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The 5 W’s of the CMS CoreQuality Process and OutcomeMeasuresUnderstanding the process and the expectationsDeveloped by Kathy Wonderly RN,BSPA, CPHQPerformance Improvement CoordinatorDeveloped : September 2011
Before we start: Core Measure Alphabet Soup AMI- Acute Myocardial InfarctionCHF- Congested Heart FailureCLABSI- Central line- associated bloodstream infectionsCMS- Centers for Medicare & Medicaid ServicesFY- Fiscal year ( for this program the year starts October 1)HCAHPS- Hospital Consumer Assessment ofHealthcare Providers and SystemsIQR- Hospital Inpatient Quality Reporting ProgramLVSD- Left ventricular systolic dysfunctionPOA- Present on admissionSCIP- Surgical Care Improvement ProjectVBP- Value Based Purchasing
Learning objectivesIdentify the CMS Core process measures. Explain the purpose of measuringperformance and public reporting. Identify the CMS outcome measures thatare used for public reporting.
1. WHAT?
What is a Core Measure? A core measure is one that utilizes theresults of evidence based medicineresearch. These basic core measureprinciples imply that it is reasonable toexpect that every patient with the givendiagnosis will receive the baseline (core)care established through such research.
How are Core Measures Reported? Thereported results represent thepercentage of patients admitted witha specific diagnosis who receive therecommended care measure.Number of patients receiving expected careTotal number of patients with givendiagnosis %
How are Core Measures chosen?Following well established qualityimprovement principles, the Core Measuresrepresent high volume, high cost diagnosesassociated with an increased rate ofmorbidity or mortality. The CMS goal is the same as most qualityimprovement projects; to do the greatestgood possible for the most people.
2. WHEN ?
When did the Core Measure processstart?The first CMS Core measure (then called theNational Hospital Quality Measures) collectionstarted in 2003. There were: 10 AMI indicators4 CHF indicators12 Pneumonia indicators3 Surgical care improvement indicators2 Pregnancy related indicatorsmeasures)The only 2 outcome measures were morality forAMI and neonatal. (31 process 2 outcome
The ChangesIn July 2006, 3 more SCIP measures wereadded bringing the total to 34 processmeasures and 2 outcome measures. By 2008, 2 more SCIP indicators and mortality for CHF andPneumonia were added. The pregnancy measures were retired for the CMSprogram. The HCAHPS survey was added to the requirementsfor participation in the CMS Hospital Quality Initiative. The program became known as RHQDAPU.
The Changes In 2010Another SCIP measure and an AMI measurewere added. One pneumonia measure was retired.Readmissions for patients with CHF, AMI andpneumonia were added as outcome results. CMS changed the name of the program tothe Hospital Inpatient Quality ReportingProgram (IQR )
Tomorrow and Beyond.The timing of the receipt of antibiotics forpneumonia has been evaluated and CMSfeels this requirement might encourage theinappropriate use of antibiotics in casesinvolving delay in diagnosis . It will bediscontinued January 1, 2012.
Tomorrow and beyond cont. FY 2014 includes the New Claim basedmeasure – Medicare Spending perBeneficiary- This measure will use claimsdata for hospital discharges occurringbetween May 15, 2012 and February 14,2013. Each episode will include all chargesfrom 3 days prior to admission through 30days post hospital discharge. This wouldinclude Medicare A, B and any paymentsmade by the beneficiary.
3. WHY ?
Why are Core Measure resultsimportant?1. The first and most important reason isthe PATIENT. Everyone in health carewants to provide the best care to eachpatient every time he/she is admitted tothe hospital.
Why are Core Measure resultsimportant?2. Participating in quality measure reportingprovides a chance to assure thecommunity that the hospital provideshigh quality care.3. With the public reporting of qualitymeasures compliance and cost of care,the patients can now choose the facilitythey think will best meet their needs.
Why are Core Measure resultsimportant?4. The Board of Directors is charged withassuring quality care and must have a toolto determine how the facility is doing inregard to providing care for thecommunity.
Why are Core Measure resultsimportant?5. Facilities that maintain higher percentagesof compliance with the core measuresreceive higher reimbursement fromMedicare and other payers. More incomefor a facility means the ability to purchasebetter equipment, enhance services orincrease pay or benefits for the employees.
Summary of the benefits of providingquality care1. Decreased operational costs through improvedcare processes and shortened lengths of stay.2. Increased patient satisfaction3. Meeting accreditation or regulatory requirements .4. Demonstrating an enhanced reputation in yourcommunity by showing your hospital’scommitment to quality health care.
4. WHAT ?
What are the current Core MeasurecategoriesThe five focus areas for the process of careare: Heart failure- CHF accounts for morethan 700,000 hospitalizations a year and isassociated with high rates of mortality,morbidity and readmission.
What are the current Core Measurecategories Acute Myocardial Infarction (AMI) ,cardiovascular disease, is America’s biggestkiller. Each year approximately 1.1 millionpeople have a heart attack and almost 2/3do not make a complete recovery.
What are the current Core Measurecategories Pneumonia accounts for nearly 600,000Medicare patient hospitalizations withmore than 4.5 million inpatient days eachyear. It is also the principle reason for more that500,000 emergency room visits a year forMedicare patients.
What are the current Core Measurecategories SCIP - Surgical care measures are focusedon reducing complications of surgery. It is reported that 22% of preventabledeaths are related to surgical complications. Approximately 500,000 surgical siteinfections occur annually. If infection occursthe patient is 60% more likely to go to ICUand 5 times more likely to be readmittedfor further care.
What are the current Core Measurecategories Surgical patients also develop venousthrombosis 20 times more often thanmedical patients . Pulmonary embolismcauses 300,000 death a year and is thethird leading cause of hospital deaths.
What are the current Core Measurecategories Global Immunization Measure Set StartingJanuary 1, 2012 all patients dischargedfor acute inpatient care with a length of stayless than 120 days must be assessed for andoffered pneumococcal and influenza asappropriate.
Outcome Quality MeasuresCMS has shifted it’s focus from reportingcompliance with the recommendedprocess of providing care sharing theoutcomes of care with the public. The first two outcome measures thatwere reported were the readmission anddeath rates for patients having a heartattack, congestive heart failure andpneumonia.
Outcome Quality MeasuresThe data for these reports will beobtained using the POA (present onadmission) coding process. To assure accurate outcomes arereported is imperative that all thepractitioners ( physicians, extenders,nurses, therapists etc.) provide the mostexact and descriptive admissionassessment documentation possible.
Outcome Quality Measures Started in the spring of 2011the publicreport includes the hospital acquiredcondition measures which include: Foreign object retained after surgeryAir embolismBlood incompatibilityPressure Ulcer stage III or IVFalls and trauma with serious injuryVascular associated infectionsCatheter associated infectionsManifestations of poor glycemic control
5. WHERE?
Some Examples of AvailablePublic ReportsThese reports are easily obtained on theintranet and the results are oftenpublished in newspapers and magazinesfor the public to review
Web page www.phcqa.org
From Penna. Health Care Quality Alliance Public Report January 2010Appropriate Care Measures Indicates how often patients received all recommended treatments for theirclinical condition. Goal is 100%.The column highlighted in yellow is the benchmark to which the hospital is compared.Hospital APA Rate *US Rate * Top 10%Nationally Overall AppropriateCare60%85%85%96%Heart Attack Care82%92%91%100%Heart Failure Care49%85%85%99%Pneumonia Care75%79%82%97%Surgical Care56%86%84%97%
Hospital Quality Compare - A quality tool provided byMedicareSearch
Other sites. Some charge a fee for reports.Why Not the Bestwww.whynotthebest.org Health Grades www.healthgrades.com Free Online Hospital Quality Reportwww. Hospital-Quality.com The Leap Frog Group for patientsafety www.leapfroggroup.org Consumer Health Ratingswww.consumerhealthratings.com Wrong Diagnosiswww.wrongdiagnosis.com
Another way the measures arereported
Appropriateness of Care measurecalculations While there are many indicators in eachof the core measure sets, many reportsuse only the appropriateness of carescore which is obtained by counting allthe patients who met every indicator inthe measure set and dividing that numberby the total number of patients with thediagnosis.
Appropriateness of Care Coremeasure calculationsFor example : In one month the facilityhas 10 patients admitted with pneumonia.Of these 10, 2 receive all of the coremeasures recommended by CMS. Even though each indicator had acompliance rate higher that 67% thepublic would only see this facility’s overallappropriateness of care score forpneumonia patients which is only 20% forthat month.
Appropriateness of Care ScoringSamplePatient 1Initial antibiotic receivedwithin 6 hours after arrivalAssessed and GivenPneumococcal vaccinationBlood culture before firstAntibiotic receivedGiven Adult smokingcessation advice/counselingAppropriate Initial Antibioticselection (ICU)Appropriate Initial Antibioticselection (Non-ICU)Assessed and GivenInfluenza VaccinetotalAppropriateness of care scorePatient 2 Patient 3 Patient 4 Patient 5 Patient 6 Patient 7 Patient 8 Patient 9 Patient 10 Indicator annayyyy83%ynanaynananannana67%nayynayyynayy100%y5 of 60n4 of 50y5 of 51y4 of 50y5 of 60y4 of 50y5 of 60y5 of 60n5 of 60y6 of 6180%2 of 10 or 20%
Quality Care takes Teamwork It is important that everyone understandsand supports the indicators included ineach core measure bundle. Some of theindicators are physician driven but manyare nursing measures. In today’s modules,we will go through each measure in detail.
Test your knowledge1. Which is not a current CMS core Qualitymeasure?a. CHFb. AMIc. COPDd. Pneumonia
Test your knowledge2.We measure quality to:a. To be sure we are providing the baselinecare to each patient admitted with aspecific diagnosisb. Provide a tool for the Board ofDirectors so they can assure good care.c. To meet regulatory requirementsd. All of the above
Test your knowledge3. Individual quality reports for eachhospital are available to the public.a. Trueb. False
Test your knowledge4. The new core measure set startingJanuary 1, 2012 is called theimmunization set.a. Universalb. Globalc. Mandatory
Jan 01, 2012 · A core measure is one that utilizes the results of evidence based medicine research. These basic core measure principles imply that it is reasonable to expect that every patient with the given diagnosis will receive the baseline (
