1. SHIP Grant Kickoff

2. 2012-13 SHIP Grant Kickoff AGENDA: 10:00 – 10:15 Opening Remarks
10:15 – 11: Value Based Purchasing Overview (Lou Semrad, HTH)
11:00 – 11: HCAHPS (Kate Valakos, Press-Ganey, remote)
11:45 – 12: Lunch
12: : Tools and Resources, Data drives improvement(Lou)
1: : ICD-10 (Kathy Whitmire, HTH)

3. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Learning Objectives:
Participant will be able to describe what VBP is & why CMS has implemented it.
Participant will be able to explain why it is important to embrace VBP
Participant will understand why “every patient encounter is important”
Participant will understand what changes will occur to VBP in the near future
Participant can list at least 5 best practices that can be applied/implemented in their organization.
Participant can identify at least 4 culture elements of high performing hospitals

4. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
What is VBP:
ACA authorized the Secretary of HHS to initiate programs to decrease the cost of healthcare, & improve quality
VBP is one of these programs.
Started October 1, 2012 for qualifying PPS hospitals
Non-qualifying PPS (low volume) and CAH are currently exempt (no napping for CAH)
KSF: No matter your hospital size or form of reimbursement, embrace VBP.

5. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Not All Hospitals Are Created Equally:
Qualifying PPS hospitals: you vs. 3,000 other qualifying hospitals > carrot & stick approach
Non-qualifying PPS & CAH (most likely scenario): you vs. hospitals with similar average daily census > likely just a carrot approach

6. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Carrot & Stick Approach:
For qualifying hospitals, a percentage of Medicare reimbursement is withheld
Hospitals have the opportunity to earn some or all of the withheld money back. About half, will earn an additional amount of money
For FFY 2013, participating hospitals will earn points for: > performance on core measures (Process of Care) > performance on HCAHPS (Patient Experience)
For FFY 2014, hospitals will earn points for keeping patients alive

7. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Carrot & Stick Approach:
How much money is at risk? How much money is in play?
FFY % ~2.00%
FFY % ~2.50%
FFY % ~3.00%
FFY % ~3.50%
FFY % ~4.00%
KSF: Leaderships definition of VBP (stick or carrot)

8. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Carrot Approach:
Low volume PPS and CAH – likely scenario is CMS will estimate savings to Medicare and use that amount (budget neutral) as a carrot to improve quality and patient experience. Notice that the likely scenario does not include a contribution or holdback.
Google “CAH and VBP” and read the white paper by HRSA dated September 2011.

9. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Common Terms of VBP:
Floor (Patient Experience Domain only) – the worst performing hospital
Thresholds – the score of the 50th percentile
Benchmarks – the score of the top 5% of the hospitals
Baseline – your score during the baseline period (9 month period)
Performance – your score during the performance period (9 month period)
Improvement Points – points awarded for improving your performance score vs your baseline score.
Achievement Points – points awarded based on where your performance score is vs. the nations threshold and benchmark score.

10. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Clinical Domain:
Process Measures:
2012 – 12 core measures
2013 – 13 core measures (adding SCIP-9, removal of urinary cath)
Focus is on ED and surgery
How involved is your Medical Staff?
KSF: Implementation and adherence to Clinical pathways

11. 2012-13 SHIP Grant Kickoff ✔ VBP Measure 2013 2014
Proposed 2015
Proposed 2016
AMI-7 (fibrinolytics) ✔
AMI-8a (PCI)
AMI-10 d/c)
n/a
HF-1 (d/c instructions)
PN-3b (blood culture)
PN-6 (abx selection)
SCIP-Inf-1
SCIP-Inf-2
SCIP-Inf-3
SCIP-Inf-4
SCIP-Inf-9 (cath removal)
SCIP-VTE-1 (prophylaxis)
remove
SCIP-VTE-2
SCIP-Card-2

12. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Patient Experience Domain:
HCAHPS:
2012 – 8 measures
2013 – 8 measures
Measures doctors to housekeeping to the patients memory (discharge instructions & communication about medications)
KSF: Everyone on the hospital staff must understand how they can impact the Patient Experience Domain score.

13. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Rearview Mirror:
Performance periods:
FFY 2013 – July 2011 to March 2012
FFY 2014 – April 2012 to December 2012 / Outcomes: July 2011 to June 2012
FFY 2015 – January 2013 to December 2013 / Outcomes: October , 2012 to June 30, 2013.

14. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Studer Group 2012

15. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Best Practices:
To whose expectations are you and your staff performing to (theirs, yours or the patients)?
Clinical pathways: Medical Staff must support leadership’s effort to drive standardization & understand why. They must be engaged.
Staff – patient interaction: Does every member of the staff know about VBP and their role in improving the patient experience
Behavior expectations: Does the staff know what is expected of them and are they held accountable? (Be nice to patients vs. introduce yourself, explain why you are there and how long upon contact with the patient, make eye contact and smile)

16. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Best Practices continued:
Communication/transparency: Data must be shared with the staff. Do you?
Hourly rounding - opportunity to build trust and consistency in messaging (key words that they will hear again don’t miss this opportunity to coach up the patient)
Leader rounding with purpose – opportunity to coach up staff, visibility
Post-discharge follow-up – who & what is discussed?

17. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Culture of High Performing Hospitals:
Educated staff that perform to high service levels & standards
Dedication to identifying and participating in PI initiatives
Culture of accountability
Engaged employees and Medical Staff
Leadership visibility and supportive in nature
Culture of transparency

18. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview
Your HTH Team:
Jimmy Lewis – CEO,
Kathy Whitmire – Managing Director,
Lou Semrad – Clinical Services,
Kristy Thompson – Hometown Health University,

19. Value Based Purchasing Overview
SHIP Grant Kickoff
Value Based Purchasing Overview