Public Reporting for CAHs


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Public Reporting for CAHs

  1. 1. The Quality Reporting Landscape for CAHs<br />Andrei Kuznetsov, MA<br />May 25, 2010<br />MO-10-05-Gen Hosp May 2010This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy<br />
  2. 2. Topics to be covered<br />Pay-for-reporting and pay-for-performance<br />Trends in measurement of quality of care<br />Inpatient and outpatient measures<br />
  3. 3. Public Reporting<br />Dept of Health and Human Services<br /><br />The Joint Commission<br /><br />
  4. 4. Why report?<br />Public interest: Promote accountability/public disclosure<br /><ul><li>Empower consumers to make informed decisions
  5. 5. Encourage competition among providers</li></ul>Provider interest:<br /><ul><li>Pay-for-reporting for IPPS hospitals
  6. 6. No payment incentives for CAHs</li></li></ul><li>Pay-for-Performance?<br />Value-Based Purchasing for Medicare<br />CMS submitted report to Congress in 2007<br /><ul><li>Weighting of individual metrics
  7. 7. Reimbursement based on achievement and/or improvement</li></ul>Premier P4P demonstration project – ongoing<br />No payment for HACs – Hospital Acquired Conditions<br />
  8. 8. The Tale of Two Agencies<br />The Joint Commission (JCAHO)<br /><ul><li>Accreditation +
  9. 9. Before 1999, measured quality by using healthcare administrative data
  10. 10. Also, American Osteopathic Association (AOA)</li></ul>CMS (Centers for Medicare & Medicaid Services)<br /><ul><li>Payment => concern with cost and efficiency
  11. 11. Medical record review to measure quality since 1994</li></li></ul><li>Core Measure Pilot<br />Conducted by TJC in 1999 – 2001<br /><ul><li>Medical record review</li></ul>Clinical richness and relevance from medical records<br /><ul><li>Not available from administrative data
  12. 12. Through a labor intensive process</li></ul>Standardized process of measurement<br /><ul><li>The “Core” in Core Measures</li></li></ul><li>Public Reporting Timeline<br />Voluntary hospital reporting in 2002<br />Ten “starter set” measures (5 AMI, 2 HF and 3 PN)<br /><ul><li>Required with Nov-2003 discharges
  13. 13. 21 process of care measures with Jul-2006 discharges
  14. 14. 26: Jan-2007 discharges: 3 SCIP measures + AMI/HF mortality rates
  15. 15. 27: Jul-2007 discharges - add Pt experience of care (HCAHPS)
  16. 16. 30: Jan 2008 SCIP Inf 3 & 6 + PN 30-day standardized mortality rate </li></ul>Added Outpatient measures for surgical and chest pain pts<br />
  17. 17. Public Reporting Timeline: Jan-2009<br />44 measures in Jan-2009<br /><ul><li>Added SCIP Beta Blocker measure
  18. 18. Dropped PN-1 Oxygenation Assessment
  19. 19. Changed PN-5 – Abx from 4 hrs to 6 hrs from arrival
  20. 20. Added AMI, HF, PN 30-day standardized readmission rates
  21. 21. Added 9 AHRQ Pt safety/Inpatient Quality indicators
  22. 22. Added one nursing sensitive measure
  23. 23. Added one structural measure: Participation in Cardiac Surgery DB</li></li></ul><li>Public Reporting Timeline: Jan-2010<br />46 measures<br /><ul><li>Added SCIP Infection 9 and 10
  24. 24. Dropped AMI-6 Beta Blocker on Arrival
  25. 25. Added two structural measures: participation in
  26. 26. Stroke Database
  27. 27. Nursing Sensitive Care Database
  28. 28. Merged one AHRQ indicator with Nursing Sensitive measure</li></li></ul><li>Proposed Changes to Start Jan-2011<br />AMI: Statin at discharge<br />Drop one AHRQ measure<br />Add 10 Hospital Acquired Condition metrics:<br />Foreign object retained after surgery<br />Air embolism<br />Blood incompatibility<br />Pressure ulcers stages 3 and 4<br />Falls and trauma<br />Etc…<br />
  29. 29. Measures in the Pipeline<br />ED throughput <br />Global measures for flu and PN immunizations<br />Hospital Acquired Infections per CDC specs:<br />Central Line Associated Bloodstream Infections<br />Surgical Site Infections<br />
  30. 30. More Measures in the Pipeline<br />Registry-based measures, choose one of four sets:<br />ICD complications registry measures<br />Stroke registry measures<br />Cardiac Surgery Registry measures<br />Nursing sensitive care registry measures<br />
  31. 31. Beyond the Medical Record Abstraction<br />Minimize reliance on medical record abstraction<br />Use administrative data<br />Use existing data sources<br /><ul><li>Patient registries
  32. 32. Electronic Medical Records
  33. 33. Explore Stroke/VTE data submission from EMR</li></li></ul><li>Beyond the Process of Care<br />Keep process of care measures<br />Augment reporting with:<br /><ul><li>Outcome measures
  34. 34. Efficiency measures
  35. 35. Cost of care measures</li></li></ul><li>Meanwhile, on the TJC side…<br />Pregnancy and Related Conditions  Perinatal Care<br />Children’s Asthma Care<br />Emergency Department (Informational => Voluntary for CMS)<br />ICU<br />Stroke<br />Venous Thromboembolism<br />Hospital Based Inpatient Psychiatric Services<br />Nursing Sensitive Measures<br />Osteoporosis Management; Blood Management<br />
  36. 36. Outpatient Reporting – Voluntary for CAHs<br />Outpatient Chest Pain and surgery cases<br />Process measures requiring med record review<br />Imaging Efficiency Measures – from Medicare claims<br />MRI Lumbar Spine for Low Back Pain<br />Mammography Follow Up Rates<br />Abdomen CT Use of Contrast Material<br />Thorax CT Use of Contrast Material<br />
  37. 37. Support Infrastructure<br />CMS supplies:<br />CMS Abstraction and Reporting Tool – CART<br />Toll-free Helpdesk for CART and data submission issues<br />Pre-recorded Online Training Sessions<br />QIO to help with abstraction questions<br />You supply:<br />Staff time to identify cases for reporting<br />Staff time to review records, record and submit results<br />May engage a private vendor<br />
  38. 38. How to Volunteer<br /> <br />Hospitals – Inpatient Hospital Quality Alliance Pledge of Participation<br />Hospitals – Outpatient Registration HOP QDRP Participation HOP QDRP Pledge<br />At a minimum, one staff member will need to be registered as QualityNet Admin at all times<br />
  39. 39. Questions?<br />Contact Andrei Kuznetsov:<br /><br />