HCAHPS and Hospital Value-Based Purchasing (Hospital VBP) Agency for Healthcare Research and Quality Centers for Medicare and Medicaid Services June 28, 2012

Acknowledgements This Web conference program is supported by the U.S. Agency for Healthcare Research and Quality (AHRQ) through a contract with the Health Research and Educational Trust (HRET). AHRQ is a federal agency whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. AHRQ is a sister agency of CMS within the U.S. Department of Health and Human Services. HRET is a charitable and educational organization affiliated with the American Hospital Association, whose mission is to transform health care through research and education. AHRQ is a federal agency within the U.S. Department of Health and Human Services (DHHS) whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. HRET is a charitable and educational organization affiliated with the American Hospital Association whose mission is Transforming health care through research and education. HRET’s vision is to leverage research and education to create a society of healthy communities, where all individuals reach their highest potential for health.

AHRQ/HRET Patient Safety Learning Network (PSLN) Project AHRQ hired HRET to partner with state hospital associations and others to create 25 Patient Safety Learning Networks (PSLNs). This year the project will provide over 30 workshops and 100 Web conferences and teleconferences to support hospitals in implementing HCAHPS, Project RED (to reduce preventable readmissions), Medication Reconciliation, AHRQ’s Quality Indicators, and the “Door to Doc” ED flow method. We want hospitals in the 25 PSLNs to learn together and share strategies across State lines. In May we hosted a Web conference on the patient-centered discharge process, and today’s Web conference is intended to answer hospital staff’s questions about how HCAHPS fits into the VBP program.

Hospitals are Focusing on the Relationship between HCAHPS, Value-based Purchasing, and Care Transitions Top four HCAHPS Priorities of over 430 hospitals participating in 18 PSLNs: RN Communication Responsiveness Medication Communication* Discharge Information* * HCAHPS domains that can be improved by a patient-centered discharge process such as Project RED

Staff Always Explained About Medicines: U.S. Benchmarks by Type of Hospital 2010-11

Patients Given Information About Recovery At Home: U.S. Benchmarks by Type of Hospital 2010-11

Today’s Speakers Christine Crofton, Ph.D., Center for Quality Measurement and Improvement, Agency for Healthcare Research and Quality (AHRQ) Elizabeth Goldstein, Ph.D., Centers for Medicare and Medicaid Services (CMS)

HCAHPS and Hospital Value-Based Purchasing (Hospital VBP) Liz Goldstein, Ph.D.

HCAHPS and Hospital VBP Hospital VBP links a portion of CMS payment to hospitals based on performance on a set of quality measures Inpatient Prospective Payment System (IPPS) hospitals only Established by the Patient Protection and Affordable Care Act of 2010 (Public Law 111-148) Affects payment for patients discharged October 1, 2012 (FY 2013) and forward

Total Performance Score

Patient Experience Domain Score Sum of HCAHPS Base Score (0 – 80 points) PLUS HCAHPS Consistency Points (0 – 20 points) Patient Experience Domain Score: 0 to 100 points Comprises 30% of Hospital VBP Total Performance Score

HCAHPS and Hospital VBP Scoring Eight HCAHPS Dimensions in Hospital VBP Communication with Nurses Communication with Doctors Staff Responsiveness Pain Management Communication about Medicines Discharge Information Cleanliness & Quietness of Hospital Environment (combined) Overall Rating of Hospital Percent of patients who chose “Top-box” response

Hospital VBP Time Periods, FY 2013 Two time periods in Hospital VBP: FY 2013 Baseline Period: July 2009 - March 2010 FY 2013 Performance Period: July 2011 - March 2012 IPPS hospitals must have at least 100 completed HCAHPS surveys in the Performance Period to be included in Hospital VBP

HCAHPS and Hospital VBP Scoring For each HCAHPS Dimension, both Improvement points and Achievement points are calculated Improvement Points (0-9 for each Dimension): Amount of change from Baseline to Performance Periods Achievement Points (0-10 for each Dimension): Difference between a Hospital’s Dimension score and the national median score in the Performance Period

HCAHPS Base Score The first component of the Patient Experience Domain in Hospital VBP is the HCAHPS Base Score For each of the Eight HCAHPS Dimensions: Improvement Points (0-9) and/or Achievement Points (0-10) are calculated The larger of the Improvement Points or Achievement Points for each Dimension Are summed to create the HCAHPS Base Score 0 to 80 points

HCAHPS Consistency Points The second component of the Patient Experience Domain in Hospital VBP is HCAHPS Consistency Points Consistency Points 0 to 20 points Target hospital’s lowest performing HCAHPS Dimension During the Performance Period

HCAHPS Consistency Points (cont’d) If the lowest scoring Dimension is below the national median, Then the hospital earns between 0 and 19 Consistency Points Calculation of Consistency Points is explained thoroughly on the CMS Hospital VBP Web site

Patient Experience Domain Score Sum of HCAHPS Base Score (0 – 80 points) PLUS HCAHPS Consistency Points (0 – 20 points) Patient Experience Domain Score: 0 to 100 points Comprises 30% of Hospital VBP Total Performance Score

Hospital IQR vs. Hospital VBP Hospital VBP FY 2013 Four quarter roll-up Three quarter roll-up Ten HCAHPS Measures Eight HCAHPS Dimensions “Cleanliness” and “Quietness” combined No “Recommend” Non-IPPS hospitals can participate IPPS hospitals only Minimum of 100 completed surveys in Performance Period

Detailed Calculations

Baseline Performance Data, FY 2013 7/1/2009 - 3/31/2010

Total Performance Score

Total Performance Score

Base Points Patient Experience of Care Domain Score equals (Greater of Improvement or Achievement Points for each HCAHPS dimension) plus Consistency Points Up to 80 Base Points are possible based on each of the eight HCAHPS dimensions: For each of the eight dimensions, determine the greater of the Achievement Points or the Improvement Points. Add these 8 values to arrive at the total HCAHPS Base Points.

Calculating Achievement Points

Achievement Ranges

Achievement Range for the 8 HCAHPS Dimensions

Example: Nurse Communication Dimension

Example: Nurse Communication Dimension

Example: Nurse Communication Dimension

Example: Nurse Communication Dimension

Calculating Improvement Points

Example: Nurse Communication Dimension

Example: Nurse Communication Dimension

Example: Nurse Communication Dimension

Comparing Achievement and Improvement Points

Example: Nurse Communication Dimension

Example: Greater of Achievement or Improvement

Total Performance Score

HCAHPS Consistency Points Patient Experience of Care Domain Score equals (Greater of Improvement or Achievement Points for each dimension) plus Consistency Points Consistency Points encourage hospitals to meet or exceed the Achievement Threshold in all HCAHPS dimensions

HCAHPS Consistency Points Up to 20 Consistency Points may be earned based on the LOWEST dimension: 20 points are awarded if all dimension rates are greater than or equal to the Achievement Threshold If any dimension rate is less than the Achievement Threshold, then Consistency Points are awarded based on the lowest dimension’s location relative to the Floor

8 HCAHPS Dimensions and Consistency Points

Consistency Points Pain Management & Discharge Information

Consistency Points Calculation

Consistency Points Calculation: Pain Management

Consistency Points Calculation: Discharge Information

Consistency Points Calculation

Consistency Points Calculation

Consistency Points Calculation

Patient Experience Domain Score

Total Performance Score

Total Performance Score

Total Performance Score

Total Performance Score

Total Performance Score

Information on HCAHPS and Hospital VBP Information about Hospital VBP available at new CMS Web site http://www.cms.gov/Hospital-Value-Based-Purchasing/ Hospital VBP slide set can be found at: http://www.cms.gov/Hospital-Value-Based-Purchasing/Downloads/HospVBP_ODF_072711.pdf Summary of the “Patient Experience of Care” domain (HCAHPS) and how this score will be calculated is on slides 35-61