Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Value Based Purchasing - West Virginia Healthcare Financial
Document related concepts
Transcript
Value-based Purchasing Jude Odu Senior Business Analyst, Health Care DataWorks Detlev “Herb” Smaltz, PhD Co-Founder & CEO, Health Care DataWorks September 27, 2012 Speaker Jude Odu • Senior Business Analyst and Healthcare Subject Matter Expert at Health Care DataWorks • Former Supervisor for Clinical Analytics and Decision Support, University Hospitals Case Medical Center, a multi-hospital health system in Northeast Ohio • 14+ years in long-term care, in acute care, and on the payer side • Instructor in healthcare informatics at Ursuline College • Master’s degree in Health Science, The George Washington University Speaker Detlev H. (Herb) Smaltz, Ph.D., FHIMSS, FACHE • Co-Chairman and CEO, Health Care DataWorks • 21+ years experience in healthcare management • Former CIO of The Ohio State University Wexner Medical Center • Fellow of the Healthcare Information & Management Systems Society (FHIMSS) • HIMSS Board of Directors (2002-2005) and Vice Chair (2004-2005) • Fellow in the American College of Healthcare Executives (FACHE) • Bachelor’s degree in MIS, University of Tampa, MBA, The Ohio State University, and Ph.D. in Information & Management Science, Florida State University Today’s Webinar • Value-based Purchasing (VBP) – – – – – – What is it? Who came up with it? When does it happen? Who does it affect? Why should I care? How do I recover reimbursements withheld through this program? WHAT IS VBP? VBP Final Rule • VBP was established by the Affordable Care Act of 2010 (ACA) • Budget neutral payment changes begin October 1, 2012 – Reduce base operating payments for each discharge by Year Payment Reduction 2013 2014 2015 2016 2017 1% 1.25% 1.5% 1.75% 2% • Rewards for achievement or improvement 6 VBP Measures – FY 2013 Core Measures or Clinical Process of Care Acute Myocardial Infarction Fibrinolytic Therapy Received within 30 mins of Hospital Arrival Primary PCl Received within 90 mins of Hospital Arrival Congestive Heart Failure Discharge instructions received Pneumonia Initial antibiotic selection for CAP in Immunocompetent patients HCAHPS Blood cultures before first antibiotic in ED Healthcare Associated Infection (SCIP) Patient Experience Nurse Communication Doctor Communication Hospital Staff Responsiveness Pain Management/Control Medication Communication Hospital Cleanliness and Quietness Discharge Information Overall Hospital Rating Prophylactic antibiotic given 1 hour prior to incision Appropriate antibiotic selection for Surgical Patients Prophylactic antibiotic discontinued within 24 hours of surgery Cardiac patients with Controlled 6 a.m. Postop. Serum Glucose Surgical Infection Indicators Beta blocker prior to admission and periop Recommended VTE Prophylaxis ordered Appropriate VTE Prophylaxis timing 2 Ways to Earn-Back Improvement Hospital Performance Standards Baseline: Hospital performance for all 20 metrics during the Baseline Period Performance: Hospital performance for all 20 metrics during the Performance Period 8 Timeline Final Payment Adjuster Delivered Hospitals will be informed of VBP payment at least 60 days in advance of the payment year Estimated Payment Adjuster Delivered Aug Nov 2009 July 2010 March FY 2013 Baseline Period 2011 July 2012 2013 March FY 2013 Performance Period 9 2 Ways to Earn Back Improvement Hospital Performance Standards Baseline: Hospital performance for all 20 metrics during the Baseline Period Performance: Hospital performance for all 20 metrics during the Performance Period or Achievement CMS Performance Standards Benchmark: Mean of top decile performance (95th percentile) nationally Threshold: 50th percentile performance nationally Floor (HCAHPS only!): Minimum performance nationally 10 WHAT DOES VBP MEAN FOR ME? The Questions • Do you know your VBP score? • Do you know how much is projected to be withheld? • Can you get to the data to understand your score? • Can you pinpoint which measure is costing you most? • Can you build a plan to improve your score? • How can you maximize your earnback? The People • Financial Management – Wants to earn back the money CMS withheld • Quality & Clinical Management – Needs to understand VBP scores – Take action to improve processes that target nurses, doctors, housekeeping staff, nursing units, etc. The Challenges • Hospitals and their technology solutions have evolved as siloed point solutions The Challenges • Data, systems and technologies are virtually everywhere with limited commonality in format and accessibility The Challenges • So you can’t get the information you need when you need it! The Opportunity • Get as much money back as possible • Improve hospital performance across measured areas HOW DO I MANAGE THIS? Common Approaches Hospitals vary in their approach: • Implement stand-alone solution • Retain consulting firms • Manage compliance manually • Figure it out later There’s a Better Way • Unified VBP Application – – – – Automate the collection of all data required View the organization across all 20 measures Evaluate root cause of positive or negative results Calculate how score improvements increase reimbursements Typical Health System Thousands of hours of manual labor Nursing ICU ED CBO Surgery VBP Dashboard Dashboard DashboardDashboardDashboard Dashboard Manual & Semi-Manual Departmental Analytics Initiatives DM Lawson Essbase Diver Hyperion TSI Premier Kronos Reports Access Dashboards Cerner Insight Lab Cerner Cerner Cognos Invision SignatureExploring Surgery Crimson Compass Ad hoc Ad hoc eClinical Morrissey Invision Signature Vision ERP VisionW Surgery Prism Analytics at Many Hospitals and Health Systems Transactional Systems Islands of Data End User Reporting abc12349x abc12349x abc12349x W External Systems 22 Unified Analytics via an EDW Internal Systems Transformation and Mapping EDW SOA/We b Services GL PA HR Cntrct EMR Time SIS PM Cost Clinical Trial Screening Multi-Dimensional Analysis & Data Mining Revenue Cleanse Validate Standardize Transform Aggregate Geo Code Data Profile Data Model Meta Data Load Ad-hoc Query Rejection Encounter Pt Sat Text Mining, NLP Meds Lab Orders SIS Census Error s End User Reporting Unified data Model Web Scorecards & Dashboards De-identified Data Readmits W Benchmarking Registries External Systems Predictive Modeling Research META DATA DATA GOVERNANCE Additional Value Effective VBP management will lead to positive change: • Improve the quality of patient care as a result of operational enhancements – Increase management visibility – Increase accountability across the organization – Decrease workforce burden • Estimate and manage financial implications Takeaways/Summary • The CMS VBP program is here and will continue to evolve • A portion of your CMS reimbursements will be withheld starting Oct. 1 and will increase through 2017 • In the absence of a unified solution, managing VBP will require heavy lifting Questions? Herb Smaltz, Ph.D., FHIMSS, FACHE 877 979 4239 [email protected]
