Hospital Metrics TAG November 10, 2015 Welcome and Introductions 2 - - PowerPoint PPT Presentation

Hospital Metrics TAG

November 10, 2015

Welcome and Introductions

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Agenda Overview

• Updates
• Year 2 data submission timeline & draft checklist
• EDIE-sourced measure validation process
• Review draft PPR specifications
• Review stakeholder survey findings
• Wrap-up

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Updates

• Year 3 CMS discussions
• Committee updates

– Work plan – Behavioral health learning session, 30 Oct. – Next meeting 20 November

• Miscellaneous

– Follow-up after hospitalization for mental illness progress reports were distributed on 27 October

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Updates (2): Proposed new domains – highlighted areas for further exploration

• No. Proposed Domain Name

1 Transitions of Care** 2 Community Health Needs Assessment, Education, and Outreach 3 Patient- and Family-Focused Care** 4 Disparities Reduction 5 Youth 6 Women and Children – Perinatal Care** 7 Efficiency** (move to bundled payments) 8 Drop all current domains – use new framework 9 Medication side (pharmacy and safety improvements)

Updates (3)

• CCO Metrics Update

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Data Submission Timeline & Draft Checklist (see materials) Apprise Health Insights Elyssa Tran

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DATA SUBMISSION TIMELINE – BASELINE

11/9/2015 8

Oregon Association of Hospitals & Health Systems

Measure Why? Data Timeframe Due Date CAUTI NHSN specs changed Jan 1, 2015-March 31, 2015 October 16, 2015 (Completed) SBIRT De-duplication Varies; need to match

• riginal submission

December 31, 2015 EDIE Validation, bug, EPIC issue Varies; need to match

• riginal submission

February 15, 2016

• Baseline data re-submission
• Done via spreadsheet outside of HTPP reporting

platform; send to Elyssa directly

• Re-submission of baseline data on any other measures

must be approved by OHA first

DATA SUBMISSION TIMELINE - PERFORMANCE

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Oregon Association of Hospitals & Health Systems

• Performance period data submission

Date What must be completed? Feb 15, 2016 All final data and changes submitted on Apprise reporting platform. System will be locked for review, and no additional data will be accepted. March 31, 2016 Apprise completed review and corrections of data and make final submission to OHA. Apprise received checklist with attestation of data adhering to specs, accuracy in data, and sign off from each hospital. June 30, 2016 Payments to hospitals by OHA completed.

DATA SUBMISSION TIMELINE - PERFORMANCE

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Oregon Association of Hospitals & Health Systems

• Measures with Oct 1, 2014-Sep 30, 2015 performance

period for all hospitals

Measure Lead for data entry into HTPP platform Checked/approved by hospital by

CLABSI Apprise (by Dec 31, 2015) Feb 15, 2016 Opioids Hospital Feb 15, 2016 Warfarin Hospital Feb 15, 2016 Insulin Hospital Feb 15, 2016 HCAHPS: Explain meds Hospital Feb 15, 2016 HCAHPS: Discharge instructions Hospital Feb 15, 2016 Hospital-wide readmissions Apprise (by Feb 1, 2016) Feb 15, 2016 FU mental health after hospitalization OHA shared with hospitals (by Feb 15, 2016) March 31, 2016

DATA SUBMISSION TIMELINE - PERFORMANCE

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Oregon Association of Hospitals & Health Systems

• Measures with other performance period

Measure Lead for data entry into HTPP platform Checked/approved by hospital by

CAUTI (Apr 1, 2015-Sep 30, 2015) – all hospitals Apprise (by Dec 31, 2015) Feb 15, 2106 SBIRT 1 – Screening (varies) Hospital Feb 15, 2106 SBIRT 2 – Brief intervention (varies) Hospital Feb 15, 2106 EDIE 1 – PCP notifications (varies) Hospital Feb 15, 2106 EDIE 2 – Development of care guidelines (varies) Hospital Feb 15, 2106

YEAR 2 DATA SUBMISSION CHECKLIST

• Full Year 2 final review checklist (see draft

in materials)

 As part of the formal submission of the Year 2 data to the OHA, hospital submissions will include a checklist  Hospitals will attest to each item on the checklist as part of the formal submission  This is to ensure the accuracy of the data submitted, and adherence to the official HTPP measure specifications

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Oregon Association of Hospitals & Health Systems

CAUTI BASELINE RECALCULATIONS

• Final data for Jan 1, 2015-March 31, 2015 submitted by

hospitals on Oct 16 to Apprise, and forwarded to OHA

• n Oct 30, 2015.

11/9/2015 13

Oregon Association of Hospitals & Health Systems

Final Preliminary Numerator 54 Numerator 51 Denominator 65,559 Denominator 61,760 Rate per 1,000 0.82 Rate 0.83 Highest 3.79 Highest 3.79 Lowest (excluding zeros) 0.39 Lowest (excluding zeros) 0.39 # of hosp w/ zero rate 12 # of hosp w/ zero rate 14 New benchmark 1.00 New benchmark 1.10 Improvement target 3% Improvement target 3%

EDIE-sourced Measure: Baseline / Year 2 Review Process and Timelines

Sara Kleinschmit, OHA Elyssa Tran, Apprise Adam Green, CMT

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EDIE Measure Review Timeline

• November 10, 2015

– CMT will make the two individual-level reports available for hospitals to review directly in EDIE.

• December 10, 2015

– Last day for hospitals to respond to CMT with initial review of reports.

• January 6, 2016

– For hospitals notifying PCPs outside of EDIE: Final day to send CMT a final file with any outreach occurring outside of the EDIE system for Year 1 or Year 2. CMT will not accept any numerator data for Years 1 or 2 after this date.

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EDIE Measure Review Timeline (2)

• February 1, 2016

– CMT will publish the final individual level reports for Years 1 and 2 (incorporating feedback from above.

• February 15, 2016

– Deadline for hospitals to enter all Year 2 data on Apprise reporting platform. – As applicable, deadline for any hospitals resubmitting EDIE- based measure baseline (sent separately to Apprise; not on reporting platform)

• March 31, 2016

– On behalf of all hospitals, OAHHS/Apprise will officially submit all Year 2 data to the OHA (and any EDIE-sourced measure baseline revisions).

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Special Note re: EDIE Baseline

• Apprise will need to be notified separately of any changes

hospitals wish to make to the EDIE-sourced measure baseline data as a result of this review process (this isn’t entered into the Apprise reporting platform).

– Contact Elyssa Tran at elyssa.tran@apprisehealthinsights.com if this applies to your hospital.

Note baseline data for the other HTPP measures are not eligible for resubmission as part of this review process; this review is limited to the EDIE-sourced metric.

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Where to Find Individual Level Report in EDIE

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Questions, Comments on Process?

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EDIE Review Process Contacts

• Questions on the individual-level HTPP reports on EDIE, contact Dylan

Barker, CMT, dylan.barker@collectivemedicaltech.com

• Questions on ensuring outreach to PCPs sent outside the EDIE

system is included in the metrics (including questions on the specifications for the file to be sent to CMT), contact Ryan Grimmett, CMT, ryan.grimmett@collectivemedicaltech.com

• Apprise Reporting Platform and Requested Changes to Baseline

Submission: Elyssa Tran, Apprise Health Insights, elyssa.tran@apprisehealthinsights.com

• General questions on HTPP and this process, contact Sara

Kleinschmit, OHA, sara.kleinschmit@state.or.us

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Review Draft Year 3 Potentially Preventable Readmissions Specifications

see draft in supplementary materials

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Review Stakeholder Survey Results

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Stakeholder survey

• OHA fielded this survey to inform Committee selection of

domains and accompanying incentive measures for the fourth year of the program (2017), and beyond.

• OHA received 58 responses from across the state.
• Respondents were asked whether each of the current

domains and measures should be dropped or modified for 2016; and to propose new domains/measures for the Committee’s consideration.

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Survey respondents

Survey feedback on current domains and measures

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Summary Results, Current Domains: Should [the domain] be dropped, kept but modified, or kept without changes? Domain Drop Keep, but modify Keep, no Changes Behavioral Health 10.9% (5) 23.9% (11) 65.2% (30) Healthcare-associated Infections 4.4% (2) 24.4% (11) 71.1% (32) Medication Safety 2.2% (1) 21.7% (10) 76.1% (35) Patient Experience 13.3% (6) 24.4% (11) 62.2% (28) Readmissions 4.2% (2) 42.6% (20) 53.2 % (25) Sharing ED Information 4.4% (2) 20.0% (9) 75.6% (37)

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Summary Results, Current Measures: Should [the measures] be dropped, kept but modified, or kept without changes? Domain Measure Drop Keep, but modify Keep, no changes Behavioral Health Follow-up after hospitalization for mental illness 12.5% (4) 18.8% (6) 68.8% (22) Screening, brief intervention, & referral for treatment (SBIRT)

• 29.0% (9)

71.0% (22) Healthcare- associated Infections Adverse drug events with opioids 3.2% (1) 12.9% (4) 83.9% (26) Excessive anticoagulation with Warfarin 10.0% (3) 10.0% (3) 80.0% (24) Hypoglycemia in inpatients receiving insulin 10.0% (3) 6.7% (2) 83.3% (25)

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Table 2. Summary Results, Current Measures: Should [the measures] be dropped, kept but modified, or kept without changes? Domain Measure Drop Keep, but modify Keep, no changes Medication Safety Catheter associated urinary tract infections (CAUTI) 2.8% (1) 19.4% (7) 77.8% (28) Central line associated bloodstream infections (CLABSI) 2.9% (1) 32.4% (11) 64.7% (22) Patient Experience HCAHPS - discharge information 3.1% (1) 15.2% (5) 81.8% (27) HCAHPS - explain medications 9.1% (3) 15.2% (5) 75.8% (25) Readmissions Potentially preventable readmission 6.2% (2) 33.3% (11) 60.6% (20) Sharing ED Information Sharing ED Information with PCPs 3.0% (1) 33.3% (11) 63.6% (21)

Survey comments

• n current domains

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Behavioral Health Domain

Behavioral health is an important area, and we need to think about measures that would demonstrate coordination with CCOs. Our behavioral health carve out is operated in our CCO by another organization and it is truly difficult as the hospital/provider to take risk on another organization’s

• perations.

We do not have these patients and it is not right for us to depend upon others or not have the ability to obtain this goal.

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Healthcare-Associated Infections Domain

it is very important to prevent healthcare-associated infections in all settings (outpatient, inpatient, long term care, etc.) for the overall health and financial well-being of Oregon. This should be collapsed into a patient safety domain. Hospitals are already incentivized/penalized in the Value Based Purchasing and Hospital Acquired Condition Reduction programs at the national level. While infection prevention is incredibly important, I do not feel that these are transformative measures and would feel very comfortable with their removal from HTPP.

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Medication Safety Domain

Takes a while to build routine for improvement. We need stability right now. Adverse drug events are common, and yet potentially preventable, causes of harm. The risk to patient safety warrants their inclusion in this program. Additionally, medication management crosses the care continuum – a primary focus area of HTPP. Consider changing the focus areas (consistent with national efforts) or the targets. This should be collapsed into a patient safety domain

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Patient Experience Domain

The current measures are important for readmission avoidance. This is too difficult to manage. Too many different personalities can throw the whole measure off.

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Readmissions Domain

It is a simple, broad-brush-stroke read of how the overall system is functioning. It’s not elegant, but it is a good litmus test. The CCO should have some financial responsibility since this is a group effort It would be useful to narrow the domain to readmissions for specific conditions; example would be readmissions for CHF and COPD .

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Sharing ED Information Domain

The EDIE measure is a perfect match for HTPP as it crosses delivery areas and is a great indicator of coordinated care Goals and benchmarks need to be evaluated closely for this measure, as we are reaching maximum notification values due to lack of primary care providers for remaining

• patients. CCO implementation of the Pre-Manage program

is an additional measure that could be combined with the hospitals to get the coordination of care that is sought.

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Summing Up Survey Comments on Current Domains

• Generally, support for continuing current domains /

focus areas

• Some ideas, however, for changing the metrics

included underneath each domain

• As will be seen later, idea for additional domains for

the Committee’s consideration

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Survey comments

• n current measures

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Follow-up after Hospitalization

I think this is a good CCO [coordination] measure – but I would ask that we are mindful of any increase in the benchmark. At [redacted], we have found that the majority of patients leave the hospital with an appointment but patient factors are resulting in missed appointments. Also consider removing patients that are transferred to jail and other areas that prohibit outpatient follow- up. This measure only gets at a very small percentage of individual in a very small number of hospitals. It is ineffective to call this a measure targeting behavioral health, and not within the hospital’s ability to change, as they do not own the community mental health system.

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SBIRT in the ED

The performance metrics dramatically increased after a short measurement cycle. I think it more conducive to improvement to make the expectations for success in a more gradient fashion: It allows time to celebrate success and build the architecture/momentum for ongoing improvement. If this is going to be an EHR-based measure in the CCO metrics, it needs to be thoroughly evaluated how ED SBIRT screening rates will affect measure reporting.

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Adverse Drug Events with Opioids

There is a lot of attention being provided to opioids and need to be consistent with this attention. Measure is topped out and rate is really low (<1%). Case reviews are not revealing opportunities and instead patient variability. Time and effort could be better spent on more pressing challenges – e.g., readmissions.

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Excessive Anticoagulation with Warfarin

If compliance means simply measuring to see whether excessive anticoagulation occurs post warfarin, I can’t think of any reason why compliance targets shouldn’t be 100%. Measure is topped out and events are extremely low. Time and effort could be better spent on more pressing challenges – e.g., readmissions.

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Hypoglycemia in Inpatients Receiving Insulin It seems like this measure has low incidence, so hard to make improvements Measure is topped out and events are low. Current processes are robust. Time and effort is better spent on more pressing challenges – e.g., readmissions.

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CAUTI

Instead of a rate that uses device days, replace with standardized infection ratio [There is a plan to change to the standardized infection ratio beginning in 2017 if the committee includes CLABSI and CAUTI moving forward.]

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CLABSI

This is a national focus area; hospitals are already penalized/incentivized [so it should be dropped]. I personally think C. difficile infection (CDI) might be a more appropriate measure. While CLABSIs are very important and costly, CDI is more common and is more of a daily concern for many facilities.

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HCAHPS: Discharge Information

This is a critical aspect that can prevent readmissions. Revise the incentive target such that at least 50%

• f hospitals will receive an incentive payment.

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HCAHPS: Explained Medicines

The national 90th may be too lofty – consider lowering targets as many, or rather most, Oregon hospitals are not meeting this national benchmark. Would suggest using different HCAHPS measure, to shift the focus to another area of patient experience; having medicines explained is not the most important

• ne.

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Potentially Preventable Readmission

Include population-specific readmission targets, i.e., congestive heart failure, chronic obstructive pulmonary disease The change to unplanned readmissions only is

• necessary. However, the measure has forced

community and hospital partnerships, and is important for continuity of care.

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Sharing ED Information with PCPs

Goals and benchmarks will need to be closely evaluated to assure that hospitals are not penalized for values that are not attainable. Many patients do not have primary care providers to share information with, or patients do not share the information. This activity should continue, but not as a measure.

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Summing Up Survey Comments on Current Measures

• Generally, support for continuing current measures
• Suggested modifications tended to focus on

– Changes to benchmarks (HCAHPS measures) – Exclusions (e.g., excluding patients without PCPs from EDIE-sourced measure) – Performance being ‘topped out’ in comparison with need to continue focusing on important areas (e.g., medication safety domain)

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Proposed new domains and measures

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Updates (2): Proposed new domains – highlighted areas for further exploration

• No. Proposed Domain Name

1 Transitions of Care** 2 Community Health Needs Assessment, Education, and Outreach 3 Patient- and Family-Focused Care** 4 Disparities Reduction 5 Youth 6 Women and Children – Perinatal Care** 7 Efficiency** (move to bundled payments) 8 Drop all current domains – use new framework 9 Medication side (pharmacy and safety improvements)

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Proposed new measures from survey

No Measure 1 Opiate use in behavioral health patients 2 Culture of safety 3 Newborn screening (NQMC: 009147): Preventive services for children and adolescents 4 Domestic violence screening 5 Population specific readmission rates (e.g., congestive heart failure, chronic obstructive pulmonary disease) 6 HCAHPS Pain Management Indicator (NQF 0166) 7 Surgical site infection rate 6 Diagnosis for dental patients seen in hospital 9 Emergency department mental health assessments 10 Identification of co-occurring disorders 11 Opioid management: reduce opioid prescriptions in excess of 120 morphine equivalent dose

Next Steps

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Wrap-up

• Next meeting

– Tuesday, December 8, 10am – 12pm

• New H-TAG webpage (for meeting materials, future

meeting dates, etc.)

• http://www.oregon.gov/oha/analytics/Pages/Hospital-

Metrics-Technical-Advisory-Group.aspx

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Questions?

Sara Kleinschmit, OHA sara.kleinschmit@state.or.us Diane Waldo, OAHHS diane.waldo@oahhs.org Elyssa Tran, Apprise Health Insights elyssa.tran@apprisehealthinsights.com Barbara Wade, OAHHS/Apprise Barbara.wade@apprisehealthinsights.com

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