1. © 2006 The Leapfrog Group and Thomson Medstat Hospital Rewards Program: Data Reporting and Scoring J. Dennis Bush February 7, 2006

2. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 1 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

3. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 2 Leapfrog Hospital Rewards Program Data Requirements Leapfrog Hospital Quality and Safety Survey JCAHO Core Measures Leapfrog Resource-Based Efficiency Measures 1 2 3

4. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 3 Data Reporting: Process Flow Hospital Leapfrog Leapfrog Patient Safety Survey JCAHO Quality-only Vendor* JCAHO Core Measures Data LFG Efficiency Measures Leapfrog Survey Results Clinical Area-specific Scores: Quality Resource-Based Efficiency Data Licensees Program Licensees New Aggregation and Scoring 1 2 3 Hospital Feedback via Vendors Full-Service Data Vendor * Hospitals may split data submission: - quality data through existing “quality-only” JCAHO CMV - efficiency data through Leapfrog-approved full-service vendor

5. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 4 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

6. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 5 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

7. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 6 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

8. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 7 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

9. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 8 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% Basis 1 : –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 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. See Weighting details in addenda and at http://leapfrog.medstat.com/hpr

10. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 9 Scoring Example: Pneumonia

11. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 10 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

12. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 11 Scoring Example: Overall – Deliveries

13. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 12 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 = 1 st tier (best quartile) on both axes –Bottom cohort = 4 th tier on either axis... by clinical area

14. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 13 Hospitals Arrayed in Four Groups Example: Pneumonia Cohort 4 Average Cohort 3 Cohort 2 Cohort 1

15. © 2006 The Leapfrog Group and Thomson Medstat Addenda Scoring Details

16. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 15 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%)

17. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 16 Leapfrog Hospital Rewards Program Scoring Component Measures – Quality (cont’d) Risk-adjusted rates, e.g., % mortality rate Example: Deliveries – 3 rd /4 th 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%

18. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 17 Weighting & Scoring – AMI MeasureSourceWeightScoring Inpatient mortalityJCAHO (AMI=9) 15.33%Percent rank (0% = worst, 100% = best) times 15.33% weight Aspirin at arrivalJCAHO (AMI-1) 16.06% compliance times weight Beta blocker at arrivalJCAHO (AMI-5) 14.61% compliance times weight Aspirin prescribed at dischargeJCAHO (AMI-2) 4.83% compliance times weight Beta blocker prescribed at dischargeJCAHO (AMI-6) 4.83% compliance times weight ACEI for LVSDJCAHO (AMI-3) 4.83% compliance times weight Thrombolytic agent received within 30 minutes of arrival JCAHO (AMI-7a) 4.83% compliance times weight PCI with door-to-balloon time within 90 minutes of arrival LFG4.83% compliance times weight Adult smoking cessation advice/ counseling JCAHO (AMI-4) 4.83% compliance times weight

19. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 18 Weighting & Scoring – AMI (cont’d) MeasureSourceWeightScoring Computerized physician order entry (CPOE) LFG8.33%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)LFG8.33%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) LFG8.33%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

20. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 19 Weighting & Scoring – CABG MeasureSourceWeightScoring MortalityLFG34.00%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 VolumeLFG12.00%Full credit if Volume ≥ 450 … else no credit Prophylactic antibiotic received within one hour prior to surgical incision JCAHO (SIP-1b) 3.50% compliance times weight Prophylactic antibiotic selection for surgical patients JCAHO (SIP-2b) 3.50% compliance times weight Prophylactic antibiotics discontinued within 24 hours after surgery end time JCAHO (SIP-3b) 3.50% compliance times weight 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 LFG9.25% + 9.25% % compliance times weight for two highest compliance rates of up to six measures reported … else no credit if not measured

21. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 20 Weighting & Scoring – CABG (cont’d) MeasureSourceWeightScoring Computerized physician order entry (CPOE) LFG8.33%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)LFG8.33%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) LFG8.33%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

22. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 21 Weighting & Scoring – PCI MeasureSourceWeightScoring MortalityLFG34.00%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 VolumeLFG12.00%Full credit if Volume ≥ 400 … else no credit Process measures: Aspirin at arrival 1 st balloon inflation within 90 minutes LFG14.50% % compliance times weight for each measure … else no credit if not measured Computerized physician order entry (CPOE) LFG8.33%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

23. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 22 Weighting & Scoring – PCI (cont’d) MeasureSourceWeightScoring Intensivist ICU staffing (IPS)LFG8.33%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) LFG8.33%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

24. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 23 Weighting & Scoring – Pneumonia MeasureSourceWeightScoring 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 vaccinationJCAHO (PN-7) 7.50% compliance times weight Pneumococcal vaccinationJCAHO (PN-2) 12.00% compliance times weight Adult smoking cessation advice/ counseling JCAHO (PN-4) 7.50% compliance times weight Intensivist ICU staffing (IPS)LFG13.50%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 assessmentJCAHO (PN-1) 14.50% compliance times weight Blood cultures (collected prior to antibiotic administration) JCAHO (PN-5b) 14.50% compliance times weight

25. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 24 Weighting & Scoring – Pneumonia (cont’d) MeasureSourceWeightScoring Computerized physician order entry (CPOE) LFG12.50%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) LFG12.50%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

26. © 2006 The Leapfrog Group and Thomson Medstat Leapfrog Hospital Rewards Program: Data Reporting and Scoring 2/07/2006 25 Weighting & Scoring – Deliveries MeasureSourceWeight*Scoring Inpatient neonatal mortalityJCAHO (PR-2) 23.00% or 60.50% Percent rank (0% = worst, 100% = best) times 23.00% or 60.50% weight NICU census *LFG23.00% or 0.00% Full credit if NICU census ≥ 15 … else no credit Antenatal steroids for certain high-risk deliveries * LFG29.00% or 0.00% % compliance times weight (if measure is applicable) Third- or fourth-degree lacerationsJCAHO (PR-3) 8.33% or 13.17% Percent rank (0% = worst, 100% = best) times 8.33% or 13.17% weight Computerized physician order entry (CPOE) LFG8.33% or 13.17% 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% ) … else no credit Leapfrog Quality Index (NQF Safe Practices) LFG8.33% or 13.17% 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 * 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.