Hospital Value-Based Purchasing for FY 2013 National Provider Call -- 28 Feb 2012


Uploaded by CMSHHSgov on 16.05.2012

Transcript:
Welcome to this video slideshow presentation on the Hospital Value Base
Purchasing program for Fiscal Year 2013. This educational call was
hosted by the CMS Provider Communications Group within the Center for
Medicare on Tuesday, February 28, 2012.
Hello, everyone, and welcome to CMS National Provider Call on the
Hospital Value-Based Purchasing Program dry run. My name is Geanelle
Griffith Herring and I will serve as your moderator during todays call.
This National Provider Call is an opportunity for CMS to discuss the dry
run simulation for the Hospital Value-Based Purchasing or Hospital VBP
Program. This dry run is designed to help hospitals anticipate how the
Hospital VBP Program will affect their hospital payments in Fiscal Year
2013 by providing simulated reports that employ hospital data from prior
years to construct the baseline period and performance period scores. Id
like to advise everyone that the slides we will be using for todays
discussion are posted at www.cms.gov/hospital-value-based-purchasing in
the download section on the CMS website. Should you like to follow
along with us, please take the time now to download those slides.
After the presentation, we will open a line to answer questions about
the program. And we would encourage you to use this opportunity to seek
clarification about the program. The presenter today is Mr. Donald
Howard, Project Lead for the Office of Clinical Standards and Quality.
Mr. Howard, I will now turn the call over to you. Thank you, Geanelle.
Slide one, the agenda, today well present an overview of the Hospital
VBP program, discuss how hospitals will be evaluated for the Fiscal Year
2013, and describe the purpose of the dry run for the Fiscal Year 2013
program. There will be a sample simulated hospital report, discuss
where to go for questions related to the report, and close with what to
expect in the next 12 months for the Hospital VBP program. We will
conclude our presentation with the questions and answers.
Id like to thank everyone for joining us for todays call. The National
Provider Call was designed to help hospitals learn more about the
Hospital VBP program for Fiscal Year 2013.
As you may recall from the Open Door Forum in July 2011, Hospital VBP is
the nations first national pay for performance program, and it will
serve as an important driver in revamping how CMS pays for care and
services. It is CMS goal that the Hospital Value-Based Purchasing
program will link payment to quality outcomes and transform CMS from a
passive payer of claims to an active purchaser of high quality material.
Our goal today is to refresh our understanding of the Hospital VBP
program and provide you with an overview of the dry run process for the
Hospital VBP program. As part of the dry run, CMS will create simulated
hospital specific Hospital VBP performance reports for each hospital
review over the next month.
During this call we will review a sample simulated report in detail and
address any questions you may have about the Hospital VBP program or
report. We will also review the critical timelines for the next year.
After this presentation well provide you with an opportunity to ask
questions, so please hold your questions until the end.
In addition to myself today, Id like to acknowledge our partners at the
MITRE Corporation, which is a Federally-funded research and development
center; and Brandeis University, who may assist with responding to some
of the questions today. Without further ado, Id like to begin. Next
slide, please.
Slide two, introduction to Hospital VBP. Overview, the Hospital VBP
program is required by Congress under Section 1886 of the Social
Security Act as added by the Patient Protection and Affordable Care Act.
Hospital VBP is designed to transform the payment of care from a system
based on volume of patient visits and procedures performed to one based
on quality of care provided to Medicare beneficiaries.
Hospital VBP is a quality incentive program built on the hospital and
inpatient quality reporting, or whats called hospital IQR, measure
reporting infrastructure. It is considered the next step in promoting
higher quality care for Medicare beneficiaries. The Hospital VBP
section of the Patient Protection Affordable Care Act strives to reward
a hospital for providing high quality care to patients at a lower cost.
Review value-based purchasing is an important driver of change moving
toward rewarding better value and outcomes, which in turn will lead to
better care and healthier patients.
Hospital VBP will be funded through a 1 percent withholding from
participating hospitals Diagnosis-Related Group, or DRG, payments in
Fiscal Year 2013. That percentage withheld rises to 2 percent by Fiscal
Year 2017.
The money that is withheld will be redistributed to hospitals based on
their Total Performance Scores, or TPS, as required by statute. And the
amount earned by the hospitals will depend on the actual range and
distribution of all TPS scores.
Hospital VBP can only use measures that have been in the Hospital IQR
program and results published on hospital compare for at least one year.
There is no additional data submission required for this program.
Next slide, slide three, Hospital Eligibility. The Hospital VBP program
defines hospitals by statutory definition as Subsection D hospitals
located in the 50 states and the District of Columbia, including acute
care hospitals in Maryland. Not every hospital is eligible for the
Hospital VBP program, however more than 3,000 hospitals nationwide will
be eligible for the Fiscal Year 2013 Hospital VBP program.
Next slide, slide four, Excluded Hospitals. The following two slides
list the categories of hospital exclusions for the Fiscal Year 2013
Hospital VBP program. First, Hospital VBP does not apply to hospitals
subject to payment reductions because they do not meet the requirements
for the Hospital IQR program for the applicable year. Second, Hospital
VBP does not apply to hospitals and hospital units excluded from the
Inpatient Prospective Payment System, IPPS, such as psychiatric,
rehabilitation, long-term care, childrens, and cancer hospitals. There
is a limited number of IPPS-exempt cancer hospitals.
Slide five, Excluded Hospitals continued. Hospital VBP does not apply
to hospitals that have received an exemption from the Secretary of the
Department of Health and Human Services after an exemption request by
their state. States must submit a report that describes how a similar
program in the state or a participating hospital or hospitals achieve or
surpass the measured results of the Hospital VBP program in terms of
patient health outcomes and cost savings.
Maryland hospitals were approved for a waiver from the Fiscal Year 2013
Hospital VBP program through this process, though we note that states
must re-submit their exemption request annually.
Other exclusions from Hospital VBP include hospitals that do not meet
the minimum number of cases, measures, or completed surveys. We will
discuss this in more detail in the next slide.
Finally, Hospital VBP does not apply to hospitals cited by the Secretary
for deficiencies during the performance period that pose an immediate
jeopardy to the patients health or safety of patients. It is important
to note that excluded hospitals will not have one percent withheld from
their DRG payments for the Hospital VBP program for the Fiscal Year 2013
program.
Next slide, eligibility requirements for measures as required by the Act
and based on independent analysis. CMS established minimum numbers of
cases and measures for hospitals to participate in the Hospital VBP
program. Hospitals do not meet minimum numbers of cases and measures
which skew results that would affect scoring. As a result, these
hospitals are excluded from the Fiscal Year 2013 program.
This slide illustrates eligibility requirement for the minimum number of
cases and measures. A minimum of 10 cases per measure, at least four
applicable measures, are required to receive a clinical process of care
domain score.
An example shown here at this hospital had at least 10 cases or clinical
process measures one, two, three, and 12, indicated by the small black
figures with a green checkmark. However, for this hospital clinical
process, measure 11 does not have 10 cases, as indicated by the red X.
This measure will be excluded from this hospitals domain score for
Hospital VBP. In this example even without clinical measure 11, this
hospital meets the minimum number of 10 cases for measure or at least
four measures and would therefore receive a clinical process of care
domain score.
To receive a patient experience of domain score, hospitals must have at
least 100 completed HCAHPS surveys during the performance period. We
will go into more detail later on domain scoring and determining your
TPS score. For now you must have a score for both the clinical process
of care and the patient experience of care domains to be eligible in the
actual reports for the Fiscal Year 2013. The dry run will provide
participating hospitals with more information for educational reasons.
Next slide, Critical Dates and Milestones. This slide presents the
critical dates, as indicated by the triangles and milestones for the
Fiscal Year 2013 Hospital VBP program. The baseline period, July 2009
through March 2010, indicated by the green bar, is the starting point
for all comparisons.
Hospital VBP scoring will be based on comparisons to performance during
the baseline period. As you can see we are now in the performance
period. That started on July 1st, 2011 and will end March 31st, 2012,
indicated by the orange bar, for the Fiscal Year 2013 program.
In August 2012, hospitals will be notified of their estimated Fiscal
2013 value-based incentive payment. By November 1st, 2012, CMS will
notify hospitals of the exact amount of their Fiscal Year 2013
value-based incentive payment. Finally we expect to have incorporated
the adjustments into our claims processing system by January 2013. We
will provide further details on the payment details of the Fiscal Year
2013 program in the Fiscal Year 2013 IPPS rule.
Next slide, slide eight, Fiscal Year 2013 Hospital VBP Domains. This
graphic depicts an overview of the 12 clinical processes of care
measures that will be used for Fiscal Year 2013 program in the blue box.
These 12 measures will contribute 70 percent of the hospitals total
performance score. These measures represent consensus-based practices
and we believe tracking quality with these measures and to the patients
on a solid track for recovery, improve patients overall health, and
shorten recovery times, thereby improving a likelihood of long-term
positive outcomes.
The remaining 30 percent of the hospital score is based on the patient
experience of care domain, which is of the age gap survey. Hospital VBP
places a strong emphasis on the patients perception of care, which is
covered by the eight dimensions listed in the red box.
Please note that the dry run has used the Fiscal Year 2013 VBP domains.
In subsequent years, the Hospital VBP program plans to add additional
domains and measures to provide a broader snapshot of quality of
improvement in efficient delivery of care.
Next slide, Fiscal Year 2013 Program Summary. There are two domains for
the Fiscal Year 2013 program, a clinical process to care domain with 12
measures and a patient experience of care domain with eight HCAHPS
dimensions.
Hospitals will receive two scores on each measure and dimension, one for
achievement and one for improvement. The two scores measure how the
hospital performed compared to other hospitals and how much a hospital
has improved compared to its own performance. We will use the greater
of the two scores on each measure and dimension to calculate the
hospitals overall performance.
For Fiscal Year 2013, 70 percent of the hospitals total performance
score was based on clinical process of care measures, and 30 percent of
hospitals total performance score will be based on patient experience of
care dimensions.
Next slide, slide 10, baseline performance data. The slide is a graphic
representation of the baseline performance data for a select period. The
bell-shaped curve represents all the hospital performance data for
sample measure or dimension in the baseline period. Represented on the
curve are three points.
The first point is the floor, which is defined as a zero percentile or
the lowest performing hospital. The second point, the achievement
threshold, which is defined as the 50th percentile for the point at
which half of the hospital performance rates lower and half of the
hospital performance rates higher. And on the third mark, the
benchmark, which is defined as the mean of the top decile or top 10
percent of the hospitals.
The floor is only used in the patient experience of care domain to
calculate consistency points. The threshold and benchmark are used in
both clinical process of care or patient experience of care domains. If
a hospitals performance on a certain measure of dimension is equal to or
exceeds the achievement threshold, then that hospital will receive
achievement points for that measure or dimension.
Next slide please, Achievement. The achievement score means, How did my
hospital perform in the performance period compared to all eligible
hospitals performance during the baseline period?
Next slide, Improvement. An improvement score means, How did my
hospital improved in the performance period compared to my performance
in the baseline period?
Next slide, Achievement Points. As discussed previously, we will award
achievement points based on an individual hospitals performance during
the performance period compared to all hospitals performance during the
baseline period. If a hospital performs at or above the benchmark, it
will be awarded the maximum 10 achievement points. If a hospital
performs below the threshold, that will receive zero points. If a
hospital performs equal to or greater than the achievement threshold but
below the benchmark, it will receive between one and nine achievement
points.
Achievement points are awarded according to a formula finalized in rule
making. In the example at the bottom of the slide, this hospitals
performance rate was 0.70, or one measure or dimension, and it would
therefore received achievement points based on where its performance
rate of 0.70 falls on the achievement range.
Next slide, Improvement Points. Improvement points compare individual
hospitals performances during the performance period with the hospitals
performance during the baseline period. If a hospital performs at or
above the benchmark it will be awarded the maximum of nine improvement
points. If a hospitals performance is less than or equal to its
performance during the baseline period, it will receive zero improvement
points. If a hospital performs between its performance in the baseline
period and the benchmark, it will receive between zero and nine
improvement points.
From a rounding perspective, the hospital may improve its performance by
a small amount. For example, the hospital can improve by 0.08 and still
receive zero improvement points. Improvement points are awarded
according to another formula finalized in rule making.
In the example at the bottom of the slide, the hospital improved their
measure rate from 0.21 in the baseline period to 0.70 in the performance
period and will therefore receive improvement points based on the
performance rate of 0.70 falls on the improvement range. As a
reminder, the greater of the achievement or improvement points is used
for the total performance score.
Next slide, Total Performance Score. The total performance score is
comprised of clinical process of care domain, as indicated in the red
box, which accounts for 70 percent of the hospitals total performance
score. And the patient experience of care domain, which is in the green
box, which accounts for 30 percent of a total performance score.
Next slide, Objectives for the Fiscal Year 2013 Program Dry Run. Now
that we have discussed how hospitals will be evaluated for the Fiscal
Year 2013 program, lets take a look at why CMS is conducting a dry run.
The purpose of the dry run is to simulate the Hospital VBP program. By
simulating the program we hope that this will provide hospitals with a
better understanding of the Hospital VBP program and how their
performance will be scored for Fiscal Year 2013.
The dry run will provide a hospitals specific reports that simulate the
Hospital VBP programs calculations. This will show a hospitals computed
scores based on the baseline period from April 1st, of 2008 to December
31st, of 2008, in the performance period of April 1st, 2010 to December
31st, 2010. It will inform hospitals of how the reports will be
distributed for the Fiscal Year 2013 program.
Hospitals can download their dry run reports through the quality their
QualityNet account. The same process will be used for the Fiscal Year
2013 program reports. It will also provide QIOs with a better
understanding of the hospital reports and the types of questions that
the hospitals may ask.
Next slide, Accessing Your Hospital Specific Report. As part of the dry
run, CMS will create simulated hospital-specific reports for each
hospital to review. These reports will be available through your
QualityNet account after this call. If your hospital has an inactive
QualityNet account, please make sure that you reactivate it by
contacting the QualityNet Help Desk at qnetsupport@sdps.org or call
866-288-8912. The number again is 866-288-8912. Make sure that you can
access your simulated hospital specific report. Next slide, Simulated
Hospital Report Overview. The simulated dry report will use a different
time period than CMS will use to compute Hospital VBP scores for the
Fiscal Year 2013. Instead the simulated report will use a baseline
period again of April 1st, 2008 to December 31st, 2008 and a performance
period of April 1st, 2010 to December 31st, 2010. CMS will provide
complete simulated reports to hospitals eligible for the Fiscal Year
2013 program, based on reporting data from the baseline and performance
periods noted above. To be eligible, a hospital must meet the minimum
reporting requirements for both domains for the dry run period.
In addition, CMS will provide abbreviated reports to non-eligible
hospitals displaying performance and scores for areas where they have
met the eligibility requirements in using N/A to indicate for program
areas that will not be eligible or where insufficient data was
available.
Slide 19, Simulated Hospital Report Overview. A few important notes
regarding the simulated hospital reports. Actual reports for the Fiscal
Year 2013 program used later this year will be different in format and
content from this dry run report. CMS has included graphics on the dry
run report to help you better understand how scoring will occur for the
Fiscal Year 2013.
The dry run report and supporting narrative are provided to help educate
hospitals about Hospital VBP and its scoring process. Dry run reports
will be sent to all hospitals while the Fiscal Year 2013 reports will
only be sent to eligible hospitals. The report does not indicate how a
hospital will actually perform in Fiscal Year 2013 or whether your
hospital will be eligible for the Fiscal Year 2013 Hospital VBP program.
The simulated dry run report has no financial implications. It is
merely a tool to help educate you about Hospital VBP.
Slide 20, Simulated Hospital Report Overview. As a reminder, the
following comment is noted on each page of the report. The simulated
report and supporting narrative are provided to help educate hospitals
about the scoring methodology for Fiscal Year 2013 Hospital Value-Based
Purchasing program. The simulated report does not indicate how your
hospital will actually perform in the Fiscal Year 2013 program or
whether your hospital will be eligible for the Fiscal Year 2013 VBP
program. The simulated report has no financial implications and will not
be available to the public. Further, the simulated report may not
resemble the actual report used in the Fiscal Year 2013 program.
Slide 21, Hospital VBP Simulated Report Content. The simulated hospital
report is divided into seven sections. The first section provides
hospitals with an overview of the Hospital VBP Program and the purpose
of a hospital report. The remaining six sections shown on this slide
display hospital specific data for the baseline and performance periods
used in the dry run. Each section within the report will be represented
by a graphic and a narrative explaining how to interpret the information
provided.
In the following slides we will review each of the six sections of a
report in detail. For sections five and six, the clinical process of
care measures and patient experience of care dimensions. We will review
scenarios you may see in your simulated hospital-specific reports. We
will not be reviewing the Hospital VBP program background as weve
already discussed that in earlier slides.
Slide 22, Estimated TPS Summary. The section shows your hospitals total
performance score, TPS, in percentile in relation to other eligible
hospitals. The report covers both a baseline and a performance period
for comparative purposes to demonstrate how your hospital was
performing. The time periods are shown at the top of the page;
comparisons of your hospitals TPS score to your state and the national
percentile scores are also provided.
As you can see in this example, the hospital has a total performance
score of 72.35 out of a total 100 points which is above the state TPS
average of 49.15 and above the national TPS average of 46.83. If we
look at the graphic, the hospital is at the 97 percentile when compared
against all other eligible hospitals, meaning that 97 percent of
eligible hospitals had total performance scores less than 72.35. It was
important to note the hospital specific reports will have narrative
explanations for each of these sections.
Slide 23, Estimated Value-Based Incentive Payment Percent. The slide
shows the Estimated Value-Based Incentive Payment Percent section of the
report. Its estimated impact summary identifies your hospitals
estimated net change in base operating DRG payment and national
distribution of net change in base operating DRG payment, which is the
horizontal bar graph.
Let's first look at the simulated report impact on the estimated net
change in base operating DRG payment for Fiscal Year 2012. This is the
percentage amount that your base operating DRG payments would have
changed for the Fiscal Year following the simulated performance period
due to the Hospital VBP program. A positive number means we estimate
that the hospital would have had higher payments because of the HVBP
program performance, and that amount of zero means that we estimate that
it would have been no change in the hospitals payments as a result of
the Hospital VBP program. A negative number means we estimate that the
payments would have been lower as a result of the Hospital VBP program.
In this example the estimated incentive payment percentage is a positive
0.119 percent. Please keep in mind that the initial one percent withheld
from your estimated DRG payment is the amount used to fund the incentive
adjustments.
The horizontal bar illustrates your hospital's net change in base
operating DRG payment amount compared to the national distribution. The
simulated dry run period of hospitals had a net change in base operating
DRG payments ranging from negative 0.78 percent and positive 0.91
percent.
In this example, the hospitals net change is greater than zero which is
indicated by the green bar at 0.1189. Please note that the rounding
used to generate the 0.119 percent if the net change is less than zero,
a red bar would be displayed showing the hospital's payment would be
lower.
Next Slide, Slide 24, Measure Performance Summary. The slide shows a
performance summary section of the report. The section of the report
summarizes your hospitals measure dimension performance with the two
domains that contribute to the hospital simulated dry run total
performance score, or TPS.
For this example the TPS score is 57.60. The score is comprised of two
domains; the total score is computed by multiplying the clinical process
domain by 70 percent and the patient experience domain by 30 percent and
then summing.
Remember the weighted clinical process domain score accounts for 70
percent and comprises your hospital scores from all 12 clinical process
domain measures that your hospital was eligible for during the
performance period, while the weighted patient experience domain score
accounts for 30 percent of your TPS and comprises your hospital scores
from all eight patient experience domain dimensions during the
performance period.
Now we'll take a closer look at each of the domain scores.
Slide 25, Unweighted Clinical Process of Care. This slide displays the
unweighted clinical process of care section in the report. The
unweighted score for the clinical process domain is the sum of your
hospital's scores from the 12 individual clinical process measures. The
score has been normalized, taking into account only those measures that
your hospital was eligible for during the performance period. For
example a hospital that scores five out of 10 for four measures would
have received the same score as the hospital that scores five out of 10
for 12 measures. Both hospitals will receive 50 out of a 100 possible
points. In this example the hospital receives 69 out of a 100 possible
points for its performance on 11 of the 12 measures.
The graphic displays the actual clinical process measures that the
hospital was eligible for. The blue portion of the columns represent
where your hospital scored above the achievement threshold and the gray
represents where the hospital scored below the achievement threshold.
Measures without a column indicate your hospital did not meet the
minimum number of cases required for that measure.
For this example, this hospital scored above the achievement threshold
for nine of 12 clinical processes of care measures and below the
achievement threshold for the SCIP Card 2 and SCIP VTE-1 clinical
process of care measures. The minimum cases required were not met for
one measure, AMI-7a.
Slide 26, Unweighted Patient Experience of Care. This slide represents
the unweighted patient experience of care section in the report. The
unweighted score for the patient experience domain is the sum of your
hospital scores from the eight patient experience dimensions.
In this example, the hospital received 31 out of a 100 possible points
for its performance in all eight of the dimensions. The graphic
displays the actual patient experience dimensions for this hospital. The
blue portion of the column represents where the hospital scored above
the achievement threshold and the gray represents the dimensions where
the hospital scored below the achievement threshold. For this example,
this hospital scored below the achievement threshold for two patient
experience dimensions, which are the communication with nurses and
responsiveness of staff, and scored over the achievement threshold for
the remaining six patient experience dimensions.
Next slide, slide 27, Scenarios You May See in Your Reports. The table
shown lists seven scenarios that you may see in your simulated
hospital-specific report. The scenarios are based on how hospitals will
be scored for the Hospital VBP program for Fiscal Year 2013, as
previously discussed. Based on how a hospital performs during the
baseline period and performance period, achievement points and
improvement points are awarded for each clinical process of care measure
and patient experience of care dimension to determine a hospitals total
performance score.
In the following slides we'll review each of the seven scenarios listed
in the table, as these scenarios apply to both 12 clinical process care
of measures and eight patient experience of care dimensions. We will
display one example for each scenario from either the clinical process
of care measures or patient experience of care dimensions.
Remember, formulas from the final rule are used to determine the exact
achievement and improvement points that will be awarded based on a
hospital performance during the performance period. Slide 28, Simulated
Hospital Reports; Scenario One. In scenario one, this hospital has a
baseline rate, a performance rate, achievement points, and improvements
points. The greater of either of the achievement or improvement points
are awarded and are used to arrive at the hospitals total performance
score.
For this scenario we will look at the clinical process care measure
example. For the initial antibiotic measure, this hospital achieved
nine achievement points since its performance rate, which are
represented by the blue bar was close to the benchmark. This hospital
receives seven of nine improvement points since its performance rate
improved from its baseline rate which is represented by the gray bar,
those scores are displayed. However, the nine achievement points are
greater than the seven improvement points and, therefore, nine points
are awarded to this hospital for the initial antibiotic measure.
Slide 29, Simulated Hospital Report; Scenario Two. In scenario two,
this hospital has a baseline rate and performance rate. The hospital
also has achievement points but it has no improvement points. The
hospital is awarded the achievement points which are used to arrive at
the hospitals total performance score. This slide shows a score for the
primary PCI, clinical process of care measure. In this example the
hospital received 10 achievement points since its performance rate,
represented by the blue bar, exceeded the benchmark. For improvement,
this hospital's performance rate is the same as its baseline rate, which
is represented by the gray bar.
Therefore no improvement points were earned. It is important to note
that even a hospital performance at a 100 percent on a measure or
dimension in both the baseline and performance periods is not actually
improved. However the hospital received achievement points based on its
performance in the performance period.
In this example, the full 10 points for its 100 percent performance in
the performance period, the greater of either of the achievement or
improvement points is awarded, therefore 10 achievement points are
awarded to the hospital for the primary PCI measure. Slide 30, Simulated
Hospital Report; Scenario Three. In scenario three, this hospital has a
baseline report and performance rate. The hospital has no achievement
points but has improvement points. The hospital is awarded the
improvement points which are used to arrive at the hospitals total
performance score.
The slide shows the score for the communications with nurses, patient
experience of care dimension. In this example this hospital received
zero achievement points since its performance rate, which is represented
by the blue bar, was below the achievement threshold. For improvement,
this hospital performance rate is greater than its baseline rate, which
is represented by the gray bar, but below the benchmark. Therefore,
four improvement points are awarded to the hospital for the
Communication with Nurses dimension.
Next slide, slide 31, Simulated Hospital Report; Scenario Four. In
scenario four, this hospital had a baseline rate and performance rate.
However the hospital had no achievement points and no improvement
points, this hospital is awarded zero points.
The slide shows the scores for the Communication About medicine, patient
of experience care dimension. In this example this hospital received
zero achievement points since its performance rate, which is again
represented by the blue bar, is below the achievement threshold. This
hospital also received zero improvement points since its performance
rate is lower than its baseline rate, which is represented by the gray
bar. Here, no points were awarded to this hospital for the
Communication About Medicine dimension.
Slide 32, Simulated Hospital Report; Scenario Five. In scenario five,
this hospital has no baseline rate but it has a performance rate. This
hospital also has achievement points and no improvement points. The
hospital is awarded the achievement points. The slide shows the scores
for the Communication with Nurses, patient experience of care dimension.
In this example, this hospital received seven achievement points and
since its performance rate, represented by the blue bar, is a little
more than halfway between the achievement threshold and the benchmark.
Since this hospital has no baseline rate, improvement points cannot be
calculated. It is important to note that the baseline period is only
needed for improvement points. So a hospital can still earn achievement
points if it does not have performance during the baseline period.
This hospital received no improvement points since it had insufficient
data for the baseline period which is represented by the N/A, thats the
greater of either of the achievement or improvement points is awarded,
this hospital received seven achievement points for the Communication
with Nurses dimension.
Next slide, Slide 33, Submitted Hospital Report: Scenario Six. In
scenario six, this hospital has a baseline rate but it has no
performance rate. The hospital also has no achievement points and no
improvement points. This hospital received N/A, or not applicable, for
its score on this measure. The slide shows the score for the Primary
PCI Clinical process of care measure.
In this example, the hospital has a baseline rate, which is represented
by the gray bar, for the baseline period. However there was
insufficient data for this hospital during the performance period. It
is important to note that the performance period is needed for both
improvement and achievement. This hospital received N/A for both
improvement and achievement points.
Next slide, which is 34, Simulated Hospital Report: Scenario Seven. In
scenario seven, this hospital has N/A with a baseline rate and
performance rate. The hospital also has N/A for achievement points and
improvement points. The hospital received N/A, or not applicable, for
each score on this measure. This slide shows a score for Fibrinolytic
Therapy, clinical process of care measure. In this example, the
hospital received N/A for both improvement and achievement scores since
there was insufficient data available for the baseline rate or
performance rate.
Next slide, Slide 35, Clarification of Criteria in Clinical Scores in
the Dry Run. Lets clarify what hospitals will see for the clinical
scores in the dry run. Where the simulated dry run report hospitals did
not report 10 cases for at least four measures will not be provided a
total clinical domain score, a total performance score, or an incentive
adjustment. For those measures, hospitals will see their baseline rate
and performance rate with N/A represented for improvement and
achievement points.
In this example, the hospital has a baseline rate of 0.8757 and has a
performance rate of 0.9307 from the SCIP VTE-1 measure. However the
rates are based on less than 10 cases. Therefore the hospital received
N/A for both improvement and achievement scores.
Next slide, Slide 36, Patient Experience Domain Score. Now lets take a
closer look at the patient experience domain score. This section report
summarizes your hospital's total patient experience domain score for the
eight patient experience of care dimensions used in a simulated Hospital
VBP dry run. Two scores based on consistency are calculated for this
domain.
Like the clinical process of care domain, the patient experience of care
dimensions are scored on the greater of the improvement or achievement
points for each of eight dimensions with 80 total points possible. This
is called your base score. Hospitals with a 100 completed reported
HCAHPS are raised during the performance period, receive a patient
experience of care domain score. Again the greater of the achievement
for improvement scores for each dimension is used to calculate the
patient experience of care domains base score.
Next slide, Slide 37, Consistency Point Details Example. In addition to
the base score, your hospital can earn between zero and 20 consistency
points towards its total patient of experience of care domain score.
Consistency points encourage the hospitals to meet or exceed the
achievement threshold in all HCAHPS dimensions. The higher your lowest
dimension score is relative to other hospitals, the more consistency
points are earned. Simply, the higher a hospitals lowest dimension
score is compared to the lowest performing hospital on this dimension,
which is shown as the floor in this example, the better your score
becomes.
For this example, the responsiveness of staff dimension was the lowest
HCAHPS dimensions score for this hospital. The consistency points for
this hospital were 17 out of 20 points based on the relative location of
this hospital performance rate of 56.07 percent, which is represented by
the blue bar, compared to the range from the floor to the threshold. If
the blue bar is close to the threshold, the majority of the 20
consistency points are awarded to the hospital. Remember, formulas from
the final rule are used to calculate the exact number of consistency
points.
Next slide, Slide 38, Non-Eligible Hospitals. Now that we have
discussed the simulated hospital report wed like to take a few minutes
to review the types of reports that non-eligible hospitals will see for
their dry run. The table shown is a list of categories for exclusions
for the Fiscal Year 2013 the Hospital VBP program and the designation of
the type of simulated hospital report that hospitals will expect to see
after todays call.
As you will see, hospitals are subject to payment reductions under the
Hospital Inpatient Quality Reporting, which is the IQR program, well get
a simulated sample report. Hospitals and hospital units excluded from
the IPPS will get their simulated report with TPS and incentive
adjustment omitted, if data is available and minimal requirements are
met. If data is not available or minimum requirements are not met,
these hospitals receive a sample report.
Next slide, Slide 39, Non-Eligible Hospitals. Hospitals that are paid
under Section 1814 (b)(3) but have received an exemption from the
Secretary of Department of Health and Human Services will receive a
similar report with only the incentive adjustments omitted, if data is
available and minimum requirements are met. These hospitals will
receive a report with both their TPS and incentive adjustments omitted
if data is not available or if the minimum requirements are not met.
Hospitals that report fewer than 100 HCAHPS surveys will receive their
simulated report showing N/A in the patient experience of care domain.
N/A will also appear in the patient experience of care dimension section
of the report. TPS and incentive adjustments are also omitted.
Next slide, Slide 40, Non-Eligible Hospitals. Hospitals without the
minimum number of cases and measures will receive their simulated report
showing N/A in the clinical process of care domain. TPS and incentive
adjustment will also be omitted. Sample reports are provided to
hospitals if data is not available or minimum requirements are not met
for both the patient experience and clinical domains. Hospitals cited
for deficiencies during the performance period that pose immediate
jeopardy to the health and safety of patients have not been incorporated
into the dry run. Immediate jeopardy will be part of the actual reports
for Fiscal Year 2013.
Next slide, 41, Questions on Hospital Reports. The table shown is a
guide to where to find answers to questions related to the dry run your
hospitals report. As discussed in a previous slide, hospitals that have
specific reports will be available through your QualityNet account after
the call, starting tomorrow February 29th. If you have questions, we
suggest you first review the Hospital VBP Frequently Asked Questions,
FAQ, located on CMS website
http://www.cms.gov/Hospital-Value-Based-Purchasing/.
The site will be periodically updated with new questions and answers. If
a hospital has a question that is not addressed in the FAQs, hospitals
should complete the feedback form available on QualityNet. Our goal is
to provide responses to your questions as soon as possible after
receiving your completed feedback form. If you have an inactive
QualityNet account, we encourage you to contact the QualityNet Help Desk
to reactivate your account to ensure you will be able to access your
simulated hospital specific report after the call.
Next slide, Feedback Form. This slide shows the feedback form that will
be posted on a QualityNet site. On this feedback form, enter your
contact information such as your name, position, e-mail address and
phone number, CMS certification number, provider number, name of the
hospital, and hospital address. Please complete all required
information to ensure a timely response to your question.
Next. Enter your questions; one question per line. There will be five
lines available to enter your questions in the table. If you have more
than five questions, please use another feedback form to enter your
remaining questions. Once completed, submit your questions by clicking
the submit form button in the upper right hand corner, or you can send
your form to the e-mail address HospitalVBP@cms.hhs.gov.
Next slide, Slide 43, Critical Dates and Milestones. We want to take
this opportunity to also discuss what to expect from the HVBP program in
the next 12 months, this includes dates and milestones for the dry run
report for Fiscal Year 2013, Fiscal Year 2014, and Fiscal Year 2015
programs. Lets start by reviewing the key dates for the Fiscal Year
2013 program. As we previously discussed performance periods for the
clinical and HCAHPS domains are July 1st, 2011 to March 31st, 2012.
Next slide, Slide 44, Critical Dates and Milestones. After this call,
CMS will make available the hospital specific dry run reports through
QualityNet. Remember hospitals that are not eligible during the dry run
performance period will not receive a hospital specific dry run report
for review, but will receive a sample report to assist in their
understanding of the Hospital VBP program.
Next slide, Slide 45, Critical Dates and Milestones. For the actual
Fiscal Year 2013 program, the focus is on payment. Hospitals will be
informed of their estimated incentive adjustment by August 1st, 2012.
Please note, the keyword in this portion of the slide is estimated.
Estimated reports are provided to hospitals as early as we can possibly
generate them. Our intent is to assist hospitals and their planning for
the upcoming year. As we all know, estimates are estimates.
Additional time to review the Fiscal Year 2013 data permits CMS to
validate information, submit it and allow the actual report in November
to be definitive and permit the inclusion of the potential request for
review of hospitals data.
Slide 46, Critical Dates and Milestones. By November 1st, 2012 the
hospitals will be provided their actual incentive adjustment for Fiscal
Year 2013. Again CMS is working to provide these reports to QualityNet
as soon as possible.
Next slide, slide 47, again Critical Dates and Milestones. Following
the release of the actual incentive adjustments for Fiscal Year 2013,
hospitals will have 30 days from that date to review and correct their
data.
Next slide, slide 48, Critical Dates and Milestones. After the review
and corrections period, CMS will make adjustments to the claim systems
to accommodate the value-based incentive payments. This will occur in
January 2013.
Next slide, Slide 49, Critical Dates and Milestones. For the Fiscal
Year 2014 program, the focus is on performance. As shown, the
performance periods for the Fiscal Year 2014 clinical and HCAHPS domains
for April 1st, 2012 to December 31st, 2012.
Next slide, Slide 50, Critical Dates and Milestones. The performance
period for the Fiscal Year 2014 mortality measure is July 1st, 2011
through June 30th, 2012. As you can see, we are eight months into the
performance period for the mortality domain, and the performance period
for the clinical and HCAHPS domains begin in one month.
Next slide, Slide 51, Critical Dates and Milestones. Finally, for the
Fiscal Year 2015 program the focus is on feedback. As shown, the
Medicare Spending per Beneficiary preview report for Fiscal Year 2015
was released in February of this year.
Next slide, Slide 52, Critical Dates and Milestones. CMS will take
comments on the Medicare Spending per Beneficiary Measure from February
1st, 2012 to March 1st, 2012.
Next slide, Slide 53, Critical Dates and Milestones. The Fiscal Year
2013 IPPS proposed rule is expected to be displayed in the spring. To
clarify, we intend to make proposals on the Fiscal Year 2015 Hospital
VBP program in that rule.
Next slide, Slide 54, Critical Dates and Milestones. Following the
release of the IPPS proposed rule for Fiscal Year 2013, CMS will take
comments for up to 60 days.
Next slide, Slide 55, Critical Dates and Milestones. As shown, we
expect to publish the IPPS final rule in late summer.
Next slide, Slide 56, Critical Dates and Milestones. As you can see,
there are a number of critical dates and milestones for the Fiscal Year
2013, Fiscal Year 2014, and Fiscal Year 2015 Hospital VBP programs in
calendar year 2012. We hope this timeline gives you an understanding of
what to expect in the next 12 months with a Hospital VBP program.
Next slide, Slide 57, Useful Resources. Listed on this slide are some
resources which can provide you with additional information regarding
the Hospital VBP program. Please refer to these resources and use the
feedback form previously discussed should you have any questions about
the Hospital VBP program or the dry run.
We are now ready to begin our question and answer session. First I
would like to remind everyone that this call has been recorded and
transcribed, so please state your name and the organization which you
represent. In an effort to get as many questions asked and answered as
possible, we ask that you limit the number of questions you ask to just
one.
Holley, when ready, were ready for our first question.
To ask a question, press star followed by the number one on your
touch-tone phone. To remove yourself from the queue, please press the
pound key. Please state your name and organization prior to asking a
question and pick up your handset before asking your question to assure
clarity. Please note, your line will remain open during the time youre
asking your question so anything you say or any backgrounds noise will
be heard in the conference.
And your first question comes from the line of Ramona Thompson.
Hi, Im Ramona Thompson from King's Daughters Medical Center. Im curious
to know where I can find the Medicare Spending per Beneficiary report
that was apparently released earlier this month. Is that on QNet?
Yes, yes, that is on QNet.
Thank you.
OK, thank you.
Please hold for your next question. Your next question comes from the
line of Lindsay Duckworth.
Hi, this is Lindsay Duckworth calling from PeaceHealth Ketchikan Medical
Center, and I know that critical access hospitals are not currently
included in the Value-Based Purchasing program but Im wondering if there
is a plan to include them in the future, and if so when that may happen?
Hi, this is Michael Lee from MITRE Corporation. The Hospital
Value-Based Purchasing does not currently incorporate critical access
hospitals, and CMS is currently considering how to best include critical
access hospitals in future program years. There are no plans to include
them at this time. And as a reminder there, the critical access
hospitals are ineligible for the program pursuant to the statute.
And your next question comes from the line of Michael Cahill.
This is Michael Cahill from Parker Adventist Hospital in Denver. I just
have a question. I am looking for the FAQs on the Value-Based Purchasing
site and I just I cant find the general CMS FAQ at the bottom, but Im
looking for the Value-Based Purchasing specific one.
Thanks for the question. This is Kelly Anderson. I am the
Communications Manager for the CMS Office of Clinical Standards and
Quality. We are currently experiencing a technical issue with our
website. You may notice that our website looks a little different than
it had in the past. We are having a little bit of a technical issue as
we go through the design change, and so we hope that they will be out in
the next 24 hours. We will ask our friends in the Listserv area where
you may have received notice of this call to let folks know when those
FAQs are up. So, thank you for your patience with us.
Thanks, Ill cancel my ophthalmology appointment.
And your next question comes from the line of Jacob Parrish.
Yes, this is Jacob Parrish of Vital Health in North Carolina. I have a
question that relates to childrens hospital, I see that theyre also
excluded. How will you treat a childrens hospital that is actually a
hospital within a hospital?
Hi, this is Jim Poyer from Clinical Standards and Quality, Director for
Quality Improvement Policy Care Division. If the CMS certification
number which the childrens hospital excludes that from, by being a
specific childrens hospital, per that CMS certification number, then
they would not be paid under an eligible for the Value-Based Purchasing
program. Its only episodes of care for patients under 18 treated by
eligible hospitals under thefor eligible hospitals and the inpatient
prospective payment system, Subsection D hospital. So if its the
childrens hospital thats excluded from the IPPS, its ineligible for
Hospital Value-Based Purchasing.
OK, thank you.
Thank you.
Your next question comes from the line of Carol Volk.
Hello, this is Kathy Gough. Im calling from the University of Arizona
Medical Center in Tucson, Arizona. I was just wondering, when we
started this journey it was originally said that we would the first
performance period would be nine months and then subsequently would be
one year and I dont see that as for our next period, it looks like its
nine months again. Is there what rationale was there for just using
nine months, and are we going to continue with just a nine-month
performance period? Thank you.
You are correct in saying that, observing that the finalized performance
period for HCAHPS, that domain as well as clinical process of care, it
continues to be nine months. The rationale is, as you might see from the
presentation for Fiscal Year 2013, were paying hospitals in January we
are trying to get back to make the initial payment by October of the
fiscal year to make to have it applicable for all 12 months of the
payment year so that were not having to withhold potential payments for
several months prior to doing it.
And we thought that and finalized to rule making that an additional year
of the nine months performance period for Fiscal Year 14 and getting the
payment out to the hospitals in a more timely manner outweighed the need
for, you know, the increased reliability for 12 months. Please stay
tuned for additional proposals for FY 15. In future years we want to
ensure that the data are as reliable as possible while ensuring as much
as possible that we want to incentivize hospitals and get the payments
out at the start of the fiscal year.
All right, then. Just see that youre looking for trends of improvement,
you know, just three quarters.
Im sorry, youre talking about Fiscal Year 2014 that these these
proposals were this is Jim Poyer again these proposals were proposed
and finalized for rule making last year. And we do recognize in terms
of that if it is increased reliability for 12 months data and recognize
that. That said, we want to make sure that the hospitals are getting
their payments as soon as possible at the start of the Fiscal Year.
Right now for Fiscal Year 13, as Mr. Howard had alluded to in the
presentation, we have to withhold the initial incentive payment until at
least three months. So we want to get to a point where were paying
hospitals sooner or at the start of the Fiscal Year recognizing cash
flow issues and ensuring that the hospitals get the payment that they
have earned. Thank you.
: Thank you for the question. Next question, Holley?
Your next question comes from the line of Richard Ketcham.
Hi, this is Rick Ketcham, St. Elizabeth Medical Center in Utica, New
York. On slide 23, you talked about the incentive payment percentage. I
understand there is a 1 percent withheld but I would like to further
understand what the maximum potential incentive could be, or conversely
the maximum percentage withheld?
Just a moment while we pull up that slide.
This is Jim Poyer again from CMS. In slide 23, the range of payments
that ranged from 0.78 to 0.91 positive, are estimated from the dry run
data baseline of nine months in 2008, discharges performance period in
2010. That exact amount percentage amount range might vary slightly
with respect to the actual data that is used for an actual baseline and
the performance period. And we take in terms of what pool of hospitals
are eligible and then determine essentially what is a slope to be able
to ensure that the pool of payments is budget neutral per the statute
that the amount of what get goes out to the hospital is the same as
what goes in.
I just wanted to emphasize also again that its going to depend on the
actual data for the performance periods so that those amounts exact
amounts and percentages might vary slightly. Thank you.
Thanks for the question. Holley, next question please.
Your next question comes from the line of Teresa Ryals.
Good afternoon, this is Teresa Ryals from Mississippi State Hospital. I
would like to thank you for putting on this afternoons call, firstly. My
question is for smaller hospitals who cannot meet the eligibility
requirements. Will there be any payment adjustments for those hospitals,
or will they remain as is?
They will remain as is. The statute is very explicit with respect to
who is an eligible hospital, also that its provision is that we must
meet minimum numbers of case thresholds. And we tried when we made the
initial proposals for Fiscal Year 13, we ran a lot of analysis to check
the reliability relative to the impact on the number of hospitals and
wanted to ensure that what has been, first and foremost, be complying
with the statute. But second, also that what were paying out the
hospital is reliable and indicative of quality of care and patient
experience of care and not, you know, as reliable as possible.
That said, for critical access hospitals statute would have to be
modified in order to in the payment system to include them and for
hospitals with minimum numbers of cases. The Affordable Care Act also
did task CMS with conducting study, and were considering that and more
details to come, in terms of those findings, but in terms of critical
access hospitals, Congress and the President would have to modify
statute in order to allow critical access hospitals to receive the
incentives for quality.
OK, thank you.
Thank you.
Thank you for your question. Holley, next question please.
Your next question comes from the line of Davida Sanders.
Yes, this is Davida Sanders from Hamilton Medical Center in Dalton,
Georgia. On slide 49, you have the clinical performance period there
and the HCAHPS performance period. What is used for the baseline for
Fiscal Year 2014? Will it be the performance period for Fiscal Year
2013? Or will it be the previously established baseline?
Give us a moment while we pull up those slides.
Hi, this is Jim Poyer from CMS again. We have proposed and finalized
through rule making in the last calendar year. For Fiscal Year 2014,
the performance period is April 1st through December 31st, 2012.
Discharges for the patient experience of care and the clinical process
of care domain, and the baseline for HCAHPS as well as clinical process
of care is two years prior, April 1st through December 31st, 2010.
Thank you for the question. Holley?
OK.
Holley?
And your next question comes from the line of Joshua Scott.
Hi, this is Joshua Scott from Madison Memorial Hospital. I have a
question about the baseline period for the Simulated Hospital report.
Why are we not using the baseline period that the actual baseline
period for that time period? Give us a moment while we pull the question
to answer that.
Its on slide number 18.
Give us a moment while we pull up slide 18.
Hi, this is Jim Poyer from CMS. We wanted we chose to utilize two
columns in the eight data because of to replicate as much as possible
the seasonality as well as the lag between the baseline period, which is
two years prior to the performance period, just to give a rough estimate
as to some of the change in the data that is not due to seasonality,
because we did finalize a performance period thats two years following
the baseline period. And that would help give a rough estimate to
hospitals in terms of what you might see with respect to change over
time that might not be associated with, lets say, quality improvement
efforts related to, you know, focusing on value-based purchasing what
you see in terms of data that were two years prior.
OK, thank you.
Thank you.
Thank you for the question. Holley, next question please.
Your next question comes from the line of Amelia Bryant.
Yes, Im from North Carolina. I would like to go to slide five, please,
regarding the I.J. letters. I want to understand clearly if a hospital
received an I.J. letter during the performance period but was cleared
and never lost their certification, are they excluded just because they
received the I.J. letter? Thank you.
We are aware of many concerns with respect to how CMS intends to
implement the immediate jeopardy language that is in the statute and we
intend to provide proposals on how we intend to implement that language
on immediate jeopardy deficiencies in future rulemaking, so. OK, thank
you. Thats all I have to say at this point, thank you.
Your next question comes from the line of Cathy Vanrudden.
Hi, Cathy Vanrudden from Essentia Health. I also have a question
regarding the payment adjustment that will go into effect January 1st of
13. The program is funded by a one percent withhold from all of the
participating hospitals. But its not like were all going to receive
that, itll depend on our payment adjustment, and theres a maximum
negative payment adjustment one percent.
This is Jim Poyer. Its going to be dependent on the pool hospitals as
in the previous question. And the number of eligible hospitals and the
amount that is in the pool and then the statutory requirement after the
1 percent was withheld, is that CMS big budget, budget neutrality which
means the pool of money that gets withheld from the hospitals, that
entire amount no more, no less gets disseminated to the hospitals. So
the actual amount, yes, we have run regulatory impact analysis and
published that in the last years proposal in the standalone rule for
Fiscal Year 13. I would refer you to that information for an estimate.
Its going to you know, the range that weve posted in this presentation
is going to slightly vary. So you mention terms of max, one percent.
Its going to vary but I would refer you to that regulatory impact
analysis for a more detailed discussion on the estimated impact. We
dont know because we dont have the actual data and the pool of hospitals
that are eligible, and we wont have that information until we have the
actual report, so I wish I had better information for you but thats the
best I can do for you at this point. Thanks.
Thank you.
Thank you for your question. Holley, your next question.
Your next question comes from the line of Adelina Vasilescu.
Hi, this is John Michel from Parma Hospital. I would like you to
confirm that the floor achievement in benchmark numbers for the purposes
of the dry run will come from that baseline period, and are those sets
of metrics published anywhere?
Give us a moment to get our question and answer together, please.
Hi, this is Jim Poyer from CMS. The National Floor Median and
Benchmark, the mean of the 90 top decile is published in the Federal
Register. Weve proposed and finalized rule making for both Fiscal Year
13 and 14 and have the National Floor Median and Benchmark.
Is that for four years for the dry run period?
This is Phil Beenhouwer from the MITRE Corporation. For the dry run
period you will see the floor, achieving threshold, and the benchmarks
used for the dry run in your hospitals specific reports. Jim was
responding to the FY 13 and FY 14 programs where those measures are from
the baseline period and they are published as part of rulemaking for the
FY 13 and FY 14 period.
OK, thank you.
Thank you for your question. Holley, next question please.
Your next question comes from the line of Tami Lewis.
Hi, this is Tami Lewis with Robinson Memorial Hospital. You actually
answered the question, but if you could just state one more time, what
is the baseline going to be for 2014? Was it April 1st to December
31st, 2010?
This is Jim Poyer. That is correct. April 1st through December 31st,
2010, discharges for patient experience of care and clinical process of
care domains.
OK, and was it two was it a two-year timeframe for our first our first
run here, our first performance and achievement, was that two years
because the timetable doesnt look like that one was two years? This is
Jim Poyer again. Its a nine-month performance period, the lag between
for the difference between the baseline period.
Right.
Which is nine months and the performance period is two years between.
OK.
So, the last nine months of 2008 versus the last nine months of 2010 and
the simulated dry run reports.
OK, thank you.
Sure.
Thank you for your question. Holley, next question please.
Your next question comes from the line of Charles Phillips. And that
question has been withdrawn.
Your next question comes from the line of Paula Parsons.
Hi, this is Tina Swing from Qualis Health in Seattle. CMS has done a
great job of describing point assignment for process and patient
experience measures in this call and in previous calls, and Im wondering
when CMS will be providing a description for point assignment for the 30
day mortality measures?
Tina, this is Jim Poyer. Thank you for the questions. Well put it on
our list of things to do, and stay tuned for a future call, potentially
well consider it. And for that we would refer you to the FY 14 final
rule and proposed rule thats published in the Federal Register for
discussion on the points for mortality measures.
I think were, you know, paging for additional information. If we have
additional information we will also put it on the QualityNet website and
let the folks know we plan to update that website on a CMS website to
provide more information, so.
Thanks so much.
And your next question comes from the line of Marsha Ford.
Hi, this is Marsha Ford with University of Illinois. I am calling more
on the finance side of the world. Is CMS considering giving hospital
administration some sort of letter or communication for their
determination on what the hospital will get for each type of
reimbursement? Meaning, for a value-based purchasing youll get a plus
.119 percent. Hospital required condition youre going to lose your
percentage point somehow, so that finance can make sure that the
hospital is getting paid what they believed theyre getting paid with all
the new changes going into effect.
This is Jim Poyer, well consider it we recognize that this information
is coming from a myriad of sources, and it can be a challenge for
hospitals, their financial administration, and C Suite to be able to get
all this information from the many sources and integrate it. But we
will consider it and will send it throughout CMS and also encourage you
when we put our proposals for rule making to submit that, that way CMS
must respond to every single comment and it has to be published in the
Federal Register, so.
OK, thank you very much.
Thank you.
Your next question comes from the line of Kelsey Pence.
This is Kelsey Pence from Summit Medical Center. And you may have
answered this question through the slides and I just didnt get it but I
was curious, is there a point range that you have to earn to guarantee
your hospital of the one percent payment?
Can you give us a moment, please?
Im sorry. We cant give you that exact information because the pool of
hospitals, as well as how the hospitals score what their total
performance scores are as I pointed out, it has to be budget neutral
and paid out, no more, no less. So what the exact measure, you know,
quality performance rates are, were going to have to run the data and
calculate the scores based on that.
So, your score is going to be based on your performance relative to
baseline as well as your improvement. And then the pool of money has to
be overall budget neutral, so we cant give you an exact. If you get
this measure rate, then you get a net positive.
OK, thank you.
Thank you for the question. Holley, next question, please.
Your next question comes from the line of Peggy Jarrett.
This is Peggy Jarrett from Platte Valley Medical Center and I have been
trying to track down a little bit more specific information related to
the consistency score for the HCAHPS. Its on slide 37. You kind of
briefly talked about it.
Performance and the improvement scores are very well defined and I
totally understand those. The consistency score is, I cant find any
place in the register or on CMS that kind of gives an easily
understandable, and I dont know if you can explain that a little bit
more as to where you come up with those 20 points. Or if theres a place
that I can go to kind of read up on that and get a little bit more
detail.
Thanks for the question. This is Bill Lehrman from CMS. I work on the
HCAHPS survey. We had a more extended discussion about how the
consistency points will be scored in our July call and I believe the
slides are still available.
OK.
And just as a brief reminder, consistency points accrued to the lowest
score amongst the HCAHPS dimension so were trying to Right.
incentivize hospitals to raise their lowest score to the achievement
threshold. And through testing analysis we did on developing VBP we
came up with a number of 20 points. That will be total 20 points for
consistency, if a hospital has every one of its eight dimensions above
the threshold.
OK, that helps. Thank you.
Thank you for the question. Holley, next question, please.
Your next question comes from the line of Rebecca Thurman.
Good afternoon and thank you for this teleconference. Its been very
informative. My question is and this is Rebecca Thurman. Im from
Coffey County Hospital in Burlington, Kansas.
My question is in regards to the clinical performance period. Im very
concerned that it goes through March 31st, 2012. As Im sure you all are
aware, the National Abstracting System has been down for the first three
months of 2012. How can we submit clinical performance data to you all
for this period when we dont have a way of doing it?
Thank you for that question, and that affects first, this is Jim Poyer,
Im sorry. This would potentially affect the only the first calendar
quarter 2010 discharges. It is our strongest intent to have this
system, and this is the QIO, Quality Improvement Organization, clinical
warehouse that accepts the Hospital IQR data. We intend to have this up
within the next several weeks hopefully no later than April 1st and
would allow hospitals approximately 4? months to be able to submit data
to CMS by the August 15th, 2012 warehouse deadline.
Now, as I understand it, hospitals can submit the fourth calendar
quarter 2011 discharges that are due to CMS by May 15th, 2012, and
theres no impact to that submission. What youre talking about, I
believe, is affecting only first calendar quarter 2012 discharges. And
were making every effort to get that released to the hospitals as
expeditiously as possible but we want to make sure that its working
correctly and I appreciate that.
But wont this affect the reports that well get November 1st where it
says our actual incentive adjustment, if we dont get these first three
months in?
The requirement is its a quarterly requirement in the hospital IQR
program to submit data prior. And for first calendar quarter discharges
that deadline is August 15th, 2012 and were making every effort to get
this warehouse up and running by, within the next several weeks.
Hopefully its March, hopefully its no later than April 1st, but even
with an April 1st release, hospitals and their vendors have April, all
of April, May, June, July and half of August to be able to submit their
patient level chart extracted data. So we
All right. Thank you.
Thank you.
Holley, we have time for just one more question, please.
Thank you. Your final question comes from the line of Denise Black.
Yes, my question was this is Denise Black from St. Vincent East in
Birmingham, Alabama. I was under the impression that the readmissions
were also going to be added to the value-based purchasing measures for
Fiscal Year 14 and weve just talked about mortality. Are readmissions
playing a role or will they in the future?
Statute precludes, we are not allowed to have measures of readmission in
the Hospital Value-Based Purchasing. Section 3025 of the Affordable
Care Act, which is separate and distinct, has a provision for
compensating hospitals for their performance on readmission measures.
That is a separate program from the Hospital Value-Based Purchasing
program. Thats why we only allude to them in the measure set that we
finalized for Fiscal Year 2014.
There is there are three 30-day mortality measures that, in addition to
patient experience of care and clinical process of care domains, no
readmission measures for Fiscal Year 2014, and statute prevents us from
adding measures on readmission in a Hospital Value-Based Purchasing
program. Thank you.
Thank you, Jim. I would like to thank everyone for attending this
National Provider Call. We hope that this call has provided you with a
better understanding of how the Hospital VBP Program will affect your
hospital payments in Fiscal Year 2013, and what to expect when you
receive your simulated hospital specific dry run report.
We also hope that this call has given you an understanding of what is
ahead in the next 12 months related to Fiscal Year 2013, Fiscal Year
2014, and Fiscal Year 2015 Hospital VBP Programs.
Remember, the impetus behind Hospital VBP is better care, better outcome
for patients, and transforming the healthcare system to a payment system
that recognizes the reward excuse me, recognizes reward and quality.
The audio file and transcript of todays call will be made available at
http://www.cms.gov/Hospital-Value-Based-Purchasing/ on the CMS website.
If you were unable to ask a question of the CMS subject matter experts
gathered here with us today, please feel free to complete the feedback
form that will be posted on the QualityNet website at
http://www.qualitynet.org. Or send an e-mail to
HospitalVBP@cms.hhs.gov.
Thank you for viewing this Hospital Value Based Purchasing Program
Fiscal Year 2013 video slideshow presentation. The information presented
in this presentation was correct as of the date it was recorded. This
presentation is not a legal document. Official Medicare program legal
guidance is contained in the relevant statutes, regulations and rulings.
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