1. Florida Hospital Association Hospital Engagement Network (HEN) Office Hours Tuesday, August 20, 2013 9 – 10 a.m. EDT Audio for today’s presentation is broadcast via phone access only: Please Dial-in - 866.740.1260 (Access Code - 8416230) We will begin momentarily... thank you for standing by as we allow participants to connect

2. Agenda for Today’s Call Quality Reporting, Value-Based Purchasing and Penalty Programs HRET Improvement Leaders Fellowship & Other Upcoming Events Are You Ready for December 2013? Questions / Open Discussion 2

3. Timeline for Quality Initiatives

4. Inpatient Quality Reporting Program (IQR) FY2015 Payment Update Process measures –8 Stroke measures –6 VTE measures –1 Perinatal measure –Removed one SCIP measure HAI measures –MRSA –C.difficile –Healthcare professional influenza vaccination Claims-based Measures –30 day All Cause Risk Std readmission rate total hip/knee –Hospital wide all cause readmissions –Hip/knee complication following primary THA and TKA –Removed 8 AHRQ measures –Removed 8 HAC measures Patient’s Experience –3 care transition measures –2 “about you” measures

5. Inpatient Quality Reporting Program (IQR) –Incorporating a “planned readmission algorithm” into the 30 day readmission measures for FY 2014, and FY 2015 IQR program –Expands CLABSI and CAUTI measures to non-ICU locations (Jan 1, 2014) –SCIP-4 controlled 6 AM glucose for Cardiac Surgery Patients (Jan 1, 2014) –Medicare spending per beneficiary –FY 2016 Removes 7 measures Adds 5 measures (COPD readmission/mortality, Stroke readmission/mortality, and AMI payment per episode of care

6. Value Based Purchasing FY 2015 – –Additional measures CLABSI PSI Composite (PSI90) Medicare spending per beneficiary –Time period Process and HCAHPS = 1Q13-4Q13 Outcome – Mortality – 4Q2012-2Q13 Outcome AHRQ – 10/15/12-6/30/13 CLABSI - 1Q13-4Q13 Efficiency – 5/1-12/31/13

8. Hospital Readmissions Reduction Program (HRRP) Began FY 2013 – –Calculates “excess readmission” rates compared to expected rates –Up to a 1% reduction in total Medicare payments –30 day readmissions for AMI, HF, PN FY 2014 –Up to a 2% reduction in total Medicare payments –Excludes planned readmissions for AMI, HF and PN –Based on discharges from 7/1/09-6/30/12 –80% of Florida hospitals receiving a penalty (81 lower penalty than FY2013) FY 2015 –COPD –Total hip & total knee arthroplasties

9. Hospital Acquired Conditions Affects FY 2015 Payment (October 1, 2014) 1% payment reduction for hospitals in top quartile of national HAC rates Two domains –Claims-based Patient Safety Indicators (35%) (July 1, 2011– June 30,2012 –Hospital Acquired Infections (65%) FY 2015 – CLABSI & CAUTI (based on data Jan 1, 2012 – Dec 31, 2013) FY 2016 – SSI FY 2017 – MRSA and C-diff

10. Tying it to the Hospital Engagement Network Initiatives IQRVBPHRRPHAC Adverse Drug Events XX CAUTIXXX CLABSIXXX FallsX Early Elective Deliveries X Pressure UlcersXX ReadmissionsX SSIXXXX VAP VTEXXX

11. How Quality Impacts the Bottom Line

12. HRET Improvement Leaders Fellowship Seven, Interactive and Virtual Sessions hosted by AHA/HRET –Aug. 21 ~ Registration is Open: www.hret-hen.org (Events)www.hret-hen.org –Sept. 11 and 25 –Oct. 16 and 30 –Nov. 13 –Dec. 4 Each session will run two hours, 2-4 p.m. ET, and will be recorded. Track 1 (New Fellows) and Track 2 (Returning Fellows) will start the session together, and break-out into their respective tracks after the keynote session. Content in Track 1 and 2 will focus on applying the Lens of Profound Knowledge and to organizational work, using organizational examples per HAC or readmissions.

13. 18 Other Upcoming Events HEN Pharmacist Round Table –Today, Aug. 20, 11 am – 12 pm Monthly OB Coaching Webinar (OB Hemorrhage) –Today, Aug. 20, 1-2 pm A Guide to Patient and Family Engagement in Hospital Quality & Safety –Aug. 21, 2-3 pm NPLH – Readmissions Office Hours –Aug. 22, 12:15-1 pm Florida CUSP/CAUTI Coaching Call –Aug. 28, 11 am – 12 pm VAE/VAP: Definitions, Algorithms and Best Practices –Sept 10, 2-3 pm FHA HEN Office Hours –Sept. 11, 12-1 pm HRET-HEN ADE Boot Camps –Sept. 26, 11am-3pm and Oct. 17, 11am-3pm Watch for the weekly “Upcoming HEN Events” e-blast or go to the FHA HEN Calendar at www.fha.org/henwww.fha.org/hen Times listed are Eastern

14. Are You Ready for December 2013?

15. How HEN Hospitals are Doing Hospitals with 40% Improvement in Eleven Topics DeSoto Memorial Hospital Health Central Hospital Hospitals with 40% Improvement in Ten Topics Broward Health Medical Center North Okaloosa Medical Center Hospitals with 40% Improvement in Nine Topics Baptist Medical Center Nassau Bayfront Health St. Petersburg Doctors' Memorial Hospital, Inc. Jackson North Medical Center Jackson South Community Hospital Morton Plant Hospital North Shore Medical Center South Florida Baptist Hospital West Boca Medical Center, Inc. Italicized hospitals are green in all applicable focus areas.

16. Questions & Open Discussion 19