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What’s Hot & What’s Not
in the Core Measure Field
B RENDA B ARTKOWSKI , C M A , C C A , B S H PA
M A N AG E R , C L I N I C A L D ATA A B ST R AC T I O N
A MY W IRTH
S A L ES E X EC U T I V E
J U LY 1 7 , 2 0 1 3
© 2013 Amphion Medical Solutions
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What’s Hot & What’s Not
DISCLAIMER: This presentation was current at the time it was published or
uploaded onto the web. Medicare policy changes frequently so links to the
source documents have been provided within the document for your reference.
This presentation was prepared as a service to the public and is not intended to
grant rights or impose obligations. This presentation may contain references or
links to statutes, regulations, or other policy materials. The information provided
is only intended to be a general summary. It is not intended to take the place of
either the written law or regulations. We encourage readers to review the
specific statutes, regulations, and other interpretive materials for a full and
accurate statement of their contents.
© 2013 Amphion Medical Solutions
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What’s
Value-Based Purchasing (VBP)
What is hospital value-based purchasing?
 A Centers for Medicare & Medicaid Services (CMS) initiative
 Rewards acute-care hospitals for quality of care to Medicare
recipients
© 2013 Amphion Medical Solutions
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What’s
Value-Based Purchasing (VBP)
Why?
 Rewards based on following best clinical practices
 How well hospitals enhance patients’ experiences of care
 Patients receive higher quality care
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What’s
Value-Based Purchasing (VBP)
How?
 Must report on minimum of 4 Hospital VBP measures
 Minimum of 10 cases per measure
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What’s
Value-Based Purchasing (VBP)
When?
 Began with FY2013
 Participating hospitals already receiving incentive payments
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What’s
FY 2015 Finalized Domains and Measures/Dimensions
This information on Hospital Value Based Purchasing was retrieved from the National Provider Call on HVBPg from March 14, 2013.
© 2013 Amphion Medical Solutions
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What’s
12 Clinical Process of Care Measures
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2
3
4
5
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10
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AMI-7a Fibrinolytic Therapy Received within 30 Minutes of
Hospital Arrival
AMI-8 Primary PCI Received within 90 Minutes of Hospital Arrival
HF-1 Discharge Instructions
PN-3b Blood Cultures Performed in the ED Prior to Initial
Antibiotic Received in Hospital
PN-6 Initial Antibiotic Selection for CAP in Immunocompetent
Patient
SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour Prior
to Surgical Incision
SCIP-Inf 2 Prophylactic Antibiotic Selection for Surgical Patients
SCIP-Inf-3 Prophylactic Antibiotics Discontinued within 24 Hours
After Surgery
SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m.
Postoperative Serum Glucose
SCIP-Inf-9 Postoperative Urinary Catheter Removal on
Postoperative Day 1 or 2
SCIP-Card-2 Surgery Patients on a Beta Blocker Prior to Arrival
That Received a Beta Blocker During the Perioperative Period
SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous
Thromboembolism Prophylaxis within 24 Hours
© 2013 Amphion Medical Solutions
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What’s
8 Patient Experience of Care Dimensions
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Nurse Communication
Doctor Communication
Hospital Staff
Responsiveness
Pain Management
Medicine Communication
Hospital Cleanliness &
Quietness
Discharge Information
Overall Hospital Rating
© 2013 Amphion Medical Solutions
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What’s
5 Outcome Measures
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2
3
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MORT-30-AMI – Acute Myocardial Infarction (AMI) 30-day mortality
rate
MORT-30-HF – Heart Failure (HF) 30-day mortality rate
MORT-30-PN – Pneumonia (PN) 30-day mortality rate
PSI-90 – Patient safety for selected indicators (composite)
CLABSI – Central Line-Associated Bloodstream Infection
1 Efficiency Measure
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MSPB-1 Medicare Spending per Beneficiary measure
Measure / Dimension
Clinical Process of Care Measures
Patient Experience of Care Dimensions
Mortality Measures (Survivability)
Rate
Higher is better
Higher is better
Higher is better
Represents a new measure for the FY 2015 program that was not in the FY 2014 program.
© 2013 Amphion Medical Solutions
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What’s
How will hospitals be evaluated?
Achievement Points
Awarded by comparing an individual hospital’s rates during
the performance period with all hospitals’ rates from the
baseline period.
Improvement Points
Awarded by comparing an individual hospital’s rates during
the performance period to that same individual hospital’s
rates from the baseline period.
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What’s
Proposed Weights VBP
Measure
Process of Care
Patient Experience
Outcome
Efficiency
Safety
2015
20%
30%
30%
20%
2016
10%
25%
40%
25%
© 2013 Amphion Medical Solutions
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10%
25%
50%
25%
15%
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What’s
 EPs that began participation in 2011 or 2012
 EPs that began participation this year (2013)
 EPs that plan to begin participation in 2014
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What’s
© 2013 Amphion Medical Solutions
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What’s
▪ MU Stages 1 & 2 Comparisons
▫ Must meet 19 objectives in Stage 1
▫ Clinical Quality Measure Reporting (CQM) required
▫ No incentive payment if any of the objectives are not met
▪ Timelines
▫ MU Stage 1 Final Rule = July 2010
▫ MU Stage 2 Final Rule = August 2012
▫ MU Stage 2 Final Rule Effective FY 2014 = October 1, 2013
© 2013 Amphion Medical Solutions
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What’s
▪ Clinical Quality Measures for Stage 1
▫ ED = 2
▫ STK = 7
▫ VTE = 6
▪ Clinical Quality Measures for Stage 2
▫ ED = 3
▫ PN = 1
▫ STK = 7
▫ SCIP = 3
▫ VTE = 6
▫ PC = 2
▫ AMI = 4
▫ Early Hearing Detection = 1
▫ Healthy Newborn = 1
© 2013 Amphion Medical Solutions
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What’s
▪ Highlights of MU Stage 2 Objectives
▫ Use CPOE
▫ Record demographics
▫ Record/chart changes
▫ Record smoking status
▫ Use clinical decision support
▫ Provide patients access to their info
▫ Protect electronic health info
▫ Import lab results
▫ Generate lists
▫ Use certified HER technology
▫ Medication reconciliation and
summary of care
▫ Submit electronic data
▫ Automatically track medications
© 2013 Amphion Medical Solutions
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What’s Not
 Medicare EPs: How to Avoid Payment Adjustments
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▫
▫
▫
Mandated to begin January 1, 2015
Based on MU data submitted prior to 2015
Applied to Medicare physician fee schedule amount
Will increase if MU is not demonstrated in subsequent years
© 2013 Amphion Medical Solutions
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What’s Not
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What’s Not
 Measure Suspension
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▫
▫
▫
AMI – 1
AMI – 3
AMI – 5
SCIP-Inf-6
▪ Measure Refinement
▫ SCIP-Inf-4
▪ Measure Retirement
▫ AMI
▫ IMM
○ AMI-2
○ IMM-1
○ AMI-10
▫ SCIP
▫ PN
○ SCIP-Inf-10
○ PN-3b
▫ HF
○ HF-1
○ HF-3
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What’s Not
 HBIPS
▫ CMS is not collecting data on HBIPS1
▫ CMS is collecting data on HBIPS-2, 3, 4, 5, 6, 7
○ HBIPS-2 – 7 are required
○ HBIPS-2, 3 are event measures
○ HBIPS-4 – 7 are discharge measures
○ No validation for HBIPS data
© 2013 Amphion Medical Solutions
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What’s Not
 Validation
▫ ED
▫ STK / VTE
▫ Quarterly Appeals
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What’s Not
Hospital Readmissions Reduction Program
◊
◊
◊
Affordable Care Act
October 1, 2012
ADDITIONAL penalty from CMS
▫ Up to 1%
▫ Grows to 3% by October 1, 2014
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What’s Not
 Readmission Measures
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▫
▫
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Defined readmission
Adopted readmission measures
Established methodology to calculate
Established policy of using the risk adjustment methodology
Established an applicable period
○ For FY 2013
○ For FY 2014
▪ Readmissions Adjustment Factor
▫ FY 2013 – the higher of the Ratio or 0.99 (1% reduction)
▫ FY 2014 – the higher of the Ratio or 0.98 (2% reduction)
▫ FY 2015 – the higher of the Ratio or 0.97 (3% reduction)
© 2013 Amphion Medical Solutions
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Resources
Medicare’s Hospital VBP Scores are now available:
http://www.medicare.gov/hospitalcompare/data/VBP/hospital-vbp.aspx
Details on how to calculate MSPB measure scores, and more on VBP, please view The Official Website for the Medicare Hospital Value-based
Purchasing Program:
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html?redirect=/HospitalValue-Based-Purchasing/
OR
https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1228772039937
Medicare’s “Hospital Compare”:
http://www.hospitalcompare.hhs.gov/hospital-search.aspx?AspxAutoDetectCookieSupport
CMS’s readmissions reduction program:
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html
and
https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1228772412458
Proposed Rule Site: http://www.ofr.gov/OFRUpload/OFRData/2013-16555_PI.pdf
Comment Site: http://www.regulations.gov/#!submitComment;D=CMS-2013-0154-0001
NFQ Website: http://www.qualityforum.org/Home.aspx
© 2013 Amphion Medical Solutions
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Amphion’s Core Measures Solutions
What’s
right now?
Outsourcing Core Measures!
What’s Not?
Overworked hospital staff
© 2013 Amphion Medical Solutions
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Thank you for the opportunity
to speak with you today
F o r m o r e i n f o r m a t i o n o n A m p h i o n ’s s o l u t i o n s ,
contact Amy Wirth at
888-830-2644 x1634 or
A m y.W i r t h @ a m p h i o n m e d i c a l . c o m
© 2013 Amphion Medical Solutions
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