Chapter 13 + quiz
Hospital Value-Based Purchasing Program
A CMS initiative that rewards acute-care hospitals with incentive payments based on the quality of care that they provide to the beneficiary/patient that is on Medicare while they are in their care.
vbp Public Reporting
A hospital's performance in the VBP will be made available to the public and will include the hospital's performance on each measure that applies, the hospital's performance on each condition or procedure, and the hospital's total performance. This information will be posted periodically on the Hospital Compare website.
The legislation that established the CMS EHR Incentive Program (AKA Meanginful Use program):
American Recovery & Reinvestment Act of 2009 (ARRA)
hcahps Survey Content
Asks recently discharged patients about their experience while in the hospital Asks "how often" or if the patient experienced a critical aspect of hospital care as opposed to if they were "satisfied" with the care provided Administered as a random sample Not restricted to just Medicare patients Can be completed by mail, telephone, mail with telephone follow-up, or active interactive voice recognition (IVR) Hospitals are required to continually survey the recently discharged patients every month of the year and complete at least 300 surveys over the past 4 consecutive quarters.
vbp The program will:
Build on existing Medicare performance measurement tools Expand to create a comprehensive performance measurement program Have VBP performance measures apply to a broad range of care delivered in the acute care setting all the while addressing the domains of clinical quality
Term used to identify EHR products that are certified and meet specific criteria or standards that are required for certification.
CEHRT
vbp Quality Domains
Clinical Process of Care --Covers discharge instructions, blood cultures performed in the ED Patient Experience of Care --Covers nurse communication, doctor communication Outcome --Covers acute myocardial infarction (AMI) 30 day mortality rate Efficiency Domains --Assesses the Medicare Part A and Medicare Part B payments for services provided to Medicare beneficiaries that take place during a spending-per-beneficiary episode (3 days prior to and 30 days after a hospital admission)
Eligible professionals/clinicians (EPs), hospitals and critical access hospitals are required to demonstrate "meaningful use" of EHR technology through the reporting of:
Clinical quality measures (CQMs)
vbp scoring of hospital performance 2/2
Consistency points are awarded during the performance period and then compared with all hospitals' Patient Experience of Care rates from a baseline period. The Total Performance Score is calculated taking the greater of either the Achievement or Improvement points for each measure and then multiplying each of the greater scores for each domain by a specified weight, or percentage, and then adding all the weighted domain scores together.
Three goals of HCAHPS
Consistent data Public reporting Accountability
Independence at Home Demonstration Project
Created by the Affordable Care Act Is a delivery and payment incentive model uses home-based primary care teams --Teams are focused on improving health outcomes and reduce healthcare costs for Medicare beneficiaries who have chronic conditions --Team is managed, or directed, by primary care physicians and nurse practitioners Incentive payments will be awarded to the providers that are successful in reducing costs and meeting the quality measures set for the program
Value-based Purchasing programs are available for all BUT WHICH of the following care settings?
Federally Qualified Health Center (FQHC)
A national, standardized, publicly reported survey of patients' perspectives of hospital care.
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
VBP has been made available for:
Hospitals Physician offices Nursing homes Home health services Dialysis centers
vbp Scoring of Hospital Performance
Hospitals are assessed on their performance by their Achievement and Improvement for each measure in the VBP Program The minimum number of cases that a hospital must have during a Performance Period is 10 cases per measure The Achievement points are awarded during the performance period and then compared to the hospital's baseline period. Improvement points are awarded during the performance period and then compared to the hospital's baseline period
CMS has defined the following goals for the VBP program (CMS 2007d, 6):
Improved clinical quality Reduction in adverse events and improve patient safety Encourage a more patient-centered care Avoid unnecessary costs incurred in the delivery of care Stimulate investments in structural components or systems such as IT and Care Management Tools. Make performance results transparent and comprehensible so that consumers can be better equipped or empowered to make value-based decisions about their health care. In the design of the VBP program, CMS will adhere to various overarching principles such as making sure that the program is budget neutral.
p4p Stakeholders using P4P (continued) 2/2
In addition to extending the project CMS also created the Physician Quality Reporting Initiative (PQRI) This is a voluntary program that allows physicians to earn incentive or bonus payments of 1.5 percent of the total allowed charges The quality measures for the program are: Diabetes Heart failure Coronary artery disease Depression Stroke, heart attack Other various age-related conditions In some of the Medicaid Managed Care Organizations (MCOs) there has been positive activity such as in California 2/2
Hospital Consumer Assessment of Healthcare Provides and Systems (HCAHPS)
Is a standardized survey and data collection tool Goal is to measure the patient's perspective of the hospital care that they received Created a national standard for collecting, and reporting to the public, information that produces valid comparison for patients to make a choice between hospitals to support their choice of hospitals
What HCAHPS Measures
Measures eight areas/items There are six summary measures, two individual and two global items that are reported on the website Hospital Compare www.medicare.gov/hospitalcompare There are adjustments made to the data that will make for fair and accurate comparisons from hospital to hospital. Factors that are not directly related to hospital performance are adjusted.
vbp Participating Hospitals
More than 3,000 hospitals are eligible for VBP Hospitals that are excluded from the Inpatient Prospective Payment System (IPPS) Any hospitals that do not participate in the IQR Program during the performance period Any hospitals that are cited for posing an immediate threat to patient health or safety Any hospital that does not meet the minimum standards (cases, measures, or surveys) required by the VBP Program
As part of the VBP Program, which domain covers the following measures: acute myocardial infarction (AMI) 30-day mortality rate, heart failure (HF) 30-day mortality rate, pneumonia (PN) 30-day mortality rate, complication or patient safety for selected indicators (composite), and central line-associated blood stream infection (CLABSI)?
Outcome
p4p Private Sector Initiatives 1/2
P4P initiatives are also sponsored by private employers, health plans, groups of employees, and Health Information Exchanges (HIEs). Coalitions, or employee groups such as unions, have brought stakeholders together to highlight the importance of safe and effective care for consumers in their groups. Health plans have also initiated P4P programs that financially reward physicians for quality care, appropriate care, accountability, and transparency through reporting publically their results. 1/2
A model of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety. This model targets high need patient populations and pays providers a management fee for coordinating the patient's care across the continuum.
Patient-Centered Medical Home (PCMH)
Value-based purchasing programs score providers using what type of data?
Performance and baseline
Independence at Home Demonstration Project Requirements for Participation
Practice must demonstrate they are familiar with and have adequate experience in delivering primary care in a patient home setting. Can be a primary care practice or a multidisciplinary practice that are led by a physician or nurse practitioner. Focus of care is on primary care or physician services. Practice must serve an average of 200 patients or eligible beneficiaries.
Independence at Home Demonstration Project Financial Incentives
Practice must succeed in offering a high level of quality care to the patient. That results in reducing the costs for the Medicare program. By demonstrating that the practice expenses are lower for the calculated target expenditure, this would be present if the Independence at Home program was not in place.
Four measures of quality for p4p
Process, Outcome, Patient Experience, and Structure
p4p Private Sector Initiatives (continued) 2/2
Purchasers thinking of using or implementing P4P need to take into consideration the idea of payment incentives and make sure that they fit into current strategies that may be in place such as: Private and public report cards Disease management Technical assistance to make sure that they align with all the physician and patient incentives already in place The overall success of the P4P in any model is how does it fit into the current way of doing business. 2/2
Pay-for-performance programs reward providers who meet or exceed:
Quality measures
HCAHPS Public Reporting
Scores are based on 4 consecutive quarters of patient surveys and are reported on the Hospital Compare website. Every time a new quarter of data is put on the website, the oldest quarter that was being reported is removed. Is the basis for the VBP Patient Experience of Care Domain that represents 30 percent of the total score for a hospital
Patient Centered Medical Homes (PCMH)
Started as a Demonstration Project to help in the redesign of the healthcare delivery model. The goal was to "provide targeted, accessible, continuous and coordinated, family-centered care to high-need populations. A high-need population is one where it consists of individuals with multiple chronic illnesses that require ongoing monitoring, advising, or treatment for their condition. The focus of the project is to engage small physician practices that have three or fewer full time equivalents.
CMS' Physician Quality Reporting Program, which allows physicians to earn bonus payments, was established through the:
Tax Relief and Health Care Act of 2006
vbp The Reward Process for Hospitals
The VBP Program is funded through a process that withholds a percentage of the Diagnosis Related Group (DRG) payments from participating hospitals. The percentage range from 1 percent in 2013 to 2 percent in 2017 and thereafter.
Characteristics of Pay-for-Performance (P4P)
The typical pay-for-performance program will provide a bonus to healthcare providers for meeting or exceeding agreed upon quality measures or performance goals In addition to incentives for good care or better performance year-over-year, P4P programs can penalize a provider for not providing quality care along with cost savings They can also penalize a provider for performance that is not improving such as an increase in the amount of avoidable readmissions The purpose for P4P is to have quality incentives that will be where the payment reflects the process and has an impact on the outcome of care. P4P strives for "The right care for every patient every time"
p4p Stakeholders using P4P
There are Public Sector initiatives that include Medicare and Medicaid that have been the leaders in the P4P environment As a result of this there has been a focus with the federal programs on the quality and efficiency of healthcare delivery, the use of health information technology, the transparency of healthcare quality and price, and better or more effective incentives for program beneficiaries including enrollees and providers This type of activity has many public and private purchasers committing to and participating in value-driven health care through Value-based Purchasing and P4P The result of the project was that quality was raised by 11.8 percent in the first 2 years CMS awarded incentive payments in year 2 of $8.7 million dollars to the top 115 performing hospitals
History of Value Based Purchasing (VBP)
Through this process, CMS created an internal group that was charged with developing the VBP plan that would be for Medicare hospital services. This group was divided into four subgroups in order to address the required planning items Measures Data infrastructure and validation, Incentive structure Public reporting
VBP Program Periods
Two periods are used in capturing data on how well a hospital is performing. Performance Period --Data is captured and is different for each year Baseline Period
p4p Return on Investment (ROI) Calculators
Used by P4P programs to identify the financial benefits realized, or dollars saved, by participating in these programs Financial benefits are not the only measure of a successful plan. The goal for the P4P program is to properly align the incentive program and payments to the providers' operations and goals to ultimately produce better quality outcomes for the patient that will ultimately result in lower costs for the payer, provider, and patient.
pcmh Quality and Safety
____ needs to demonstrate a high level of commitment to quality care and to Continuous Quality Improvement. This ongoing commitment to quality will be in using evidence-based medicine and clinical decision-support tools through the use of tools such as the EHR. The _____ will need to adapt their care model to meet the population's needs that they practice in and serve
p4p Quality Indicators
_____ and process measures have been developed for the healthcare industry and are continually being refined. There are web-based portals for many of the types of providers in our healthcare system and allow the patient to compare providers on different quality measures.
pcmh Accessible Services
_____ is responsible for delivering accessible services to their patient base that come with: Shorter wait times for urgent needs Enhanced office hours where a patient can see a clinician or the physician 24-hour access through telephone or electronic communications such as e-mail or texting ____ is responsible for being responsive to all the patient's needs and their preferences in how they wish to receive care and not limiting the patient's access to the practice based on those needs.
Pay-for-performance (P4P)
came into being as an option to fight the escalating costs of health care. Definitions of P4P can vary, but Leapfrog Group defines P4P as a: "Performance-based provider payment arrangements, including those that target performance on cost or efficiency measures. Typically, pay-for-performance programs offer financial incentives to physicians and other healthcare providers who meet defined performance targets which tend to focus on quality, efficiency, or related areas" (Leapfrog 2006).
pcmh Comprehensive Care
is responsible for supplying a large portion of a patient's physical and mental healthcare needs. This includes prevention, wellness, acute care, and chronic care of a patient under their care
quality measure outcome
is where the healthcare provider is measured on the effectiveness of the care provided
quality measure process
is where the provider is measured on the activities that contribute to the positive quality outcomes of a patient stay
quality measure structure
measures how well the facilities, equipment, and personnel were used in the treatment of the patient
quality measure patient experience
measures the patient's perception of care that they received during their stay in the hospital or the care given as an outpatient
How does VBP Work
works by making incentive payments are based on how well the hospital performs on each measure or how much they have improved in a measure that they were previously measured on in a previous period or baseline period
