1. HCAHPS and Hospital Value-Based Purchasing (Hospital VBP) Agency for Healthcare Research and Quality Centers for Medicare and Medicaid Services June 28, 2012

2. Acknowledgements
This Web conference program is supported by the U.S. Agency for Healthcare Research and Quality (AHRQ) through a contract with the Health Research and Educational Trust (HRET).
AHRQ is a federal agency whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. AHRQ is a sister agency of CMS within the U.S. Department of Health and Human Services.
HRET is a charitable and educational organization affiliated with the American Hospital Association, whose mission is to transform health care through research and education.
AHRQ is a federal agency within the U.S. Department of Health and Human Services (DHHS) whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.
HRET is a charitable and educational organization affiliated with the American Hospital Association whose mission is Transforming health care through research and education. HRET’s vision is to leverage research and education to create a society of healthy communities, where all individuals reach their highest potential for health.

3. AHRQ/HRET Patient Safety Learning Network (PSLN) Project
AHRQ hired HRET to partner with state hospital associations and others to create 25 Patient Safety Learning Networks (PSLNs).
This year the project will provide over 30 workshops and 100 Web conferences and teleconferences to support hospitals in implementing HCAHPS, Project RED (to reduce preventable readmissions), Medication Reconciliation, AHRQ’s Quality Indicators, and the “Door to Doc” ED flow method.
We want hospitals in the 25 PSLNs to learn together and share strategies across State lines. In May we hosted a Web conference on the patient-centered discharge process, and today’s Web conference is intended to answer hospital staff’s questions about how HCAHPS fits into the VBP program.

4. Hospitals are Focusing on the Relationship between HCAHPS, Value-based Purchasing, and Care Transitions
Top four HCAHPS Priorities of over hospitals participating in 18 PSLNs:
RN Communication
Responsiveness
Medication Communication*
Discharge Information*
* HCAHPS domains that can be improved by a patient-centered discharge process such as Project RED

5. Staff Always Explained About Medicines:
U.S. Benchmarks by Type of Hospital

6. Patients Given Information About Recovery At Home:
U.S. Benchmarks by Type of Hospital

7. Today’s Speakers
Christine Crofton, Ph.D., Center for Quality Measurement and Improvement, Agency for Healthcare Research and Quality (AHRQ)
Elizabeth Goldstein, Ph.D., Centers for Medicare and Medicaid Services (CMS)

8. HCAHPS and Hospital Value-Based Purchasing (Hospital VBP) Liz Goldstein, Ph.D.

9. HCAHPS and Hospital VBP
Hospital VBP links a portion of CMS payment to hospitals based on performance on a set of quality measures
Inpatient Prospective Payment System (IPPS) hospitals only
Established by the Patient Protection and Affordable Care Act of 2010 (Public Law )
Affects payment for patients discharged October 1, 2012 (FY 2013) and forward

10. Total Performance Score

11. Patient Experience Domain Score
Sum of
HCAHPS Base Score (0 – 80 points)
PLUS
HCAHPS Consistency Points (0 – 20 points)
Patient Experience Domain Score: 0 to 100 points
Comprises 30% of Hospital VBP Total Performance Score

12. HCAHPS and Hospital VBP Scoring
Eight HCAHPS Dimensions in Hospital VBP
Communication with Nurses
Communication with Doctors
Staff Responsiveness
Pain Management
Communication about Medicines
Discharge Information
Cleanliness & Quietness of Hospital Environment (combined)
Overall Rating of Hospital
Percent of patients who chose “Top-box” response

13. Hospital VBP Time Periods, FY 2013
Two time periods in Hospital VBP:
FY 2013 Baseline Period:
July March 2010
FY 2013 Performance Period:
July March 2012
IPPS hospitals must have at least 100 completed HCAHPS surveys in the Performance Period to be included in Hospital VBP

14. HCAHPS and Hospital VBP Scoring
For each HCAHPS Dimension, both Improvement points and Achievement points are calculated
Improvement Points (0-9 for each Dimension):
Amount of change from Baseline to Performance Periods
Achievement Points (0-10 for each Dimension):
Difference between a Hospital’s Dimension score and the national median score
in the Performance Period

15. HCAHPS Base Score
The first component of the Patient Experience Domain in Hospital VBP is the HCAHPS Base Score
For each of the Eight HCAHPS Dimensions:
Improvement Points (0-9) and/or Achievement Points (0-10) are calculated
The larger of the Improvement Points or Achievement Points for each Dimension
Are summed to create the HCAHPS Base Score
0 to 80 points

16. HCAHPS Consistency Points
The second component of the Patient Experience Domain in Hospital VBP is HCAHPS Consistency Points
Consistency Points
0 to 20 points
Target hospital’s lowest performing HCAHPS Dimension
During the Performance Period

17. HCAHPS Consistency Points (cont’d)
If the lowest scoring Dimension is below the national median,
Then the hospital earns between 0 and 19 Consistency Points
Calculation of Consistency Points is explained thoroughly on the CMS Hospital VBP Web site

18. Patient Experience Domain Score
Sum of
HCAHPS Base Score (0 – 80 points)
PLUS
HCAHPS Consistency Points (0 – 20 points)
Patient Experience Domain Score: 0 to 100 points
Comprises 30% of Hospital VBP Total Performance Score

19. Hospital IQR vs. Hospital VBP
Hospital VBP FY 2013
Four quarter roll-up
Three quarter roll-up
Ten HCAHPS Measures
Eight HCAHPS Dimensions
“Cleanliness” and “Quietness” combined
No “Recommend”
Non-IPPS hospitals can participate
IPPS hospitals only
Minimum of 100 completed surveys in Performance Period

20. Detailed Calculations

21. Baseline Performance Data, FY 2013 7/1/2009 - 3/31/2010

22. Total Performance Score

23. Total Performance Score

24. Base Points Patient Experience of Care Domain Score equals
(Greater of Improvement or Achievement Points for each HCAHPS dimension) plus Consistency Points
Up to 80 Base Points are possible based on each of the eight HCAHPS dimensions:
For each of the eight dimensions, determine the greater of the Achievement Points or the Improvement Points.
Add these 8 values to arrive at the total HCAHPS Base Points.

25. Calculating Achievement Points

26. Achievement Ranges

27. Achievement Range for the 8 HCAHPS Dimensions

28. Example: Nurse Communication Dimension

29. Example: Nurse Communication Dimension

30. Example: Nurse Communication Dimension

31. Example: Nurse Communication Dimension

32. Calculating Improvement Points

33. Example: Nurse Communication Dimension

34. Example: Nurse Communication Dimension

35. Example: Nurse Communication Dimension

36. Comparing Achievement and Improvement Points

37. Example: Nurse Communication Dimension

38. Example: Greater of Achievement or Improvement

39. Total Performance Score

40. HCAHPS Consistency Points
Patient Experience of Care Domain Score equals
(Greater of Improvement or Achievement Points for each dimension) plus Consistency Points
Consistency Points encourage hospitals to meet or exceed the Achievement Threshold in all HCAHPS dimensions

41. HCAHPS Consistency Points
Up to 20 Consistency Points may be earned based on the LOWEST dimension:
20 points are awarded if all dimension rates are greater than or equal to the Achievement Threshold
If any dimension rate is less than the Achievement Threshold, then Consistency Points are awarded based on the lowest dimension’s location relative to the Floor

42. 8 HCAHPS Dimensions and Consistency Points

43. Consistency Points Pain Management & Discharge Information

44. Consistency Points Calculation

45. Consistency Points Calculation: Pain Management

46. Consistency Points Calculation: Discharge Information

47. Consistency Points Calculation

48. Consistency Points Calculation

49. Consistency Points Calculation

50. Patient Experience Domain Score

51. Total Performance Score

52. Total Performance Score

53. Total Performance Score

54. Total Performance Score

55. Total Performance Score

56. Information on HCAHPS and Hospital VBP
Information about Hospital VBP available at new CMS Web site
Hospital VBP slide set can be found at:
Summary of the “Patient Experience of Care” domain (HCAHPS) and how this score will be calculated is on slides 35-61