Medicare Incentive and Penalties: Critical Lessons Learned (Elizabeth Mort)
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From effectively implementing electronic health records to reducing hospital readmissions to reporting more specific Medicare patient data, health care providers are reaping rewards from the Centers for Medicare and Medicaid Services for improving particular quality and safety measures. But many are also facing penalties, and the results for some institutions have been mixed. On the whole, the national readmission rate is dropping, but in 2014 a record 2,600-plus hospitals were fined for seeing too many patients return for care within 30 days, according to federal data. This session will help attendees understand the range of CMS cuts and bonuses and a firsthand look at how the new regulations can help providers improve care.
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Medicare Incentive and Penalties: Critical Lessons Learned (Elizabeth Mort)
- 1. Medicare Incen+ve and Penal+es: Cri+cal Lessons Learned Elizabeth Mort, MD, MPH Senior Vice President, Quality and Safety Chief Quality Officer Massachuse:s General Hospital and Mass General hPhysicians OrganizaAon
- 2. Move from Fee for Service to Pay-‐for-‐Value: authorized in 2005
- 3. Started with small voluntary set of quality metrics
- 4. CMS starter set of 10 measures grew to 60 4Source: Advisory Board Img source: hKp://blog.healthcarefirst.com/Portals/52995/images/HospiceDataRepor+ng.jpg
- 5. Five Major CMS Pay for Value Programs § Inpa+ent Quality Repor+ng § Value-‐Based Purchasing § Readmissions Reduc+on § Hospital Acquired Condi+ons (HAC) Penalty § Meaningful use of Informa+on Technology (IT) Img Source: hKp://incendant.com/wp-‐content/uploads/2014/07/002631040_Stethoscope-‐Laying-‐on-‐Stacks-‐of-‐Hundred-‐Dollar-‐Bills-‐with-‐Narrow-‐Depth-‐of-‐Field..jpg
- 6. 6 Department of Public Health CMS and others….
- 7. The Hospital Pay for Performance world in Boston 2015 AMI-‐7a Fibrinoly+c Therapy MORT 30-‐AMI: Acute Myocardial Infarc+on 30 day mortality MORT 30-‐HF: Heart Failure 30 day mortality MORT 30-‐PN: Pneumonia 30 day mortality Medicare Spend Per Beneficiary HCAHPS– clean & quiet HCAHPS – Pain mgt HCAHPS – Med comm HCAHPS – overall ra+ng IQI-‐32 Mortality AMI w/o transfer cases PSI-‐6 Iatrogenic Pneumothorax, Adult PSI-‐7 Central Venous Catheter Associated Bloodstream Infec+ons PSI-‐11 Post-‐opera+ve Respiratory Failure PSI-‐12 Post-‐opera+ve PE/DVT PSI-‐15 Accidental Puncture or Lacera+on PSI-‐18 OB Trauma -‐ Vag w Instrument PSI-‐19 OB Trauma -‐ Vag w/o Instrument VBP (21 measures) Commercial (13 measures) MassHealth P4P (14 measures) System (54 measures) PioneerACO (33measures) MassHealth Readmission Penalty (1 measure) 30-‐day all cause poten+ally preventable readmission rate AHRQ PSI 90 CLABSI CAUTI SSI (2) AHRQ PSI 90 CLABSI CAUTI SSI MAT-‐1: Intrapartum An+bio+c Prophylaxis for GBS MAT – 2a: An+bio+c Timing MAT -‐2b: An+bio+c Selec+on MAT – 4: Cesarean Sec+on HD-‐2 Health Dispari+es CCM 1: Reconciled Medica+on List ED 1: Median +me (arrival to admit) ED 2: Median +me (admit to decision) TOB 1: Tob Use Screening TOB 2: Tob Use treatment provided TOB 3: Tob Use treatment provided at discharge Medicare Readmission Penalty (6 measures) AMI, HF, PN, COPD, TKA/THA, CABG HCAHPS– comm. w. nurses HCAHPS –responsiveness of staff HCAHPS– Discharge info HCAHPS -‐ Comm. W docs IMM-‐2-‐ Influenza Immuniza+on STK-‐1 VTE Prophylaxis VTE-‐1 VTE Prophylaxis VTE-‐2 ICU VTE Prophylaxis VTE-‐3 An+coag Overlap Therapy OP-‐4 Aspirin at Arrival OP-‐3b Median Time to Transfer Acute Coronary OP-‐5 Median Time to ECG HCAHPS Cleanliness HCAHPS Quietness HCAHPS Care Transi+ons PC-‐01/MAT-‐3: Elec+ve delivery prior to 39 weeks gesta+on CCM 2: Transi+on Record CCM 3: Timeliness of transi+on record PCMH: Primed Status, NCQA Recogni+on iCMP: Pt Survey, Post Disch Bundle, Med admits/k, Innova+on Specialty: PCP/Specialist, Specialty Programs, Innova+on Warm Handoffs PCC: Reduce readm, complete transfer doc with Eds, screen for high risk readm eCSME: Trend, service level Diabetes: HbA1c, LDL, BP CVE: LDL HTN: BP MRSA C.Diff HAC Reduc?on (6 measures)
- 8. 8 At +mes it feels like this…
- 9. Patient Safety Occ. Health Public Affairs MESAC PFACs PCS Quality Program Potential Q&S Targets Performance, Analysis, Improvement Simulation Center HIS Quality Mgmt Care Redesign Pharmacy Disparities Comm. Exec. WalkRounds Research Partners Quality & Safety Infection Control CMO Affiliates Critical Care Comm. Pt Experience How do we manage? Review important signals and strategic priori3es Training Directors Trainees Quality Chairs Population Health Patient Advocacy Analytics Sr mangt Quality & Safety Fellows Ambulatory/ ARMS 9
- 10. Priori3ze: Inputs from signals Excellence every day, IOM pillars, regulatory asks, contracts, strategic goals § Lead the Nation in Quality and Safety Research Leadership: Measurement and IT Leadership: Systems Excellence: Quality, safety and service excellence every day: 10
- 11. 2015 Goals and Tac3cs MGH and MGPO 1. Lead in quality of care a. Demonstrate measurable improvements in episodic specialty care b. Improve performance in managing popula+ons under risk contracts c. Advance pilot for obtaining guardianship to inpa+ents on medical units who cannot speak for themselves d. Reduce observed dispari+es in quality of care with focus on Limited English Proficiency e. Advance pa+ent and family engagement in Q&S programs 2. Improve pa?ent safety a. Address common causes of harms iden+fied through safety repor+ng b. Improve safety in ambulatory care in focused areas c. Improve medica+on safety in targeted areas d. Reduce healthcare associated infec+ons e. Implement IPASS and demonstrate improvement in safety culture scores 3. Excel on external surveys and measures a. Achieve excellent results on external surveys and reviews (The Joint Commission Hospital & Lab due 2015) b. Achieve excellent results on key performance programs (Value Based Purchasing, Readmissions, Mass Health, Meaningful Use) 11
- 12. Assessment of first 10 years: a good start § Amazing progress § CMS listens and revises • An+bio+cs within four hours • HACs sunset • Topped out measures re+red • Documenta+on based measures phased out • Moving from process measures to NHSN surveillance data § Have we improved care? 12
- 13. 13 Process measure performance 2005-‐2014
- 14. 14 Pa+ent experience performance 2005-‐2014
- 15. 15 Mortality & readmission performance 2005-‐2014
- 16. Lessons and New direc+ons § Reality check on volume of metrics § Implementa+on science and reliability approaches § Revisit structural measures (CPOE, EMAR, intensive care staffing) § Advance outcomes (registries) § Move away from measures using administra+ve data § Par+cipa+on in Improvement collabora+ve work § Cross con+nuum care, Popula+on health, innova+ons in health care delivery, Systems of care and affilia+ons 16