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Hospital Safety Net AssessmentQuality IncentiveJanuary 18, 2011Washington State Hospital Association

PresentersCarol WagnerVice President,Patient SafetyWSHAThuy Hua‐Ly,Director,Rates & Finance,Medicaid PurchasingAdministrationClaudia SandersSenior Vice President,Policy DevelopmentWSHAAndrew BuszDirector,Financial PolicyWSHAWashington State Hospital Association 2

History: House Bill 2956 Introduced at WSHA request Safety Net Assessment increaseshospital rates –using dollars fromhospitals (assessments) and federal match Amended by Representative Cody to include a qualityincentive•July 2012: one percent increase in Medicaid inpatient rates for noncriticalaccess hospitals as “pay‐for‐performance” Passed in the 2010 legislative sessionWashington State Hospital Association

Washington State Hospital AssociationTimeline• January 2011Hospitals begin collecting performance data• January 2012Medicaid Purchasing Administration uses 2011scores to determine which hospitals qualify forpayment• Winter 2012Medicaid Purchasing Administration recalculatesassessment rates for July 1, 2012 to support stateshare of increase• July 1, 2012: Medicaid Purchasing Administrationincreases payments to qualifying hospitals

• Measures must be: Evidence‐basedLegislative Principles Consistent with national measures where possible• Methodology for earning incentive: Recognize that some measures may not be appropriate tospecialty pediatric, psychiatric, or rehabilitation hospitals Represent real improvements in quality Designed so all hospitals can earn incentive payments ifperformance is at or above the benchmarkWashington State Hospital Association

Additional Framework•Measures need to be of value to Medicaidpatients. Medicare’s Hospital Compare, with heart attack andpneumonia emphasis, applies to older population.•WSHA requested measures be consistent withwhat hospitals are working to improve. Minimal additional data collection is desired.Washington State Hospital Association

Medicaid Incentive:No Good ModelsNew processBreaking new groundCollaboration between the State and clinicalexperts was essential!Washington State Hospital Association

Quality Incentive Workgroup• Developed by the Medicaid Purchasing Administration• Input from working group, which included: David Fisher, MD, Seattle Children’s Gene Peterson, MD, University of Washington Medical Center Lawrence Schecter, MD, Providence Regional Medical Center Everett Carol Wagner, RN, Claudia Sanders, Andrew Busz, WSHA staff Thuy Hua‐Ly, Jeff Thompson, MD, Mary Ann Lindeblad, RN,Bev Court, MPA staffWashington State Hospital Association

Payment Increases•One percent inpatient Medicaid increase to: APDRG Conversion Factor Per Diems Case Rates•Acute general and pediatric hospitals Receive increase across all services based onoverall hospital performance Except for those with psych units, where psychincreases based on behavioral health measures• Behavioral health hospitals and units Increase based on separate measuresWashington State Hospital Association

Funding for increases• Assessments increased uniformly for non‐criticalaccess hospitals to support the payment increases• Payment increases provided to all qualifyinghospitals•No partial increases Hospitals receive either zero or one percent increaseWashington State Hospital Association

Process for Selecting Measures•Clinical experts were consultedon which measures the groupshould consider• Potential measures selected byQuality Incentive Workgroup• Additional vetting with experts insetting definitionsWashington State Hospital Association

Washington State Hospital AssociationSelected Measures:Adult, Rehab, and Pediatric Acute CareReduce Hospital Acquired Infections1. Healthcare Worker Influenza ImmunizationSafe Discharges (Reduce Rehospitalizations) – adult only2. Patient Discharge InformationSafe Deliveries (if provide service)3. Elective Delivery Prior to 39 WeeksReducing Emergency Department Cost4. Reducing Preventable Emergency Room Visits

Selected Measures:Behavioral Health ServicesReduce Hospital Acquired Infections1. Healthcare Worker Influenza ImmunizationSafe Medications2. Patients Discharged on Multiple AntipsychoticMedications with Appropriate JustificationWashington State Hospital Association

Incentive Methodology• Current results used to set improvement goals• Points awarded based on performance in 2011 Depending on results, 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 receivethe increase.• Additional recognition for hospitals that score 10 on allmeasures• All hospitals have the opportunity to earn the one percentincentive based on their resultsWashington State Hospital Association

Benchmark ThresholdsMeasure Threshold PointsImmunizationDischarge InfoElective Delivery80% or more 1071‐79% 561‐70% 30‐60% 086% or more 1084‐85% 582‐83% 30‐81% 07% or less 108‐17% 518‐30% 33‐100% 0Washington State Hospital Association

Benchmark ThresholdsMeasure Threshold PointsJustification onAntipsychoticsER Visits– PlanDevelopment31% or more 1021‐30 511‐20 30‐10 05 sections 104 sections 53 sections 30‐2 sections 0Washington State Hospital Association

Development of BenchmarksExample: Flu ImmunizationBaseline:Ranges were setbased on currentbaseline data.Data is measured based on the 2011 period and more hospitals can move into the higherthreshold categories.Same limits areused for the“award year”allowing allhospitalsopportunity toimprove scores andearn maximumpoints.Washington State Hospital Association

Example: Flu ImmunizationThreshold 0‐60% 61‐69 % 70‐79% 80 % or morePointAward 0 3 5 10Washington State Hospital Association

Measure Reporting• Depending on the measure, data will be reported toWSHA through: WSHA’s Quality Benchmarking System Email•The ER plan will be submitted directly to MPA•The data needs to be submitted: Quarterly for Quality Benchmarking System measures As a one‐time submission for emailed measuresWashington State Hospital Association

MeasureHealthcare Worker FluImmunizationMeasure ReportingSubmission MethodEmailed to WSHAReportingFrequencyAnnually(May 1, 2011)Patient Discharge InformationElective Delivery Prior to 39WeeksReducing Preventable EmergencyRoom VisitsPatients Discharged on MultipleAntipsychotic Medications withAppropriate JustificationEmailed to WSHA(by vendor or hospital)WSHA Quality BenchmarkingSystemEmailed to Medicaid PurchasingAdministrationWSHA Quality BenchmarkingSystemQuarterlyQuarterlyAnnually(September 1,2011)QuarterlyWashington State Hospital Association

Hospitals will be asked to attest to the accuracy oftheir data.Washington State Hospital Association

Measure Definitions• Based on Joint Commission, National Quality Forum,and CMS Measures•Detailed definitions available on WSHA’s website:http://bit.ly/g7FzCZ•Detailed information on the payment methodology isavailable: http://bit.ly/gpFDqjWashington State Hospital Association

Preventable Emergency Room Visits•Key issue for Medicaid Purchasing Administration 16 percent of Medicaid ER visits may be forpreventable diagnoses•Asking for hospitals to develop a plan by Sept. 1 Section 1: Community Partnerships Section 2: Data Reporting Section 3: Strategies to Prevent Unnecessary Visits Section 4: Strategies to Educate Patients Section 5: Attend educational programsWashington State Hospital Association

WSHA and MPA Collaboration• MPA will fund emergency room educationsummit Working with WSHA to develop program•WSHA will be issuing ER report Health Information Program report onpreventable visits, with key facts Educational brochure for patientsWashington State Hospital Association

The Future• Assessment sunsets on July 1, 2013 But expect it will be renewed•If so, measures will be updated and revisited Revised measures? New benchmarks based on 2011 performance? ER plan likely to become measure based on percent ofpreventable visits Commitment to use measure based on cesareansection rate rather than simply elective deliveryWashington State Hospital Association

Questions and CommentsCarol Wagner, carolw@wsha.org, (206) 577‐1831Claudia Sanders, claudias@wsha.org, (206) 216‐2508Washington State Hospital Association 26