Use this presentation to complete the new Discussion
using the powerpoint provided on Value Based Purchasing and other Quality measures for hospitals please provide one meaningful post on one of the topics covered in the presentation.
Provide a meaningful response to two other posts:
1- Value-based programs are a great thing for health care workers, the fact that they get payments or incentives for the quality of care, creating an environment where there is a emphasis on being precise, and consistent. This is what value based care is wanting to place great emphasis on. These programs are part of the larger quality strategy to reform how health care is delivered and paid. Value based care aims for : better individual care, better health for individuals and lower cost.United, Anthem and Aetna are other payers that follow the CMS guidelines, they are have contracts with hospitals through different time periods. They will have their own payer specific data such as safety indicators and many have readmission component similar to CMS where they don’t pay for the second hospital admission which is for the same reason which is different from CMS where they are cause readmission or in the penalty. Based on the three used as an example for this instance, Anthem would be the more well known insurance providers. Anthem is one of many that are well known for their measures for their measure on quality and how many people that use their insurance plan. Anthem has a lot of structural measures such as asking the hospitals to prove that they have certain policies and practices in place or that they offer certain services for to their patients. Though it can be annoying for the health care providers, it works for Anthem and their customers. This is to make sure they are receiving the right care and not wasting money on unneeded test &etc.As for United, they are unique because they are mostly focused on primarily on utilization such as patients going to the ER readmission rates and etc. Many hospitals aren’t able to prevent readmission, however they have to still put their best foot forward and show they provided the best care they could the first time with that patient. Therefore even leading to some instances hopsitals not being paid by the insurance company due to that readmission. As for Atena, it is a mix of the two as they include a lot of the CMS measures but also have some unique cost metrics that others don’t include.Overall, each program determines what payers to include. Anthem gets all their data from CMS therefore is a mix of all payer and Medicare patients. United uses only their own data so its only United patients. Aenta is a mix, combination of some of the data from CMS and some data they collect themselves for only beneficiaries . They all have their own measures in making sure they are providing the best for their patients, which is a unique way of to keep health care workers accountable and incentives for the best care. The value based program and these commercial programs are positives for all those involved: the insurance companies, customer(patience) and health care.2- The CMS Hospital-Acquired Condition (HAC) Reduction Program is a Medicare pay-for-performance program that links Medicare payment to healthcare quality in the inpatient hospital setting to achieve the goals of reducing hospital acquired conditions, improving patient care, and reducing healthcare costs. Hospitals with a total HAC score greater than the 75th percentile of all total HAC scores, who are considered the worst performers, are subject to a one percent reduction in payment.CMS evaluates two domains when calculating hospitals’ total HAC scores. Domain 1 focuses on the CMS Patient Safety Indicators 90 measures score (PSI 90) which is comprised of 26 measures that highlight safety-related adverse events occurring in hospitals following operations, procedures, or childbirth. PSIs are determined by data from the AHRQ. Domain 2 is comprised of the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) hospital-associated infections (HAI) measure scores including central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infection (CAUTIs), surgical site infections (SSIs), and infection rates from MRSA and C.Difficile.Each hospital is assigned a score based on a weighted average of these measures which is then compared to the HAC scores of all other hospitals. Those who score in the bottom 25% of performers are penalized with a 1% reduction in payment by CMS. The penalty for this program, unlike other pay-for-performance measures, is “all or nothing” comparable to a “pass or fail” grade. Because lower performing hospitals are consistently penalized regardless of individual improvement year over year, one could argue that this program fails to recognize improvement efforts made by lower performers. This lack of recognition for improvement means that there inevitably must always be a lowest scoring 25%, regardless of the actual quality of care in those hospitals. In reality, there could be very little statistical difference in scores between those in the lowest 25% and those above. Perhaps an alternative could be to determine a benchmark to which hospitals are rewarded for exceeding, and not penalized unless they fall below. If a bonus system is desired, those in the top 25% of performers should be rewarded instead.
PAY FOR PERFORMANCE = VALUE BASED PROGRAMS CMS VALUE BASED PURCHASING (VBP) CMS HOSPITAL READMISSION REDUCTION PROGRAM (HRRP) VALUE BASED PROGRAMS CMS HOSPITAL ACQUIRED CONDITIONS (HAC) ANTHEM Q-HIP UNITED HOSPITAL PERFORMANCE BASED COMPENSATION (HPBC) AETNA PERFORMANCE IMPROVEMENT PROGRAM (PIP) Pay for Performance at Deaconess CLINICAL CARE 25% • AMI MORTALITY RATE • HF MORTALITY RATE • PN MORTALITY RATE • COPD MORTALITY RATE • CABG MORTALITY RATE • HIP/KNEE REPLACEMENT COMPLICATIONS PERSON & COMMUNITY ENGAGEMENT 25% • NURSE COMMUNICATION • DOCTOR COMMUNICATION • CLEANLINESS AND QUIETNESS • RESPONSIVENESS OF STAFF • COMMUNICATION ABOUT MEDS • DISCHARGE INSTRUCTIONS • OVERALL RATING • CARE TRANSITIONS SAFETY 25% • CLABSI • CAUTI • SSI COLON • SSI ABDOMINAL HYSTERECTOMY • C. DIFF • MRSA • PC 01 (ELECTIVE DELIVERIES) EFFICIENCY 25% • MEDICARE SPENDING PER BENEFICIARY Measure Explanations Mortality Patient expires 30 days from the date of admission Risk adjusted Severity of illness Risk of mortality HCAHPS- Hospital Consumer Assessment of Healthcare Providers and Systems CAUTI, CLABSI, SSI, PSI Hospital Acquired Conditions/Infections (HAC/HAI) Medicare Spend Per Beneficiary (MSPB) 3 days prior, inpatient admission, 30 days after discharge HRRP Cohorts and Dates AMI, Heart Failure, Pneumonia, COPD, Total Hip Replacement, Total Knee Replacement, CABG FY 2019 FY 2020 (current fiscal year) July 1, 2016- June 30, 2019 FY 2022 (current performance period) July 1, 2015- June 30, 2018 FY 2021 July 1, 2014- June 30, 2017 July 1, 2017- June 30, 2020 FY 2023 July 1, 2018- June 30, 2021 30 Day Readmissions Index Admission Admitted as an inpatient for AMI, HF, PN, COPD, THA/TKA, CABG Readmission Admitted as an inpatient to any facility 30 days from date of discharge for any reason HAC Domains and Dates Domain 1: PSI 90 Domain 2: CAUTI, CLABSI, SSI Colon, SSI Abdominal Hysterectomy, MRSA, C. diff FY 2020 (current fiscal year) Domain 1: July 1, 2016- June 30, 2018 Domain 2: Calendar Years 2017 and 2018 HAC Measures PSI 90 Composite of individual Patient Safety Indicators CAUTI Catheter-Associated CLABSI Central Urinary Tract Infections Line-Associated Bloodstream Infection SSI Surgical Site Infection Commercial Programs Anthem, United and Aetna Similar measures to CMS programs Different time periods Payer specific data Hospital Specific Measure VBP HRRP HAC Anthem United Aetna HCAHPS Nurse Communication x x x HCAHPS Doctor Communication x x x HCAHPS Hospital Environment x x HCAHPS Responsiveness of Staff x x HCAHPS Pain Management x HCAHPS Communication about Meds x x x HCAHPS Discharge Information x x x HCAHPS Overall Rating x x x HCAHPS Care Transitions x x CLABSI x x x x CAUTI x x x x SSI Colon x x x x C. Diff x x x x MRSA x x x x Readmissions Hip/Knee Complications x x x x x x Financial Impact Value Based Purchasing: 2% of payments Hospital Readmission Reduction: 3% of payments Hospital Acquired Conditions: 1% of payments Anthem: tiered rate increase United: rate increase Aetna: rate increase Total at Risk Over $15,000,000
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