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US News and World Report
2012 Results and Analysis
Thomas W. Feeley, MD
Head, Division of Anesthesiology and
Critical Care
Victoria Jordan, PhD, MS, MBA
Director, Quality Measurement
and Engineering
Office of Performance Improvement
November 14, 2012
Results
• MD Anderson ranked number 1 with overall score of 100. Also
achieved national ranking in 4 other specialties: gynecology 6,
urology 26, ENT 5, and pediatric cancer 15
• MSK number two with score of 93.8 (down from 94.7 last year)
Was 4
Was 3
Was 9
Was 6
Was 10
Was 16
2
Summary of Scoring
• Outcomes - 32.5% of score
– O/E Mortality (30 days from Admission)
– MDACC had the best survival score - 10
• Process - (Reputation) 32.5% of score
– MDACC had highest score - 69.5%
• Structure - 30% of score
– MDACC had the highest possible score in each
category (with two exceptions – discharge volume
and nursing index)
• Patient Safety Index - 5% of score
– MDACC scored 1 of 3
3
Outcome Analysis (32.5%)
Observed/Expected Mortality Index by Year (UHC data)
Lower is Better
Observed/Expected Mortality Rate
1.6
USNWR Reporting Period
Post Reporting Period
1.5
1.4
1.3
Our performance
1.2
1.1
1.0
Other top 20 cancer programs
0.9
0.8
FFY2008*
FFY2009
MDACC Medicare
FFY2010
FFY2011
USNWR Medicare
FFY2012**
4
Impact of Transfers on Outcome
• Major problem for our future outcome scoring
• Transfer patients have been excluded from USNWR
mortality index calculation since 2007
• Error in our data discovered by USNWR in 2009
– We incorrectly coded Emergency Center patients as transfer
patients since mid-2004
– Incorrectly coded patients account for 40% of admissions
• Mortality rate higher for admitted Emergency Center
patients (which were inappropriately excluded) leading
to a lower mortality ratio
• Error corrected in 2009 resulting in incremental
increases in our mortality ratio that will progressively
worsen our outcome score through 2014
5
2011 US News & World Report
Observed/Expected Mortality Index by Fiscal Calendar Years
1.8
100%
Time Period of O/E data Included in Survey
Observed/Expected Mortality Rate
80%
1.4
70%
60%
1.2
50%
1.0
40%
30%
0.8
20%
0.6
Percent of corrected EC/transfer
90%
1.6
10%
8%
0.4
FFY2007
FFY2008
USNWR Reporting Period
0%
FFY2009
FFY2010
FFY2011
Percent of data with EC/Transfer Admit Status Corrected
FFY2012**
MDACC Medicare
6
2012 US News & World Report
Observed/Expected Mortality Index by Fiscal Calendar Years
1.8
100%
90%
80%
1.4
70%
60%
1.2
50%
1.0
40%
42%
30%
0.8
20%
0.6
Percent of corrected EC/transfer
Observed/Expected Mortality Rate
Time Period of O/E data Included in Survey
1.6
10%
0.4
0%
FFY2007
FFY2008
USNWR Reporting Period
FFY2009
FFY2010
FFY2011
Percent of data with EC/Transfer Admit Status Corrected
FFY2012**
MDACC Medicare
7
2013 US News & World Report
Observed/Expected Mortality Index by Fiscal Calendar Years
1.8
100%
90%
80%
1.4
70%
75%
60%
1.2
50%
1.0
40%
30%
0.8
20%
0.6
Percent of corrected EC?transfer
Observed/Expected Mortality Rate
Time Period of O/E data Included in Survey
1.6
10%
0.4
0%
FFY2007
FFY2008
USNWR Reporting Period
FFY2009
FFY2010
FFY2011
Percent of data with EC/Transfer Admit Status Corrected
FFY2012**
MDACC Medicare
8
2014 US News & World Report
Observed/Expected Mortality Index by Fiscal Calendar Years
100%
Observed/Expected Mortality Rate
Time Period of O/E data Included in Survey
1.6
100%
90%
80%
1.4
70%
60%
1.2
50%
1.0
40%
30%
0.8
20%
0.6
Percent of corrected EC/transfer
1.8
10%
0.4
0%
FFY2007
FFY2008
USNWR Reporting Period
FFY2009
FFY2010
FFY2011
Percent of data with EC/Transfer Admit Status Corrected
FFY2012**
MDACC Medicare
9
Process Analysis (32.5%)
• Reputation used as surrogate for our processes of care determined by a survey
• Surveyed physicians asked to list the “best hospitals” in their
specific field of care, irrespective of expense or location, for
patients with serious or difficult conditions
• Up to five hospitals can be listed
• 200 board certified physicians in 4 US regions. Includes medical
oncology, surgical oncology, gynecologic oncology, radiation
oncology and hematology
• Three year average used and response rate is about 40% - in three
years that is 228 individuals for this year’s results
• Future will likely include results of Hospital Consumer Assessment
of Health Care Providers and Systems (HCAHPS) and other data
available from CMS on Hospital Compare
10
Structure Analysis (30%)
Category
Score
Weighted
Value
Comment
Advanced
Technologies
7/7
14.2%
Includes full-field digital mammography, imageguided radiation therapy, PET/CT scanner,
robotic surgery, shaped-beam radiation,
stereotactic radiosurgery, and transplant services
Volume
High
18.9%
Second patient volume in the group (4597
compared to MSK’s 4628)
2.1
18.9%
Higher is better. Range 1.0 - 3.1. Last year
MDACC was 2.0 within a range of 1.0 – 3.2
Nurse Staffing
8/8
9.6%
Includes genetic testing/counseling, hospice,
infection isolation room, pain-management
program, palliative care, patient-controlled
analgesia, translators, and wound-management
services
Intensivists
1
9.6%
Best score that can be received is 1. All 50 cancer
centers received this score
NCI Cancer
Center
Yes
9.6%
44 out of 50 cancer centers have an NCI
designation (including all of the top 20)
Nurse Magnet
Yes
9.6%
38 out of 50 cancer centers have a Nurse Magnet
designation (including 15 of the top 20)
FACT
accreditation
2/2
9.6%
Includes accreditation for both autologous and
allogeneic transplantation
Patient Services
11
Patient Safety Analysis (5%)
MD Anderson scored 1 out of 3 (higher is better)
Patient Safety Scores for
Top 50 Cancer Hospitals
30
Frequency
25
20
Includes MSK
Includes
MDACC
15
10
5
0
1 - Limited
2 - Moderate
3 - Superior
Patient Safety Score
12
Calculation of the Patient Safety Score
• Medicare data from the MedPar file
• Not a count, but an index, standardized and grouped
into terciles (three’s)
• Based on the following
–
–
–
–
–
–
(equally weighted, same as 2011):
PSI 04 – Death Among Surgical Inpatients (16.7%)
PSI 06 – Iatrogenic Pneumothorax (16.7%)
PSI 09 – Post op Hemorrhage or Hematoma (16.7%)
PSI 11 – Post op Respiratory Failure (16.7%)
PSI 14 – Post op Wound Dehiscence (16.7%)
PSI 15 – Accidental Puncture or Laceration (16.7%)
• Difficult to reconstruct actual score received but likely a
function of issues related to documentation and coding,
methodology, and practice issues
13
Major Recommendations
1. Conduct independent external review of documentation
and coding to ensure that coding reflects the acuity levels
of our patients. (Scheduled for Dec 4-5.)
2. Implement a comprehensive internal review process for
Medicare deaths and Patient Safety Indicator (PSI) events
before submission of final coding.
3. Develop automated documentation templates and
supporting education for physicians, mid-levels, and
trainees to assist in electronically documenting
appropriate “coding specific” terminology.
14
USNWR Workgroup
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•
Heidi Albright
Thomas Aloia, MD
John Bingham
Eduardo Bruera, MD
Thomas Feeley, MD
Lewis Foxhall, MD
Lyle Green
Victoria Jordan, PhD
Hagop Kantarjian, MD
•
•
•
•
•
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•
•
•
Leslie Kian
Eugenie Kleinerman, MD
Edward Miller, MD
Sarah Newson
Raphael Pollock, MD
John Skibber, MD
Steve Stuyck
Barbara Summers, PhD
Ron Walters, MD
16