Hospital Metrics Advisory Committee July 7,

Welcome and Agenda Steve Gordon, Chair 2

CMS Update Lori Coyner, OHA 3

Hospital Performance Measures Update Lori Coyner, OHA 4

5 Detailed Domains and Measures Focus AreaDomainsMeasures Hospital focus 1. Elective Deliveries1. PC-01 Elective Delivery (NQF 0469) 2. Readmissions2. Hospital-Wide All-Cause Unplanned Readmission (NQF 1789) 3. Medication Safety 3. Hypoglycemia in inpatients receiving insulin 4. Excessive anticoagulation with Warfarin 5. Adverse Drug Events due to opioids 4. Patient Experience 6. HCAHPS, Staff always explained medicines (NQF 0166) 7. HCAHPS, Staff gave patient discharge information (NQF 0166) 5. Healthcare- Associated Infections 8. CLABSI in all tracked units (NQF 0139) 9. CAUTI in all tracked units (NQF 00754) Hospital-CCO Coordination focus 6. EDIE10. Emergency Department Information Exchange (EDIE) 7. Behavioral Health 11. Follow-up after hospitalization for mental illness (adapted from NQF 0576) 12. Screening for alcohol and drug misuse, brief intervention, and referral to treatment (SBIRT) in the Emergency Department

Quality Pool Distribution Methodology Lori Coyner, OHA 6

Reminder: Data and Performance Requirements Year 1 o Hospital receives credit upon OHA review and acceptance of baseline data submission for each measure Year 2 o Hospital receives credit for each measure on which it achieves an absolute benchmark or demonstrates improvement over its own baseline (improvement target) 7

Two Phases of Allocation Phase 1: Floor Allocation Phase 2: Allocation per Measure Achieved 8

Phase 1: Floor Allocation Each hospital eligible to earn $500,000 floor in each year Must achieve at least one measure in each domain to earn floor Example 1: Phase 1 Floor Allocation (statewide) o Assuming 27 participating hospitals 9 Total HTPP available funds – one year$133 million Available funds – floor for 27 hospitals (assuming all achieve at least one measure within each domain) ($500,000 * 27) $13.5 million Remaining to earn in Phase II allocation (payment per measure achieved) (Total – floor) $119.5 million

Phase 1: Floor Allocation (2) Example 2: Phase 1 Floor Allocation (individual hospitals) o Assuming two participating hospitals 10 Total HTPP available funds - one year$100,000,000 Number of hospitals2 Floor payment/hospital calculation Eligible for Floor? Floor Payment Hospital A (achieves one measure in each domain)Y$500,000 Hospital B (only achieves measures in four domains)N$0 Total floor payments $500,000 Remaining to earn in Phase II allocation (Total HTPP funds - total floor payment)$99,500,000

Phase 2 Step 1: Determine hospital performance against each domain/measure Step 2: Calculate amount each domain/measure is worth (“base amount”) o Weight each measure according to CMS weighting methodology (hospital-focused domains versus hospital-CCO collaboration domains) Step 3: Allocate base amount to hospitals according to hospital size (adjustment factor) o 50% Medicaid discharges and 50% Medicaid days 11

Phase 2, Step 1 – Determine Hospital Performance Against Each Measure Funds remaining after floor payments are allocated based on the number of measures a hospital achieves Hospital performance on these measures is per measure (pass/fail) and all measures are treated independently Once the number of hospitals achieving each measure target is determined, the amount of Phase 2 funds each hospital will receive is calculated 12

Phase 2, Step 2: Calculate Amount Each Measure Worth Per CMS, weighting of payment shifts from emphasis on hospital-focused to hospital-CCO coordination domains 13 Year One 100% of hospital pool Baseline data submission for approved domains and measures (allocation is per measure) Year Two 75% Performance on Hospital-focused domains and measures – 5 domains (15% each) 25%Performance on Hospital-CCO focused domains and measures – 2 domains

Phase 2, Step 2: Calculate Amount Each Measure Worth (2) 14

Phase 2, Step 2: Calculate Amount Each Measure Worth (3) The amount each measure is worth after the floor allocation is the ‘base amount’. This is impacted by the number of measures achieved by hospitals. Apply proportions from table above (adjusted for number of measures achieved by hospitals, if needed) to amount remaining after floor allocation. This is the ‘base amount’ available for each measure. 15

Phase 2, Step 3: Adjust Base Amount by Hospital Size After base amount is calculated, it is adjusted and allocated to hospitals achieving the measure based on hospital size: o 50% based on Medicaid discharges o 50% based on patient days 16

Phase 2 Example, Elective Deliveries 17 Example, Year One Total HTTP Funds Available$300,000,000 Number of Hospitals Achieving at least 1 target in each domain (eligible for floor allocation)2 Phase 1 Amount (floor allocation - 500,000*2)$1,000,000 Funds Remaining for Phase II Allocation (total - floor)$299,000,000 Elective Delivery Share of Available Funds, Year One15% Base Amount - total available to earn for measure (share of funds*funds for Phase II allocation)$44,850,000 Phase II Allocation per Hospital Achieving Domain (Elective Delivery Example) Hosp DischargesDays Adjustment Factor (% discharges*0.5) + (% days*0.5) Amount Earned for Measure (Total Available for Measure * Adjustment Factor) #%#% A5, %2, % (33.3%*.5) + (20.0%*.5) = 0.27 $44,850,000 * 0.27 = $11,960,000 B5, %1, % (33.3%*.5) + (10.0%*.5) = 0.22 $44,850,000 * 0.22 = $9,717,500 C5, %7, % (33.3%*.5) + (70.0%*.5) = 0.52 $44,850,000 * 0.52 = $23,172,500 Total15, %10, % 1.00 $44,850,000

Discussion Steve Gordon, Chair 18

Next Steps Timeline and method for solidifying measure specifications Negotiations with CMS Rules and implementation Steve Gordon, Chair Lori Coyner, OHA 19

Public Comment 20