Hospital Rewards Program: Data Reporting and Scoring J. Dennis Bush February 6, 2006

Leapfrog Hospital Rewards Program Data & Reporting Requirements Objectives Minimize additional reporting burden for hospitals Rely on existing reporting systems, i.e., LFG hospital survey, JCAHO Core Measures Parallel formats and processes already in place for any new data, e.g., data formats, severity adjustment processes Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Leapfrog Hospital Rewards Program Data Requirements Leapfrog Hospital Quality and Safety Survey JCAHO Core Measures Leapfrog Resource-Based Efficiency Measures 1 2 3 Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Data Reporting: Process Flow 1 Leapfrog Patient Safety Survey Program Licensees Leapfrog Survey Results Clinical Area-specific Scores: Quality Resource-Based Efficiency JCAHO Core Measures Data Aggregation and Scoring 2 Hospital Leapfrog JCAHO Quality-only Vendor* 3 Full-Service Data Vendor New Data Licensees LFG Efficiency Measures Hospital Feedback via Vendors * Hospitals may split data submission: - quality data through existing “quality-only” JCAHO CMV - efficiency data through Leapfrog-approved full-service vendor Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Leapfrog Hospital Rewards Program Data Requirements Leapfrog Hospital Quality and Safety Survey Required for LHRP participation in ANY clinical area Current survey, including affirmations Latest (new cycle) survey as of May 31 for Jul 1 results Latest survey as of Nov 30 for Jan 1 results LHRP participating hospitals also complete “authorization & release” at on-line survey Partial completion: no points earned for that component Example: process compliance not measured 1 Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Leapfrog Hospital Rewards Program Data Requirements JCAHO Core Measures Objective: no additional reporting burden Core Measures must be reported for clinical area(s) Copy of JCAHO data submission to LFG add LFG hospital identifier split HCO into component hospitals (<1%) extraneous data ignored on submission, e.g., heart failure, unused measures Timing quarterly 15-30 day lag after JCAHO deadlines 2 Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Leapfrog Hospital Rewards Program Data Requirements Leapfrog Resource-Based Efficiency Measures By clinical area for which hospital participates in LHRP Actual length of stay (LOS), routine and special* Severity-adjusted expected LOS, routine and special** # cases with readmit following discharge, within 14 days, same hospital, any condition at readmit 3 * Total length of stay for Deliveries ** See details about risk adjustment models at http://leapfrog.medstat.com/hpr Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Core Measure Vendors Play Critical Role All hospitals must work through Leapfrog-approved “full-service” Core Measure Vendor Register hospitals Hospital authorization for data release Participation options: Time periods Clinical areas Masked/identified election Assist hospitals with added efficiency measures Pay hospital participation fees to Leapfrog Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Core Measure Vendors Play Critical Role (cont’d) Submit JCAHO and LFG efficiency data to national aggregator; decertify or replace bad data Track data confirmations and data/program status of hospitals Re-distribute hospital-specific results from Leapfrog Vendor-only access to secure Web portal for hospital registration, data submission, status, and hospital-specific results Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Vendor Qualifications Operating as approved JCAHO Core Measures vendor Commit to support LFG efficiency measures Successfully submit test data to national aggregator Contract with Leapfrog re: roles and responsibilities Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Leapfrog Hospital Rewards Program Scoring Weights Scoring component measures Composite score Rankings on each axis Quality Resource-Based Efficiency rankings Performance groups (4) . . . by clinical area . . . for participating hospitals Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Leapfrog Hospital Rewards Program Quality Weighting % Weight is assigned to each measure Represents maximum points available for a measure Add to 100%; possible composite score 0 – 100% Basis1: 46% for mortality-related measures 29% for morbidity-related measures 25% for complication-related measures Allocated evenly for measures within category, unless evidence of odds-ratio differences See Weighting details in addenda and at http://leapfrog.medstat.com/hpr 1 Pauly, M.V., Brailer, D.J., Kroch, E., and O. Even-Shoshan. "Measuring Hospital Outcomes from a Buyer's Perspective." American Journal of Medical Quality. Vol. 11(8):112-122, Fall 1996. Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Scoring Example: Pneumonia Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Leapfrog Hospital Rewards Program Scoring Component Measures – Efficiency Derive relative severity index from expected LOS Standardize actual LOS for severity differences Adjust total standardized LOS for readmissions = std LOS * (1 + readmit rate) Score = # standard deviations better/ (worse) than all-group average adjusted LOS . . . by clinical area Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Scoring Example: Overall – Deliveries Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Leapfrog Hospital Rewards Program Ranking Overall Quality and Efficiency Scores Four tiers along each axis 1: Best quartile 2: Not significantly below best quartile (p > .10) 3: Significantly below best quartile (p < .10) 4: Significantly below best quartile (p < .05) Cohorts – performance on both axes Top cohort = 1st tier (best quartile) on both axes Bottom cohort = 4th tier on either axis . . . by clinical area Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Hospitals Arrayed in Four Groups Example: Pneumonia Cohort 1 Cohort 2 Average Cohort 3 Cohort 4 Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Process Timeline – Baseline In process Due Date Corrections Closed 2006 2007 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Inbound Data Processing Outbound Data Validation/Confirmation Aggregation/Scoring Plan Data History Re-Scoring/Computing Rewards Paid Hospital Feedback/Benchmarks Plans & Purchasers Program Reporting Other Events JCAHO Core Measures Efficiency – ALOS & Readmit LFG Survey Results 3Q05 4Q05 3Q-4Q05 ’06 3Q 4Q 3Q, 4Q Initial rewards for top performers at implementer’s option ’06 Program Changes (v1.1) Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Process Timeline – Ongoing In process Due Date Corrections Closed 2006 2007 2008 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Jan Mar May Jul Dec Feb Apr Jun Inbound Data Processing Outbound Data Validation/Confirmation Aggregation/Scoring Plan Data History Re-Scoring/Computing Rewards Paid Hospital Feedback/Benchmarks Plans & Purchasers Program Reporting Other Events JCAHO Core Measures Efficiency – ALOS & Readmit LFG Survey Results . . . . . . Cycle 1 . . . . . . . . . . . . Cycle 2 . . . . . . . . . . . . Cycle 3 . . . . . . . . . . . . Cycle 4 . . . . . . . . . . . . Cycle 5 . . . . . . 3Q05 4Q05 1Q06 2Q06 3Q06 4Q06 1Q07 2Q07 3Q07 4Q07 3Q-4Q05 1Q, 2Q06 3Q, 4Q06 1Q, 2Q07 3Q, 4Q07 ’06 ’06 ’07 ’07 ’08 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 3Q, 4Q 1Q, 2Q 3Q, 4Q 1Q, 2Q 3Q, 4Q Base period plus two periods improvement or sustained top performance ’07 Program Changes (v2.0) ’08 Program Changes (v3.0) CMV Contract turnover CMV Contract turnover Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Addenda Scoring Details

Leapfrog Hospital Rewards Program Scoring Component Measures – Quality Continuous measures, e.g., % compliance Example: AMI - aspirin at arrival (weight 16.06%) 72.3% compliance x 16.06% = 11.61% contribution to total score multiple compliance measures within category are further weighted by denominators of each measure Graded/categorical measures, e.g., LFG partial credit results Example: Pneumonia - Leapfrog Quality Index (weight 12.5%) Fully implemented = full weight (12.50%) Good progress = 2/3 of weight (8.33%) Good early stage effort = 1/3 of weight (4.17%) Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Leapfrog Hospital Rewards Program Scoring Component Measures – Quality (cont’d) Risk-adjusted rates, e.g., % mortality rate Example: Deliveries – 3rd/4th degree lacerations (weight 8.33%) Percent rank (0 – 100%), where 0 = worst, 100 = best, times weight All or none, e.g., LFG NICU average census Example: NICU average daily census 15+ for hospitals electively admitting high-risk deliveries (weight 23.0%) Yes = 23.0% No (or no NICU) = 0.0% Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Weighting & Scoring – AMI Measure Source Weight Scoring Inpatient mortality JCAHO (AMI=9) 15.33% Percent rank (0% = worst, 100% = best) times 15.33% weight Aspirin at arrival (AMI-1) 16.06% % compliance times weight Beta blocker at arrival (AMI-5) 14.61% Aspirin prescribed at discharge (AMI-2) 4.83% Beta blocker prescribed at discharge (AMI-6) ACEI for LVSD (AMI-3) Thrombolytic agent received within 30 minutes of arrival (AMI-7a) PCI with door-to-balloon time within 90 minutes of arrival LFG Adult smoking cessation advice/ counseling (AMI-4) Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Weighting & Scoring – AMI (cont’d) Measure Source Weight Scoring Computerized physician order entry (CPOE) LFG 8.33% Fully implemented: Full credit (8.33%) Good progress: 2/3 credit (5.55%) Good early stage effort: 1/3 credit (2.78%) … else no credit Intensivist ICU staffing (IPS) Leapfrog Quality Index (NQF Safe Practices) Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Weighting & Scoring – CABG Measure Source Weight Scoring Mortality LFG 34.00% Full credit if Public risk-adjusted mortality rate better than state median OR STS risk-adjusted mortality rate better than national average … else no credit Volume 12.00% Volume ≥ 450 Prophylactic antibiotic received within one hour prior to surgical incision JCAHO (SIP-1b) 3.50% % compliance times weight Prophylactic antibiotic selection for surgical patients (SIP-2b) Prophylactic antibiotics discontinued within 24 hours after surgery end time (SIP-3b) Process measures: CABG using internal mammary artery Aspirin at discharge Beta blocker within 24 hours after surgery Beta blockers prescribed at discharge Lipid-lowering therapy prescribed at discharge Extubation within 24 hours after surgery 9.25% + % compliance times weight for two highest compliance rates of up to six measures reported … else no credit if not measured Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Weighting & Scoring – CABG (cont’d) Measure Source Weight Scoring Computerized physician order entry (CPOE) LFG 8.33% Fully implemented: Full credit (8.33%) Good progress: 2/3 credit (5.55%) Good early stage effort: 1/3 credit (2.78%) … else no credit Intensivist ICU staffing (IPS) Leapfrog Quality Index (NQF Safe Practices) Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Weighting & Scoring – PCI Measure Source Weight Scoring Mortality LFG 34.00% Full credit if Public risk-adjusted mortality rate better than state median OR ACC risk-adjusted mortality rate better than national average … else no credit Volume 12.00% Volume ≥ 400 Process measures: Aspirin at arrival 1st balloon inflation within 90 minutes 14.50% 14.50% % compliance times weight for each measure … else no credit if not measured Computerized physician order entry (CPOE) 8.33% Fully implemented: Full credit (8.33%) Good progress: 2/3 credit (5.55%) Good early stage effort: 1/3 credit (2.78%) Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Weighting & Scoring – PCI (cont’d) Measure Source Weight Scoring Intensivist ICU staffing (IPS) LFG 8.33% Fully implemented: Full credit (8.33%) Good progress: 2/3 credit (5.55%) Good early stage effort: 1/3 credit (2.78%) … else no credit Leapfrog Quality Index (NQF Safe Practices) Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Weighting & Scoring – Pneumonia Measure Source Weight Scoring Initial antibiotic received within 4 hours of hospital arrival JCAHO (PN-5b) 5.50% Percent rank (0% = worst, 100% = best) times 5.50% weight Influenza vaccination (PN-7) 7.50% % compliance times weight Pneumococcal vaccination (PN-2) 12.00% Adult smoking cessation advice/ counseling (PN-4) Intensivist ICU staffing (IPS) LFG 13.50% Fully implemented: Full credit (13.50%) Good progress: 2/3 credit (9.00%) Good early stage effort: 1/3 credit (4.50%) … else no credit Oxygenation assessment (PN-1) 14.50% Blood cultures (collected prior to antibiotic administration) Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Weighting & Scoring – Pneumonia (cont’d) Measure Source Weight Scoring Computerized physician order entry (CPOE) LFG 12.50% Fully implemented: Full credit (12.50%) Good progress: 2/3 credit (8.33%) Good early stage effort: 1/3 credit (4.17%) … else no credit Leapfrog Quality Index (NQF Safe Practices) Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006

Weighting & Scoring – Deliveries Measure Source Weight* Scoring Inpatient neonatal mortality JCAHO (PR-2) 23.00% or 60.50% Percent rank (0% = worst, 100% = best) times 23.00% or 60.50% weight NICU census * LFG 23.00% or 0.00% Full credit if NICU census ≥ 15 … else no credit Antenatal steroids for certain high-risk deliveries * 29.00% or 0.00% % compliance times weight (if measure is applicable) Third- or fourth-degree lacerations (PR-3) 8.33% or 13.17% 8.33% or 13.17% weight Computerized physician order entry (CPOE) Fully implemented: Full credit (8.33% or 13.17% ) Good progress: 2/3 credit (5.55% or 13.17% ) Good early stage effort: 1/3 credit (2.78% or 13.17% ) Leapfrog Quality Index (NQF Safe Practices) Fully implemented: Full credit (8.33%) Good progress: 2/3 credit (5.55%) Good early stage effort: 1/3 credit (2.78%) * For a hospital indicating in its Leapfrog survey responses that it electively admits high-risk deliveries (mothers expected to deliver complicated newborns), NICU census and Antenatal steroids measures do not apply. The weights associated with these measures are allocated to the remaining measures and the second set of weights applies. Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/06/2006