1. Washington State Hospital Association Medicaid Quality Incentive Web Conference June 3, 2013 1

2. Washington State Hospital Association Presenters Carol Wagner, RN Senior Vice President, Patient Safety Washington State Hospital Association Daniel Lessler, MD Chief Medical Officer Washington State Health Care Authority

3. Washington State Hospital Association Thank You Vision and drive for quality incentive Rep. Eileen Cody

4. Washington State Hospital Association Today’s Presentation History of the Medicaid Quality Incentive July 1, 2013 program and timeline Purpose and goals Measures Factors to consider Additional resources Questions

5. Washington State Hospital Association History First Medicaid Quality Incentive was passed by the Washington State Legislature in 2010 Among the first in the country Tied to the Hospital Safety Net Assessment Significant quality improvements occurred 90 percent of eligible hospitals earned an incentive payment 5

6. Washington State Hospital Association Medicaid Quality Incentive July 1, 2013 The program is included in the Hospital Safety Net Assessment legislation Expected to Pass as Part of the Budget

7. Washington State Hospital Association Timeline July 1, 2013 - December 31, 2013 Hospitals collect performance data (Work force flu immunization October 1, 2013 to March 31, 2014) April 2014 Chief Financial Officer attestation May 2014 HCA determines which hospitals qualify for payment July 2014 Qualifying hospitals receive incentive payment

8. Washington State Hospital Association Guiding Principles Measures must be: Evidence based Consistent with national measures where possible Methodology for earning incentives: Recognize some measures may not be appropriate to specialty, pediatric, psychiatric, or rehabilitation hospitals Represent real improvement in quality Designed so hospitals can earn incentive payments if performance is at or above the benchmark Consistent with areas Washington hospitals are working on

9. Washington State Hospital Association Process for Selecting Measures Clinical experts from hospitals provided guidance for measure development Improvement and sustaining measures Moving safety and quality forward while sustaining gains of first incentive program while also Final selection by HCA in collaboration with WSHA, clinical experts, and payors

10. Washington State Hospital Association Payment Increases One percent inpatient Medicaid increase for non-critical access hospitals Acute general and pediatric hospitals Receive increase across services based on overall hospital performance Behavioral health hospitals and units Increase based on behavioral health measures

11. Washington State Hospital Association Funding for Incentives The money comes from savings to the program as match rates improve with federal ACA enrollment. Will only be paid if there are sufficient funds to pay for it — we expect there will be.

12. Washington State Hospital Association Funding for Incentives Quality incentive provided to all qualifying Washington hospitals No partial increases Hospitals receive either zero or one percent increase

13. Washington State Hospital Association Selected Measures Acute, Rehabilitation, and Pediatric Services Infection Prevention Improvement Measure: Catheter Associated- Urinary Tract Infection Per Patient Day (Hospital-wide) Sustaining Measure: Health Care Personnel (HCP) Influenza Vaccination Rate

14. Washington State Hospital Association Selected Measures Acute, Rehabilitation, and Pediatric Services ER is for Emergencies (Adult and pediatric hospitals with emergency rooms only) Improvement Measure: Percent of Patients (all payors) with Five or More Visits to Emergency Room with Care Plans

15. Washington State Hospital Association Selected Measures Acute, Rehabilitation, and Pediatric Services Safety Improvement Measure: Falls with Injury Per Patient Day

16. Washington State Hospital Association Selected Measures Acute, Rehabilitation, and Pediatric Services Readmissions Improvement Measure: Reducing Readmissions Rates

17. Washington State Hospital Association Selected Measures Acute, Rehabilitation, and Pediatric Services Safe Deliveries: Induction Appropriateness and Elective Deliveries Prior to 39 Weeks (Applies to hospitals with obstetrical programs only) Improvement Measure: Percent of Patients Undergoing Labor Induction with Documentation of Consent, Bishop Score, and Indication Sustaining Measure: Percent of Patients with Elective Deliveries 37 to Less than 39 Weeks Gestational Age

18. Washington State Hospital Association Selected Measures: Behavioral Health Services Improvement Measure: Percent Patients Post-Discharge Continuing Care Plan Transmitted Sustaining Measures: Health Care Personnel (HCP) Influenza Vaccination Rate Percent of Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification

19. Washington State Hospital Association Incentive Payments All non-Critical Access Hospitals have the opportunity to earn the one percent incentive based on their results Critical Access Hospitals are welcomed and encouraged to participate in improvement efforts, but cannot receive incentive payments Hospitals with ten points in all eligible measures will be recognized. Includes critical and non-critical access hospitals.

20. Washington State Hospital Association Incentive Methodology Current results used to set improvement goals For sustaining measures, hospital data were arrayed in quartiles based on prior performance Points awarded for each quartile For each measure, hospitals can earn 10, 5, 3, or 0 points Points averaged across all applicable measures Hospitals receiving an average score of 5 or above receive the increase

21. Washington State Hospital Association Methodology Example The quartiles were then reviewed for: Patient Safety Appropriateness

22. Washington State Hospital Association Medicaid Quality Incentive Thresholds MeasureThresholdPoints CA-UTI ICU>11.80 11.8-6.23 6.1-1.55 <1.510 CA-UTI Non-ICU>3.50 3.5-1.13 1.0-0.15 <0.110 Healthcare Personnel Influenza Vaccination <85%0 85-89.4%3 89.5-93%5 >93%10

23. Washington State Hospital Association Medicaid Quality Incentive Thresholds MeasureThresholdPoints ER is for Emergencies<1%0 1-4.9%3 5-9.9%5 >9.9%10 Falls with Injury>1.50 1.5-0.853 0.84-0.705 <0.7010 Induction Appropriateness<60%0 60-71%3 72-84%5 >84%10

24. Washington State Hospital Association Medicaid Quality Incentive Thresholds MeasureThresholdPoints Elective Delivery 37 to 39 Weeks >2%0 2-1.1%3 1-0.1%5 <0.1%10 Behavioral Health: Post Discharge Continuing Care Plan Transmitted <60%0 60-69.9%3 70-79.9%5 >80%10 Behavioral Health: Justification on Antipsychotic Medications <85%0 85-89%3 90-94%5 >94%10

25. Washington State Hospital Association Earning the Incentive Patient days should match those submitted in financials Reporting begins July 1, 2013, regardless of when Legislature passes budget WSHA is here to help!

26. Washington State Hospital Association Additional Resources WSHA webpage with definitions, methodology, and tools to help make successful Safe Tables to share best practices http://www.wsha.org/qualityincentive.cfm For official documents: See website. Items on this web conference may change.

27. Washington State Hospital Association Additional Training in June Upcoming Events: June 4 Safe Deliveries Safe Table June 19 Reducing Infections Measurement Details Web Conferences: Web conference in June (date to be determined)

28. Washington State Hospital Association Safe Tables Safe Table Participation: Sharing best practices Learn together

29. Washington State Hospital Association Public/Private Collaboration And the many expert advisors Thanks to the Medicaid Quality Incentive Advisory Group David Fisher, MDSeattle Children’s Karen Geheb, MDPullman Regional (Critical Access Hospital) Thuy Hua-LyHealth Care Authority Daniel Lessler, MDHealth Care Authority MaryAnne Lindeblad, RNHealth Care Authority Michael Owens, MDMolina Healthcare of Washington Gene Peterson, MDUniversity of Washington Health System Claudia SandersWashington State Hospital Association Larry Schecter, MDProvidence Health & Services Carol Wagner, RNWashington State Hospital Association

30. Questions? Dr. Daniel Lessler - D aniel.Lessler@hca.wa.gov Carol Wagner, RN - CarolW@wsha.org