1 © 2013 Amphion Medical Solutions 1 B RENDA B ARTKOWSKI, CMA, CCA, BS HPA M ANAGER, C LINICAL D ATA A BSTRACTION A MY W IRTH S ALES E XECUTIVE J ULY 17, 2013 What’s Hot & What’s Not in the Core Measure Field

2 © 2013 Amphion Medical Solutions 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.

3 © 2013 Amphion Medical Solutions 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 What’s

4 © 2013 Amphion Medical Solutions 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 What’s

5 © 2013 Amphion Medical Solutions Value-Based Purchasing (VBP) How?  Must report on minimum of 4 Hospital VBP measures  Minimum of 10 cases per measure What’s

6 © 2013 Amphion Medical Solutions Value-Based Purchasing (VBP) When?  Began with FY2013  Participating hospitals already receiving incentive payments What’s

7 © 2013 Amphion Medical Solutions This information on Hospital Value Based Purchasing was retrieved from the National Provider Call on HVBPg from March 14, What’s FY 2015 Finalized Domains and Measures/Dimensions

8 © 2013 Amphion Medical Solutions What’s 12 Clinical Process of Care Measures 1AMI-7a Fibrinolytic Therapy Received within 30 Minutes of Hospital Arrival 2AMI-8 Primary PCI Received within 90 Minutes of Hospital Arrival 3HF-1 Discharge Instructions 4PN-3b Blood Cultures Performed in the ED Prior to Initial Antibiotic Received in Hospital 5PN-6 Initial Antibiotic Selection for CAP in Immunocompetent Patient 6SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour Prior to Surgical Incision 7SCIP-Inf 2 Prophylactic Antibiotic Selection for Surgical Patients 8SCIP-Inf-3 Prophylactic Antibiotics Discontinued within 24 Hours After Surgery 9SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m. Postoperative Serum Glucose 10SCIP-Inf-9 Postoperative Urinary Catheter Removal on Postoperative Day 1 or 2 11SCIP-Card-2 Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the Perioperative Period 12SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis within 24 Hours

9 © 2013 Amphion Medical Solutions What’s 8 Patient Experience of Care Dimensions 1Nurse Communication 2Doctor Communication 3Hospital Staff Responsiveness 4Pain Management 5Medicine Communication 6Hospital Cleanliness & Quietness 7Discharge Information 8Overall Hospital Rating

10 © 2013 Amphion Medical Solutions What’s 5 Outcome Measures 1 Efficiency Measure Represents a new measure for the FY 2015 program that was not in the FY 2014 program. 1MORT-30-AMI – Acute Myocardial Infarction (AMI) 30-day mortality rate 2MORT-30-HF – Heart Failure (HF) 30-day mortality rate 3MORT-30-PN – Pneumonia (PN) 30-day mortality rate 4PSI-90 – Patient safety for selected indicators (composite) 5CLABSI – Central Line-Associated Bloodstreem Infection 1MSPB-1 Medicare Spending per Beneficiary measure Measure / DimensionRate Clinical Process of Care MeasuresHigher is better Patient Experience of Care DimensionsHigher is better Mortality Measures (Survivability)Higher is better

11 © 2013 Amphion Medical Solutions 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. What’s

12 © 2013 Amphion Medical Solutions What’s Proposed Weights VBP Measure Process of Care20%10% Patient Experience30%25% Outcome30%40%50% Efficiency20%25% Safety15%

13 © 2013 Amphion Medical Solutions  EPs that began participation in 2011 or 2012  EPs that began participation this year (2013)  EPs that plan to begin participation in 2014 What’s

14 © 2013 Amphion Medical Solutions ▪ 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 What’s

15 © 2013 Amphion Medical Solutions ▪ Clinical Quality Measures for Stage 1 ▫ ED = 2 ▫ STK = 7 ▫ VTE = 6 ▪ Clinical Quality Measures for Stage 2 ▫ ED = 3▫ PN = 1▫ Early Hearing Detection = 1 ▫ STK = 7▫ SCIP = 3▫ Healthy Newborn = 1 ▫ VTE = 6▫ PC = 2 ▫ AMI = 4 What’s

16 © 2013 Amphion Medical Solutions ▪ Highlights of MU Stage 2 Objectives ▫ Use CPOE▫ Use certified HER technology ▫ Record demographics▫ Medication reconciliation and ▫ Record/chart changes summary of care ▫ Record smoking status▫ Submit electronic data ▫ Use clinical decision support▫ Automatically track medications ▫ Provide patients access to their info ▫ Protect electronic health info ▫ Import lab results ▫ Generate lists What’s

17 © 2013 Amphion Medical Solutions  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 What’s Not

18 © 2013 Amphion Medical Solutions  Measure Suspension▪ Measure Refinement ▫ AMI – 1 ▫ SCIP-Inf-4 ▫ AMI - 3 ▫ AMI - 5 ▫ SCIP-Inf-6 ▪ Measure Retirement ▫ AMI▫ IMM ○ AMI-2 ○ IMM-1 ○ AMI-10▫ SCIP ▫ PN ○ SCIP-Inf-10 ○ PN-3b ▫ HF ○ HF-1 ○ HF-3 What’s Not

19 © 2013 Amphion Medical Solutions  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 What’s Not

20 © 2013 Amphion Medical Solutions  Validation ▫ ED ▫ IMM ▫ STK / VTE ▫ Quarterly Appeals What’s Not

21 © 2013 Amphion Medical Solutions 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

22 © 2013 Amphion Medical Solutions  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 2014 – the higher of the Ratio or 0.97 (3% reduction) What’s Not

23 © 2013 Amphion Medical Solutions  Outpatient Prospective Payment System (OPPS) Proposed Rule with Comment Period ▫ CY 2014 now on display ▫ Program requirements and proposed changes are included ▫ CMS encourages participation ▫ Comments due by 11:59 p.m. (ET) September 6, 2013 ▫ Final Rule scheduled for November 2013 OPPS

24 © 2013 Amphion Medical Solutions Medicare’s Hospital VBP Scores are now available: 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: purchasing/index.html?redirect=/Hospital-Value-Based-Purchasing/ OR Medicare’s “Hospital Compare”: CMS’s readmissions reduction program: and Proposed Rule Site: Comment Site: purchasing/index.html?redirect=/Hospital-Value-Based-Purchasing/ Resources

25 © 2013 Amphion Medical Solutions Amphion’s Core Measures Solutions What’s right now? Outsourcing Core Measures! What’s Not? Overworked hospital staff

26 © 2013 Amphion Medical Solutions 26 For more information on Amphion’s solutions, contact Amy Wirth at x1634 or Thank you for the opportunity to speak with you today