1. Quality….. The True Sustainable Strategy To Ensure Viability
L. Keith Granger
Chair – AlaHA Quality Task Force
October 3, 2017

2. Federal quality measurement and transparency
2005 Hospital Compare is launched
2012 Value-based purchasing
2013 Readmission penalties
2015 Penalty for being in top poorest performing quartile of HACs
2015 Meaningful Use Penalties began
About 9% of Medicare payments at risk
Add that this is not just Medicare payments:
Mention insurers negotiations based on quality
Medicaid instituting quality measures

3. Hospital Compare Website
Value Based Purchasing (VBP)
Readmissions Reduction Program (RRP)
Hospital Acquired Conditions (HAC)
Comprehensive Care for Joint Replacement (CJR)
Episode Payment Model (EPM)

4. 9/27/17
CMS announced it will not update the overall hospital quality star rating in October.

5. IS IT PAY FOR PERFORMANCE OR PENALTY FOR FAILURE TO PERFORM ???

6. Do you really have a TEAM?
Quality
Clinical (nursing and ancillaries)
Medical Staff
Finance
Risk, IP, Wound Care, etc.
Case Management
Others

7. Impact Areas Reputation Clinical Efficiency/Outcomes
Financial Security

8. VBP --- Started with a bang
In the first year of CMS’s value-based purchasing program, Alabama hospitals ranked number one in quality performance and quality improvement.
As a result, Alabama’s hospitals received the second largest bonus payment, $1.9M, of any state – 113 percent of pool
Estimates for FY2018
Alabama rank – 40!
Alabama estimated to lose $2.1 million ($12 million in worst case scenario on this single program)
In the first year of value-based purchasing, Alabama scored well on the improvement points. Now that we’ve made great improvements, the outcomes or achievement points are more important, and that’s where Alabama is not doing so well.

9. Domain weights over time

10. Alabama VBP Trends
Statewide Performance Percentage (remove Payback)

11. Domain Weighting for FY2018 VBP
Patient Experience of Care—25%
Clinical Care—25%
Safety of Care—25%
Efficiency and Cost Reduction: 25%

12. FFY 2018 (Based on FFY 2017 Performance)
Alabama Hospitals
IN-PLAY
LOSS PROJECTED
VBP (2% of Payment)
(38 Hospitals Penalized)
$30,374,200
$2,124,900
Readmission (3% of Base)
(70 Hospitals Penalized)
$46,375,251
$12,642,000
HAC Penalty (1%)
(14 Hospitals Penalized)
$18,784,487
$1,820,300
TOTAL
$95,533,968
$15,587,200

13. No specific reimbursement tied to Star Rating…… but ……
Hospital Compare Update
2nd Quarter 2017
Overall Star Rating: 1-5 Stars
Q thru Q4 2016
HCAHPS Star Rating
Q thru Q2 2017
HCAHPS Star Rating Breakdown by Measure
No specific reimbursement tied to Star Rating…… but ……

14. Safety of Care Measures
6 Hospital Acquired Infection HAI Measures
Q thru Q for data that is complete
Patient Safety PSI-90
Q thru Q (* PSI not updated due to AHQA software issues)
Process Measures: IMM-2, AMI-7a, PC-01
For 2018 IMM-2 and AMI-7a will be removed along with process domain. PC-01 will go to safety domain.

15. Safety of Care Measures
CLABSI (ICU & Select Wards – HAI-1)
CLABSI (ICU Only – HAI-1a)
CAUTI (ICU & Select Wards – HAI-2)
CAUTI (ICU Only – HAI-2a)
SSI (Colon – HAI-3)
SSI (Abdominal Hysterectomy – HAI-4)
MRSA (HAI-5)
C-Diff (HAI-6)
Patient Safety Indication Composite (PSI-90)

16. VBP – Patient Outcomes Composite taken from 2 SSI categories.
Clinical Care Process Measures
Patients assessed and given Influenza vaccination (IMM-2)
Fibrolytic Therapy within 30 minutes of hospital arrival (AMI-7a)
Elective Delivery Prior to 39 Weeks (PC-01)

17. Patient Experience of Care
Q – Q2 2017
10 measures (technically become 9 measures):
Patient Experience (CJR & EPM) – Q thru Q2 2017
Not the same as VBP
CJR and EPM use linear mean score for each and use all “Would you recommend” scores.
Communication with Nurses
Communication with Physicians
Responsiveness of Hospital Staff
Pain Management
Communication about Medication
Patient Rooms and Bathrooms Kept Clean
Quietness Around Patient Rooms
Discharge Information
Overall Rating of Hospital
3 Item Care Transition Measure (CTM-3)
Combined on VBP

18. Outcome of Care Measures
5 Mortality and 1 Complications Rate measures
Q – Q (where complete data is available)
The 6 Patient Outcomes:
AMI - 30 day mortality (MORT-30-AMI)
HF - 30 day mortality (MORT-30-HF)
PN - 30 day mortality (MORT-30-PN)
COPD - 30 day mortality (MORT-30-COPD)
CABG - 30 day mortality (MORT-30-CABG)
Risk Standardized Complications Rate (RSCR)
Following elective primary Total Hip (THA) and Total Knee Arthroplasty (TKA)
*Q – Pneumonia Readmission expanded to include aspiration pneumonia and patient with sepsis and secondary diagnosis of pneumonia (therefore previous periods are not comparable)

19. Readmission Measures Readmission Measure – 6 measures
Q – Q2 2017
AMI 30 day readmissions rate
HF 30 day readmissions rate
PN 30 day readmissions rate
COPD 30 day readmissions rate
CABG 30 day readmissions rate
RSCR Risk Standardized Complications Rate following Total Hip and Total Knee – 30 day readmissions rate
*Q – Pneumonia Readmission expanded to include aspiration pneumonia and patient with sepsis and secondary diagnosis of pneumonia (therefore previous periods are not comparable)

20. Efficiency Measure
Medicare Spending per Beneficiary Q through Q3 2016

55. AL Lowest Scoring Areas for Action
Measure
Rank
Hip/Knee Complications
47th
HCAHPS – Patient Information for Recovery at Home
36th
HCAHPS – Patient Understanding Their Care Leaving Hospital
40th
MRSA
42nd
AMI – Mortality (30 day)
48th
CABG – Mortality (30 day)
46th
Pneumonia – Mortality (30 day)
45th
PSI 4 – Deaths Serious Treatable Complications After Surgery
49th
SSI Abdominal Hysterectomy
30th
Readmissions – HIP/KNEE
50th
Readmissions – AMI
41st

56. AlaHA Contacts
Rosemary Blackmon
Margaret Borders
Wesley Ashmore

57. Do you really have a TEAM?
Quality
Clinical (nursing and ancillaries)
Medical Staff
Finance
Risk, IP, Wound Care, etc.
Case Management
Others

58. Questions?