WIXLIB

Overview of the HospitalValue-Based Purchasing (VBP)Fiscal Year (FY) 2017Bethany WheelerHospital VBP Program Support Contract LeadHSAGFebruary 17, 20152 p.m. ET

PurposeThis event will provide an overview of the FY2017 Hospital VBP Program including: Evaluation criteria for hospitals within eachdomain and measure Eligibility requirements for the VBP Program Explanation of the scoring methodology used inthe VBP Program2/17/20152

ObjectivesParticipants will be able to: Identify how hospitals will be evaluated withineach domain and measure Recall the eligibility requirements for the VBPProgram Interpret the scoring methodology used in theVBP Program2/17/20153

Hospital VBP ProgramIntroduction Initially required by provisions in the Affordable CareAct and further defined in Section 1886(o) of theSocial Security Act Quality Incentive program built on the Hospital InpatientQuality Reporting (IQR) measure reportinginfrastructure Based on the quality of care, not just quantity of theinpatient acute care services provided Funded by a 2.00% reduction from participatinghospitals’ base operating Diagnosis-Related Group(DRG) payments for FY 20172/17/20154

Hospital VBP ProgramEligibility Who is eligible for the program? As defined in Social Security Act Section 1886(d)(1)(B), the programapplies to subsection (d) hospitals located in the 50 states and theDistrict of Columbia. Who is excluded from the Hospital VBP Program? Hospitals and hospital units excluded from the Inpatient ProspectivePayment System (IPPS) Hospitals subject to payment reductions under the Hospital IQRProgram Hospitals cited for deficiencies during the performance period that poseimmediate jeopardy to the health or safety of patients Hospitals with less than the minimum number of domains calculated Hospitals with an approved disaster/extraordinary circumstanceexception specific to the Hospital VBP Program Short-term acute care hospitals in Maryland Hospitals excluded from the Hospital VBP Program will not have2.00% witheld from their base operating DRG payments in FY 2017.2/17/20155

FY 2017 DomainWeights and MeasuresDomain WeightsPatient- and Caregiver-Centered Experience ofCare/Care CoordinationHospital Consumer Assessment of HealthcareProviders and Systems (HCAHPS) SurveyClinical Care25%Patient- andCaregiverCentered Experienceof Care/CareCoordinationClinical HFMORT-30-PNAMI-7aIMM-2PC-01*Efficiency and Cost Reduction25%20%OutcomesEfficiency and CostReductionMSPB-1SafetyCLABSICAUTISSI: Colon & Abdominal HysterectomyMRSA Infections*C-difficile Infections*AHRQ PSI-90An asterisk (*) indicates a newly adopted measure for the Hospital VBP Program.Safety2/17/20156

Domains and Measures/DimensionsClinical Care - ProcessDomain WeightsMeasuresAMI-7a: Fibrinolytictherapy received within30 minutes of hospitalarrival5%ProcessIMM-2: InfluenzaImmunizationPC-01: ElectiveDelivery Prior to 39Completed WeeksGestation2/17/20157

Clinical Care - ProcessSubdomain Scoring Requirements A measure must have at least 10 eligible cases during the baseline period tohave an improvement score calculated on the Percentage Payment SummaryReport. A measure must have at least 10 eligible cases during the performance periodto have an achievement or improvement score calculated on the PercentagePayment Summary Report. The Clinical Care - Process subdomain requires at least 1 out of the 3measures to be scored in order for the subdomain score to be included in theTotal Performance Score (TPS) on the Percentage Payment Summary Report.2/17/2015AMI-7aIMM-2PC-01(10 Cases)(25 Cases)(9 Cases)Clinical Care –Process subdomain8

Domains and Measures/DimensionsClinical Care - OutcomesDomain WeightsOutcomes25%Measures MORT-30-AMI: AcuteMyocardial Infarction (AMI)30-Day Mortality Rate MORT-30-HF: Heart Failure(HF) 30-Day Mortality Rate MORT-30-PN: Pneumonia(PN) 30-Day Mortality RateUtilizes admissions for Medicare Fee-forService (FFS) beneficiaries aged 65 yearsdischarged from subsection(d) and Marylandacute care hospitals having a principaldischarge diagnosis of AMI, HF, or PN andmeeting other measure inclusion criteria.2/17/20159

Clinical Care - OutcomesSubdomain Scoring Requirements A measure must have at least 25 eligible cases during the baseline period tohave an improvement score calculated on the Percentage Payment SummaryReport. A measure must have at least 25 eligible cases during the performanceperiod to have either an achievement or improvement score calculated on thePercentage Payment Summary Report. The Clinical Care - Outcomes subdomain requires at least two out of the threemeasures to be scored in order for the subdomain score to be included in theTPS on the Percentage Payment Summary Report.MORT30-AMI(90 Cases)2/17/2015MORT30-HF(25 Cases)MORT30-PN(24 Cases)Clinical Care–Outcomes subdomain10

Domains andMeasures/Dimensions Clinical CareDomain WeightsProcess subdomain:AMI-7aIMM-2PC-01Clinical CareOutcomes25%5%MeasuresProcessOutcomes 11

Scoring RequirementsClinical Care Domain A TPS requires scores from at least 3 out of the 4 domains in FY 2017.A hospital meeting the minimum cases in both or either of the Clinical Caresubdomains outlined in the previous slides will be treated as meeting theminimum measures for the count of one domain.ClinicalCare ProcessClinicalCare Nono02/17/2015“For purposes of the Clinical Care domainscore, we (CMS) proposed to consider eitherthe Clinical Care - Process or Clinical Care Outcomes subdomains as one domain inorder to meet this proposed requirement However we would only reweight hospitals’TPSs once and would therefore not reallocatethe Clinical Care - Process and Clinical Care Outcomes subdomains’ weighting within theClinical Care domain if a hospital does nothave sufficient data for one of thesubdomains.”- FY 2015 IPPS Final Rule (79 FR 50084)12

Domains and Measures/DimensionsPatient- and Caregiver-Centered Experience ofCare/Care CoordinationDomain Weights25%Patient- andCaregiverCentered Experienceof Care/CareCoordination2/17/2015MeasureHCAHPS Dimensions: Communication with Nurses Communication with Doctors Responsiveness of HospitalStaff Pain Management Communication aboutMedicines Cleanliness and Quietness ofHospital Environment Discharge Information Overall Rating of Hospital13

Scoring RequirementsPatient- and Caregiver-Centered Experience ofCare/Care Coordination The Patient- and Caregiver-Centered Experience of Care/Care Coordination Domainrequires at least 100 completed HCAHPS surveys during the baseline period to have animprovement score calculated on the Percentage Payment Summary Report. The Patient- and Caregiver-Centered Experience of Care/Care Coordination Domainrequires at least 100 completed HCAHPS surveys during the performance period to haveeither an achievement or improvement score calculated on the Percentage PaymentSummary Report. The Patient- and Caregiver-Centered Experience of Care/Care Coordination Domainrequires at least 100 completed HCAHPS surveys during the performance period for thedomain score to be included in the TPS on the Percentage Payment Summary rvey100Patient- and Caregiver-CenteredExperience of Care/CareCoordination Domain14

Domains and Measures/Dimensions SafetyDomain WeightsMeasuresCLABSI: Central line-associated bloodstream infections among adult, pediatric, andneonatal Intensive Care Unit (ICU) patientsCAUTI: Catheter-associated urinary tractinfections among adult and pediatric ICUsSSI: Surgical site infections specific toabdominal hysterectomy and colon surgeryMRSA: Methicillin-Resistant Staphylococcusaureus BacteremiaCDI: Clostridium difficile InfectionSafety20%2/17/2015AHRQ PSI-90: Complication/patient safetyfor selected indicators (composite)15

Scoring RequirementsSafety: Healthcare Associated Infections (HAIs) A measure must have at least onepredicted infection calculated by theCenters for Disease Control andPrevention (CDC) during the baselineperiod to have an improvement scorecalculated on the PercentagePayment Summary Report. A measure must have at least onepredicted infection calculated by theCDC during the performance periodto have either an achievement orimprovement score calculated on thePercentage Payment redictedInfections)(0.999PredictedInfections)16

HAI Scoring RequirementsSafety: SSI A stratum must have at least one predicted infection calculated by the CDCduring the baseline period to have an improvement score calculated on thePercentage Payment Summary Report. A stratum must have at least one predicted infection calculated by the CDCduring the performance period to have either an achievement or improvementscore calculated on the Percentage Payment Summary Report. At least one stratum must have at least one predicted infection calculated bythe CDC during the performance period to have a combined SSI measure scorecalculated on the Percentage Payment Summary 1.000 predictedinfections)(0.999 predictedinfections)Combined SSI Measure17

Domains and Measures/DimensionsSafety: Agency for Healthcare Research andQuality (AHRQ) PSI-90 AHRQ PSI-90 is a Claims-Based Measure.It is a composite of eight underlying component patient safety indicators(PSIs) which are sets of indicators on potential in-hospital complicationsand adverse events during surgeries and procedures, including: 2/17/2015PSI 03 Pressure Ulcer RatePSI 06 Iatrogenic Pneumothorax RatePSI 07 Central Venous Catheter-Related Bloodstream Infection RatePSI 08 Postoperative Hip Fracture RatePSI 12 Postoperative Pulmonary Embolism or Deep Vein Thrombosis RatePSI 13 Postoperative Sepsis RatePSI 14 Postoperative Wound Dehiscence RatePSI 15 Accidental Puncture or Laceration RateCMS announced the decision to use AHRQ QI Software version 4.5afor calculations in the FY 2017 Program.CMS will utilize nine Diagnosis codes and six Procedure codes.18

Scoring RequirementsSafety: AHRQ PSI-90 Composite The measure must have at leastthree eligible cases on any oneunderlying indicator during thebaseline period to have animprovement score calculated onthe Percentage Payment SummaryReport. The measure must have at leastthree eligible cases on any oneunderlying indicator during theperformance period to have eitheran achievement or improvementscore calculated on the PercentagePayment Summary Report.2/17/2015PSINumber of -141PSI-15019

Scoring RequirementsSafetyThe Safety Domain requires at least three of the sixmeasures to be scored in order for the domain score to beincluded in the TPS on the Percentage Payment redictedinfections)(0.999predictedinfections)(1 Strata of1.000predictedinfections)(3 cases inoneunderlyingindicator)2/17/2015SafetyDomain20

Domains and Measures/DimensionsEfficiency and Cost ReductionDomain WeightsMeasureMSPB: MedicareSpending per BeneficiaryEfficiency and CostEfficiencyandReductionCost Reduction25%2/17/2015 Claims-Based Measure Includes risk-adjusted andprice-standardizedpayments for Part A andPart B services providedthree days prior to hospitaladmission through 30 daysafter hospital discharge21

Scoring RequirementsEfficiency and Cost Reduction The measure must have at least 25eligible episodes of care during thebaseline period to have an improvementscore calculated on the PercentagePayment Summary Report. The measure must have at least 25eligible episodes of care during theperformance period to have either animprovement or achievement scorecalculated. The Efficiency and Cost Reduction Domainrequires at least 25 eligible episodes ofcare during the performance period to bescored in order for the domain score to beincluded in the TPS on the PercentagePayment Summary Report.2/17/2015MSPB(25episodesof care)Efficiency andCostReductionDomain22

Baseline and Performance PeriodsFY 2017 TableSubdomain/MeasureBaseline PeriodPerformance PeriodProcess1/1/2013– 2/31/20131/1/2015–12/31/2015Clinical 2015Patient- andCaregiverCenteredExperience ofCare/CareCoordinationHCAHPS I SafetyAHRQ 30/2015Efficiency andCost /2015DomainClinical CareSafety2/17/201523

Baseline and Performance PeriodsFY 2017 Timeline2/17/201524