to clinical performance (exclusiveof M f Meaningful Use i i f l U incentives). ti )• CMS has stated its intention to extend the performance-based reimbursement to the state-run Medicaid program.This is not only federal administrative intent it is law intent, law.• Affordable Care Act mandates “Value-Based Purchasing” in the Medicare program and stipulates: Payment tied to hospital performance on core measures and HCAHPS. Decreased reimbursement for high readmission rates. Decreased reimbursement for high rates of HACs.2011 2012 2013 2014 2015 2016 2017 2018 2019 Hospital Value‐Based Purchasing (1‐2%; Phased in over 4 Years) 1.00% 1.25% 1.50% 1.75% 2.00% Hospital Readmissions (1‐3%; Phased in over 3 Years) 1.00% 1 00% 2.00% 2 00% 3.00% 3 00% Hospital Acquired Conditions (1%) 1.00%
  7. 7. CMS Value Based PurchasingAffordable Care Act, Section 3001◦ CMS funds the VBP program by reducing the base operating DRG payment amount by an amount equal to the amount the hospital can earn in a VB incentive payment (i.e. no increase in overall Medicare spending for IP stays) 2013 = 1.0% = $850M to be awarded to hospitals 2014 = 1.25% 2015 = 1.5% 2016 = 1 75% 1.75% 2017 = 2.0% All subsequent years = 2.0%◦ Possible impact: p Predict that 9% of hospital payments and 11% MD payments affected by 2016 The only way to ensure full payback is to hit the benchmark on every measure.
  8. 8. CMS Value Based PurchasingProposed rule released Jan. 7, 2011; Final rule released April 29, 20112 Domains◦ Process (core) measures (17 12)◦ HCAHPS (8 dimensions) Will not use “willingness to recommend” “cleanliness” and “quietness” indicators will be combined (average of the individual domain scores)All measures within a domain are equally weightedThe two domains are weighted differently◦ Process measures (70%)◦ HCAHPS (30%)Points assigned for:◦ (a) level of achievement and◦ (b) improvement
  9. 9. Incentive Payment Calculations ◦ CMS will notify each hospital of their estimated amount via QualityNet account at least 60 days prior to Oct 1, 2012 ◦ CMS will notify each hospital of the exact amount on Nov 1, 2012. ◦ Th Those hospitals with hi h TPS will h it l ith higher ill receive higher payments ◦ Will use a linear exchange function to calculate the % of payment
  10. 10. Linear Exchange CurveVBP payments are based upon the slope of the linear exchangeline. The slope of the linear exchange is determined by theaggregate performance of all US hospitals.
  11. 11. Core Measure Selection
  12. 12. FY 2013 Clinical Process Measures 20
  13. 13. FY 2013 HCAHPS Measures Nurse Communication Composite Doctor Communication Composite Cleanliness and Quietness Composite (New C (N Composite)it ) Responsiveness of Hospital Staff Composite Pain Management Composite Communication About Medications Composite Discharge Information Composite Overall Rating
  14. 14. HCAHPS Scoring Achievement ◦ Scoring is done at the individual measure level Hospital performance: Equal to or greater than the Benchmark = 10 point Hospital performance: Less than the Benchmark but equal to or greater than the Achievement Threshold = 1 – 9 points based on a linear scale for the achievement range Hospital performance: Less than the Achievement Threshold = 0 points Improvement ◦ Scoring is done at the individual measure level Hospital performance: Greater than its baseline period score but less Benchmark = 0 – 9 points b B h k i t based on a li d linear scale f th i l for the improvement t range Hospital performance: Equal to or lower than is baseline period on the measure = 0 points Hospital earns the greater of the two NEW FACTOR: Consistency ◦ How well the hospital performed on all the HCAHPS dimensions (applicable to HCAHPS measures only) (0-20 points) ◦ Hospital performance: All HCAHPS dimensions exceed the achievement threshold
  15. 15. HCAHPS Scoring Example
  16. 16. VBP MetricsHeavilyyInfluenced byNursing Care
  17. 17. FY 2014 VBP RevisedNov 1, 2011◦ CMS will NOT include the following: OUTCOME MEASURES HACs AHRQ composites EFFICIENCY MEASURESWeight percentage revisions in 2014:◦ HCAHPS = 30%◦ Outcomes (Mortality) = 25%◦ Clinical Performance (core) Measures = 45%Performance Period◦ Clinical Performance & HCAHPS (4/1/2012 – 12/31/2012)◦ 30 day Mortality (7/1/11 – 6/30/12)
  18. 18. AHRQ is is….. The health services research arm of the U.S. Department of Health and Human Services (HHS), complementing the biomedical research mission of it sister agency, th National Institutes of h i i f its i t the N ti l I tit t f Health. Home to research centers that specialize in major areas of health care research: ◦ Quality improvement and patient safety. ◦ Outcomes and effectiveness of care. ◦ Clinical practice and technology assessment. ◦ Health care organization and delivery systems. g y y ◦ Primary care (including preventive services). ◦ Health care costs and sources of payment. A major source of funding and technical assistance for health services research and research training at leading U.S. universities and other institutions. A science partner, working with the public and private sectors to build the knowledge base for what works—and does not work—in health and health care and to translate this knowledge into everyday g y y practice and policymaking.
  19. 19. AHRQ Indicators The Patient Safety Indicators are part of a set of software modules of the Agency for Healthcare Research and Quality ( (AHRQ) Quality Indicators ( ) y (QIs) ) developed by the University of California, San Francisco–Stanford University Evidence-based Practice Evidence based Center and the University of California, Davis under a contract with AHRQ. The Patient Safety Indicators were originally released in 2003 2003.
  20. 20. AHRQ Inpatient Quality IndicatorsInpatient Quality Indicators Can be used to help hospitals identify potential problem areas that might need further study, study as well as for quality improvement, comparative public reporting trending and pay improvement reporting, trending, pay- for performance initiatives. Can provide an indirect measure of in hospital quality of care by using administrative data found in a typical discharge record. Include mortality indicators for conditions or procedures for which mortality can vary from hospital to hospital. Include utilization indicators for procedures for which utilization varies across hospitals or geographic areas. areas Include volume indicators for procedures for which outcomes may be related to the volume of those procedures performed. Are free and publicly available. A f d bli l il bl Include risk adjustment where appropriate.
  21. 21. AHRQ Inpatient Quality Indicators Hospital-level procedure utilization rates • Cesarean section delivery • Primary cesarean delivery Mortality rates for conditions y • Acute myocardial infarction (AMI) • Vaginal birth after cesarean, uncomplicated transfer • AMI without • Vaginal birth after cesarean, all • Congestive heart failure • Incidental appendectomy in the • Gastrointestinal hemorrhage elderly • Bilateral cardiac catheterization • Hip fracture •PPneumonia i • Laparoscopic cholecystecomy • Acute stroke Area-level utilization rates (county, State) rates for Mortality • Coronary artery bypass graft procedures •H t Hysterectomy t • Abdominal aortic aneurysm repair • Laminectomy or spinal fusion • Coronary artery bypass graft • Craniotomy • Percutaneous transluminal coronary angioplasty • Esophageal resection • Hip replacement • Pancreatic resection Volume of procedures • Percutaneous transluminal coronary • Abdominal aortic aneurysm repair angioplasty • Carotid endarterectomy • Carotid endarterectomy • Coronary artery bypass graft • Esophageal resection • Pancreatic resection • Percutaneous transluminal coronary angioplasty
  22. 22. AHRQ Patient SafetyIndicatorsPatient Safety Indicators Can be used to help hospitals and health care organizations assess, monitor, p p g track, and improve the safety of inpatient care. Can be used for comparative public reporting and pay-for-performance initiatives. Can identify potentially avoidable complications that result from a patient’s exposure to the health care system. Include hospital-level indicators to detect potential safety problems that occur during d i a patient’s h ti t’ hospital stay. it l t Include area-level indicators for potentially preventable adverse events that occur during a hospital stay to help assess total incidence within a region. Are publicly available at no charge to the user. Include risk adjustment where appropriate.
  23. 23. AHRQ Patient SafetyIndicatorsindicators Hospital-level Death in low-mortality diagnosis-related groups Pressure ulcer Death among surgical inpatients with treatable serious complications Foreign body left in during procedure Iatrogenic pneumothorax Central venous catheter-related bloodstream infections Postoperative hip fracture Postoperative hemorrhage or hematoma Postoperative physiologic and metabolic derangements Postoperative respiratory failure Postoperative pulmonary embolism or deep vein thrombosis Postoperative sepsis Postoperative wound dehiscence Accidental puncture or laceration Transfusion reaction Birth trauma—injury to neonate Obstetric trauma—vaginal delivery with instrument Obstetric trauma—vaginal delivery without instrument
  24. 24. AHRQ Patient Safety and Inpatient Quality Indicators Hospital Compare – 4Q2008 thru 2Q20105) No data are available for publication from thehospital for this measure Data Source: Hospital Compare October 2011 . (
  25. 25. AHRQ StrategiesAHRQ Strategies Individual case review Professional peer review Validate use of evidenced based practices Quality of documentation & accuracy of coding
  26. 26. Potential Future Measures andChangesCh In 2013, hospitals will receive a payment reduction if they have excess 30-day readmissions for patients with AMI, HF, y p , , and PN. By 2015, a portion of Medicare payments will be linked to Meaningful Use Hi Technology Over time, scoring methodologies will be weighted more heavily towards outcome, patient experience, and functional status measures. In 2015, hospitals with certain Hospital Acquired Conditions (HAC’s) ill (HAC’ ) will receive additional payment reductions f i dditi l t d ti from Medicare With more to come…………. come
  27. 27. CMS Physician Quality Reporting System(PQRS) Formerly known as PQRI (initiative) Established by 2006 Tax Relief & Health Care Act ◦ Required establishment of a PQRS ◦ Including an incentive payment for eligible professionals who report data on q p quality measures for covered y professional services furnished to Medicare beneficiaries Annual CMS rulemaking process for each program year ◦ Program requirements and measure specifications may be different year to year diff t t Eligible professionals may choose to report quality measures or measure groups: ◦ To CMS on Medicare Part B claims ◦ To a qualified PQRS registry ◦ To CMS via a qualified EHR product
  28. 28. PQRI Financial Incentives/Penalties for participation ◦ Incentives: 1.0% in 2011, 0.5% in 2012- , 2014 ◦ Penalties: -1.5% in 2015, -2.0% in 2016 and beyond 2009 Experience Report Highlights ◦ $234 million total payout ◦ Average $1,956 p eligible p g per g professional/ $18,525 per practice
  29. 29. PQR Eligible Professionals1. Medicare physicians ◦ Doctor of Medicine ◦ Doctor of Osteopathy ◦ Doctor of Podiatric Medicine ◦ Doctor of Optometry ◦ Doctor of Oral Surgery ◦ Doctor of Dental Medicine ◦ Doctor of Chiropractic2. Practitioners ◦ Physician Assistant ◦ Nurse Practitioner ◦ Clinical Nurse Specialist ◦ Certified Registered Nurse Anesthetist (and Anesthesiologist Assistant) ◦ Certified Nurse Midwife ◦ Clinical Social Worker ◦ Clinical Psychologist ◦ Registered Dietician ◦ Nutrition Professional ◦ Audiologists A di l i t
  30. 30. PQR Eligible Professionals3. Therapists p ◦ Physical Therapist ◦ Occupational Therapist p p ◦ Qualified Speech-Language Therapist Eligible But Not Able to Participate ◦ Eligible to participate but are not able to participate for one or more reasons (specifics listed in www.cms.gov/PQRS)
  31. 31. 2011 PQR Measures List
  32. 32. 2012 PQR Group Measures
  33. 33. CMS Public Reporting Metrics
  34. 34. Future Public Measure Changes
  35. 35. 2012 and beyond….looking ahead…. Four primary buckets of quality metrics: ◦ CMS VBP measures ◦ CMS HQA IPPS measures ◦ CMS HQA OPPS measures ◦ TJC Core Measures TJC Accountability of Care Measures or TJC Non-Accountability of Care Measures
  36. 36. CMS HQA Measures: Current/Future Public Reporting per OPPS 2011 Final Rule1Measures collected in one year are used to determine Annual Payment Update status for the subsequent year.2Medicare patients only, administrative claims based data
  37. 37. Joint CommissionCore MC Measure R Requirements i t Hospitals are only required to submit data on four measure sets: ◦ AMI ◦ HF ◦ PN ◦ Surgical Care Improvement Project (SCIP) ◦ Perinatal ◦ VTE ◦ Stroke ◦ Behavioral Health (HBIPS) ◦ Children’s Asthma Care (CAC) ◦ Outpatient O t ti t ◦ ED Chart Abstracted Measures ◦ IMM
  38. 38. TJC Accountability Measures Accountability measures are now used by TJC to identify their Top Performers on JC Key Quality Measures Top Performer – 95% on each and all measures Based on 2010 data AMI, HF, PN, SCIP and CAC ◦ In January, 2012 the f following measure sets were added: HBIPS (6 indicators) Stroke (5 indicators) VTE (8 indicators) Changes to current measure set (1 new indicator for AMI, PN, & SCIP) Composite Score – 85% target rate for accountability measures. Facilities not meeting 85% target will receive a Direct Impact RFI (ESC submission within 45 days) y ) Re-evaluate your measure selection decision The last time hospitals could make a measure selection change: December, 2011
  39. 39. Managed Care VBP Engaging in P4P initiatives ◦ Appropriate use of Surgical Safety Checklists Monitoring hospital public reported M it i h it l bli t d metrics ◦HHospital C it l Compare ◦ Leapfrog ◦ Others Using quality data to manage contract (re)negotiations Using quality data for steerage
  40. 40. First Do No Harm…….. “It may seem a strange y gprinciple to enunciate as the very first y requirement in a Hospital that it should p do the sick no harm.” - Florence Nightingale, Notes g g on Hospitals, 1859
  41. 41. CMS Hospital-Acquired Conditions Hospital-(HAC) Proposed rule released Feb 17, 2011 Final rule released June 1 2011 1, Requirements effective July 1, 2011 ◦ States have option to delay implementation through July 1, 2012 Prohibits federal payments (Medicare & Medicaid) for 27 HAC’s ◦ Excludes DVT/PE for total hip & knee replacement for pediatric and obstetric populations ◦ Includes state managed care contracts New T N Terms ◦ Provider Preventable Conditions (PPC) – two categories: Healthcare Acquired Conditions (HCAC) – current Medicare HAC’s Other Provider Preventable Conditions (OPPC) – state specific
  42. 42. CMS Hospital-Acquired Conditions Hospital-(HAC) OPPC gives states leeway to add additional preventable conditions to the list (with CMS approval) for Medicaid ( pp ) nonpayment. ◦ Also allows nonpayment provisions beyond IP hospital setting (i.e. OP) ◦ Minimally must include: Wrong surgical or other invasive procedure patient, site, or procedure Projected impact: ◦ 1:15,000 surgery procedures results in RFB ◦ Average cost of RFB is $63K per hospital stay (CMS) ◦ After legal defense & indemnity payments = $166K ◦ Medicare = withhold of approximately 20M per year ◦ Medicaid = cost savings of 2M for FY 2011 ◦ Aggregate cost savings of 35M for FY 2011 through 2015 20M for Federal share 15M for State share
  43. 43. Public Perception
  44. 44. HAC Top Performer 5ThemesFacilities with zero (or the fewest) HACs based on10 quarters of coding data1.1 Engaged leadership 1. Support and enforce for accountability at the unit level2. Evaluate daily process measures 1. MEDITECH NPR reports to evaluate length of time with a p g foley and/or central line/PICC3. Rounding daily by clinical experts (Infection Preventionist, Clinical Nurse Specialist, etc.) 1. Educating nurses and physicians based on facility needs 2. Questioning on clinical justification for urinary catheters and/or central line/PICC4. Supportive physician champion 1. 1 Engaged physician champion and medical staff5. Review process 1. Charts coded POA=N for HACs reviewed before bill is dropped
  45. 45. ChallengesRapid expansion of Growth in hospital andmeasures physician P4P programsCombination of clinical, ◦ Physician Quality Reportingexperience, and outcome p System (PQRS)measures Types of performanceFocus on episode of targetsillness Types of financialPatients crossing incentivesmeasure sets (IP & OP) ( ) Care management redesign Staffing costs
  46. 46. Building a Culture“We must stop putting silos around the various facets of healthcare.”“The ti t“Th patient experience i not an i l t d event. Rather, it is the sum of all interactions, i is t isolated t R th i th f ll i t tishaped by an organizations culture, that influence patient perceptions across thecontinuum of care.”“…the patient experience is comprised of every impression and encounter a patient (or thefamily member) has with your health system.”“Like it or not, the patient experience is the holy grail for healthcare providers. That said,hospitals need to focus on their culture, not on their grade…..We need to keep the focuson th patient.” the ti t ”“Building relationships with patients is the single most important thing hospitals can do tomake a lasting change in the delivery of care. When the focus is on building a relationshipwith every patient, every time, there is better communication, better compliance, bettercoordination of care, and better outcomes. And yes, an enhanced bottom line as well.” Whitehurst, S. (September 30, 2011). Patient Experience: Hospitals Holy Grail? HealthLeaders Media 59
  47. 47. Interdisciplinary Ownership Everyone at every level needs to “own” the quality agenda: Senior Leaders Directors Quality Pharmacy Nursing: Leaders Charge Nurses g Unit Staff Unit Clerks Emergency Department Surgery Department Nursing Supervisors Case Management Medical Staff 60
  48. 48. As a result…………… result Priorities/Initiatives…………must be directly li k d to: di l linked ◦ building a culture of patient centered excellence ◦ pay for performance activities ◦ current and future public reporting metrics p p g ◦ evidence-based practice guidelines Investment in the infrastructure of your facility Quality Program is critical to your facility’s future success! f ilit ’ f t !
  49. 49. Questions/Comments

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