1. Health Care Effectiveness Summer Quarterly Meeting July 19, 2011

3. LSU Medical Home DIABETES CHF HIV KIDNEY DISEASE KIDNEY DISEASE CANCER ASTHMA THROMBOGENIC STATE CONTROL BLOOD PRESSURE CONTROL GLYCEMIC CONTROL LIPID CONTROL SMOKING CESSATION DIETEXERCISEWEIGHT CONTROL SCREENING

4. Domain #1: Development of medical home patient rosters and orientation of patients to medical homes. Domain #2: Access to primary care, with subareas: Domain #3: Access to specialty care Domain #4: Primary care efficiency Domain #5: Wellness, with subareas: Domain #6: Chronic disease management and high-risk patient management, with subareas: Domain #7: Patient perceptions of medical home experiences Domain #8: Provider perceptions of medical home experiences. Domain #9: Reduction of inpatient stays

5. Funded in part by HRSA Grant #H97HA08476

6. LaPHIE identified persons (N=345*) 40% <35 years of age 72% black/African American 38% female MOT (most common) – Of males 22% MSM – Of females and non-MSM 27% heterosexual 66% NIR/unknown 24% had no prior labs in OPH system 32% had not been in LSU system for any HIV-related test or care – Would have been missed in the absence of LaPHIE Source: LaPHIE linked file; OPH N=378 through March 2011

7. Follow up Of those previously in care – Months return to care Median 20 (IQR 15 to 36) – CD4 at return to care Median 233 (IQR 120-333) Of those not previously in care – CD4 at first engagement in care Median 247 (IQR 58-394) Of those followed at least 6 months –82% had at least one LSU visit –82% had at least one viral load and/or CD4 count –62% had at least one HIV specialty visit in LSU system Source: OPH

12. Quality “ the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” - AAP Policy Statement

13. The BP improvement levels seen for diabetes reflects a general improvement in BP levels in our PC population.

14. Our colonoscopy levels have been rising across all sites

16. Value Based Purchasing With Thanks to Simone Olivier!

17. Requirements Legislation requires that the VBP program apply to payments for discharges starting October 1, 2012. To fund the VBP incentive pool our base DRG payments will be reduced by 1% starting FFY 2013. It will increase by.25% per year to 2% by 2017. The incentive pool will be budget neutral.

18. Timeframes For FFY 2013 VBP Program Baseline period = July 1, 2009 through March 31, 2010 Performance period = July 1, 2011 through March 31, 2012

19. FFY 2013 Domains and Measures/Dimensions 30% 70% Two Domains

22. Clinical Process of Care Domain Measures Total of 12 measures Each measure is worth up to 10 points (improvement or achievement points – whichever is higher) A hospital can earn a total of 120 points Hospitals need to have at least 10 cases for each measure to qualify 58% of the 12 measures are SCIP measures CMS will only use the measures that hospitals qualify for or are able to collect data on to calculate an overall score. Ex: EWE only qualifies for 9 of the 12 measures therefore total points possible = 90

23. Clinical Process of Care Domain Measures Acute Myocardial Infarction AMI 2 Aspirin Prescribed at Discharge – removed 4/29/11 AMI 7a Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival AMI 8 Primary Percutaneous Coronary Intervention (PCI) Received Within 90 Minutes of Hospital Arrival Heart Failure HF 1 Discharge Instructions HF 2 Evaluation of Left Ventricular Systolic (LVS) Function – removed 4/29/11 HF 3 ACE Inhibitor or ARB for LVS Dysfunction – removed 4/29/11 Pneumonia PN-2 Pneumococcal Vaccination – removed 4/29/11 PN 3b Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in Hospital PN 6 Initial Antibiotic Selection for CAP in Immunocompetent Patient PN 7 Influenza Vaccination – removed 4/29/11 Surgeries (as measured by Surgical Care Improvement (SCIP) measures) SCIP Card 2 Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the Perioperative Period SCIP VTE 1 Surgery Patients with Recommended VTE Prophylaxis Ordered SCIP VTE 2 Surgery Patients Who Received Appropriate VTE Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery Healthcare Associated Infections (as measured by SCIP measures) SCIP Inf 1 Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision SCIP Inf 2 Prophylactic Antibiotic Selection for Surgical Patients SCIP Inf 3 Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time SCIP Inf 4 Cardiac Surgery Patients with Controlled 6 AM Postoperative Serum Glucose

24. Patient Experience of Care Domain Dimensions (HCAHPS) Total of 8 dimensions Each dimension is worth 10 points (improvement or achievement points – whichever is higher) Hospitals can also earn up to 20 “consistency points” This equals to a total of 100 points possible Hospitals need to have at least 100 HCAHPS surveys during the performance period to qualify for the VBP program

25. Patient Experience of Care Domain Dimensions 1 - Communication with Nurses 2 - Communication with Doctors 3 - Responsiveness of Hospital Staff 4 - Pain Management 5 - Communication About Medicines 6 - Cleanliness and Quietness of Hospital Environment 7 - Discharge Information 8 - Overall Rating of Hospital

26. National Performance Standards used in Calculating the VBP Incentive The average performance score for the top 10% of all hospitals during the baseline period The median performance score (50 th percentile) for all hospitals during the baseline period Process of Care Measures HCAHPS National Benchmark Achievement Threshold

27. Achievement Points vs. Improvement Points for Clinical Process of Care Measures How are achievement points awarded? If our performance score for the measure is: ► at or above the national benchmark = 10 points ► below the achievement threshold = 0 points ► between the national benchmark and the achievement threshold = a formula is used to determine # of points

28. Achievement Points vs. Improvement Points for Clinical Process of Care Measures How are improvement points awarded? If our performance score for the measure is: ► at or below our baseline period performance score = 0 points ► above our baseline period performance score = a formula is used to determine # of points awarded ( range of 0 – 9 points)

29. Achievement Points vs. Improvement Points for Clinical Process of Care Measures Final points awarded are the higher of the Achievement Points vs. the Improvement Points.

30. Achievement Points vs. Improvement Points for HCAHPS Dimensions Achievement/Improvement points for HCAHPS are calculated using the same method as for the Process of Care Measures.

31. Achievement Points vs. Improvement Points for HCAHPS Dimensions

32. Consistency Points for HCAHPS CMS will use consistency points to recognize consistent achievement across the HCAHPS dimensions. If our lowest performance score for each HCAHPS dimension during the performance period is at or above the achievement threshold for that dimension = 20 consistency points If the lowest score is at or below the floor (minimum score) = 0 consistency points If the lowest score is between the achievement threshold and the floor = a formula is used to determine the # of consistency points (vary between 0-19)

33. Consistency Points for HCAHPS

34. Calculating an Overall VBP Score Process of Care Domain Overall Score = Total points (achievement vs. improvement) 90 (only qualified for 9 measures)  has a weight of 70% Example: 41 (total of final points) / 90 = 46% 46 X 70% (domain weight) = 32%

35. Calculating an Overall VBP Score Patient Experience of Care Domain Overall Score = Total points (achievement vs. improvement) + Consistency points 100  has a weight of 30% Example: 89 (total of final points + 20 consistency points) /100 = 89% 89 X 30% (domain weight) = 27%

36. Overall VBP Score Equals to the Process of Care Domain Score + Patient Experience of Care Domain Score 32% + 27% = 59% Overall VBP Score

37. Public Reporting of the VBP Scores and Payments In addition to what is presently posted on the Hospital Compare website, CMS will add each hospital’s domain-specific score and its overall VBP score.

38. Quality “ the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” - AAP Policy Statement