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The Claims-Based Measures
– How to Move Ahead
Vicki Tang Olson, RN, MS, Program Manager
PPS Core Measure Meeting
January 21, 2014
Objectives
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Review measure changes for FY2014
Define Measure Application Partnership
Understand PSI-90 measures
Review Medicare Spending per
Beneficiary measure
• Share learnings from FY2014 Mortality
discharge level files
2014 Measure Changes
2014 Measure Removals
January 1, 2014 Removals
CMS and SQRMS
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AMI-2 Aspirin prescribed at discharge
AMI-10 Statin prescribed at discharge
HF-1 Discharge Instructions
HF-3 ACEI or ARB for LVSD
PN-3b Blood cultures performed in the Emergency Department
prior to initial antibiotic received in hospital
• SCIP-Inf-10 Surgery patients with perioperative temperature
management
January 1, 2014 Suspension
CMS (suspension) and SQRMS (removal)
• IMM-1 Pneumococcal immunization (PPV23)
CMS (removal)
• Stroke registry structural measure
2014 Removals – SQRMS
• 3 appropriate care measures (ACM) for
AMI, Heart Failure and Pneumonia
• CAC-3 pediatric asthma (3rd qtr 2013)
• PSI 3 Pressure ulcer
• PSI-12 Postoperative pulmonary
embolism (PE) or deep vein thrombosis
(DVT)
2014 Removals – SQRMS
• IQI 4 Abdominal aortic aneurysm (AAA)
repair volume
• IQI 5 Coronary artery bypass graft
(CABG) volume
• IQI 6 Percutaneous transluminal
coronary angioplasty (PTCA) volume
2014 Removals – SQRMS
• IQI 11 Abdominal Aortic Aneurysm (AAA)
Mortality Rate (with or without volume)
• IQI 12 Coronary artery bypass graft
(CABG) mortality rate
• IQI 19 Hip Fracture Mortality Rate
• IQI 30 Percutaneous transluminal
coronary angioplasty (PTCA) mortality rate
Changed to Voluntary
for CAH
• ED-1 Median time from ED arrival to ED
departure for ED admitted patients
• ED-2 Median time from admit decision
to departure for ED admitted patients
2014 Additions
SQRMS Hospital Measure
Additions for 2014 Reporting
• PC-01 Early Elective Deliveries
– CMS submission is sufficient for PPS hospitals
– CAH will need to start CMS submission with Jan dc
• Time to intravenous thrombolytic therapy
for stroke patients
– New for both PPS and CAH
– Submitted through MN Stroke registry
– Begins with 3rd quarter 2013 discharges
New for PPS
30 day Mortality
• MORT-30-STK Stroke (STK)
• MORT-30-COPD Chronic Obstructive
Pulmonary Disease (COPD)
30 Day Readmission
• READM-30-STK Stroke (STK)
• READM-30-COPD Chronic Obstructive
Pulmonary Disease (COPD)
New for PPS
• Safe Surgery Checklist
• AMI Payment per Episode of Care
• OP-27 Influenza Vaccination Coverage
among Healthcare Personnel
New for PPS – Delayed to
2nd Quarter
• OP-29 Endoscopy/Poly Surveillance:
appropriate follow-up interval for normal
colonoscopy in average risk patients
• OP-30 Endoscopy/Poly surveillance:
colonoscopy interval for patients with a
history of adenomatous polyps – avoidance
of inappropriate use
• OP-31 Cataracts – improvement in patient’s
visual function within 90 days following
cataract surgery
Special Considerations for
OP-29, OP-30, OP-31
• Web-based measure
• Start date is delayed by one quarter to
2nd qtr 2014
• Does have sampling methodology
• No submission if 20 or fewer relevant
procedures per year
New for CAH only
Rule 62 J Infection reporting
• CAUTI hospital wide submitted
through NHSN
MBQIP
• CPOE Verification of Medication order
within 24 hrs
Measures Application
Partnership (MAP)
Measure Applications
Partnership
• Public-private partnership
• Convened by the National Quality Forum
(NQF)
• Created to provide input to the Department of
Health and Human Services (HHS) on the
selection of performance measures
• For public reporting and performance-based
payment programs
Measure Applications
Partnership
• December 1, 2013 MAP received from
HHS a list of 234 measures under
consideration for MAP
• Purpose was to provide input on their
potential use in 20 federal programs
• Final report to be delivered on February
1, 2014
Program Areas
1. Ambulatory Surgical Center Quality Reporting
2. End-Stage Renal Disease (ESRD) Quality Incentive Program
3. Home Health Quality Reporting
4. Hospice Quality Reporting
5. Hospital-Acquired Condition (HAC) Reduction Program
6. Hospital Inpatient Quality Reporting (IQR) Program
7. Hospital Outpatient Quality Reporting (OQR) Program
8. Hospital Readmission Reduction Program
9. Hospital Value-Based Purchasing
10. Inpatient Psychiatric Facility (IPF) Quality Reporting
11. Inpatient Rehabilitation Facility (IRF) Quality Reporting
Program Areas (continued)
12. Long-Term Care Hospital (LTCH) Quality Reporting
13. Medicare and Medicaid EHR Incentive Program for Eligible
Professionals
14. Medicare and Medicaid EHR Incentive Program for Hospitals and
Critical Access Hospitals (CAHs)
15. Medicare Shared Savings Program
16. Medicare Physician Quality Reporting System (PQRS)
17. Physician Compare
18. Physician Feedback/Quality and Resource Utilization Reports(QRUR)
19. Physician Value-Based Modifier Program
20. Prospective Payment System (PPS)-Exempt Cancer Hospital Quality
Reporting
Future Measures
• Measures need to be included in MAP
report to be considered for IPPS and
OPPS rules
• Look ahead (particularly for VBP,
Readmission reduction, and HAC
programs) so you have time to work on
improvement
Annual Process
IPPS
OPPS
SQRMS
January
MAPS comment
period
MAPS comment
period
Focus defined
February
MAPS final report
MAPS final report
Input
March
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Input
April
Proposed Rule
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Recommendations
May
Comment period
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Submit
June
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Public forum
July
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Proposed Rule
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August
Final Rule
Comment period
Proposed rule
September
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Comment period
October
…
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….
November
…
Final rule
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December
MAPS prerulemaking report
MAPS prerulemaking report
Final Rule
Value-Based Purchasing
Top 10
Priorities
Measures
that are
part of VBP
Latest
public data
http://www.stratishealth.org/providers/vbp.html
PSI 90
PSI 90 Weighting
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PSI #03 Decubitus Ulcer
PSI #06 Iatrogenic Pneumothorax
PSI #07 Selected Infection Due to Medical Care
PSI #08 Postop Hip Fracture
PSI #09 Postop Hemorrhage or Hematoma
PSI #10 Postop Physio and Metabol Derangmts
PSI #11 Postop Respiratory Failure
PSI #12 Postop PE Or DVT
PSI #13 Postop Sepsis
PSI #14 Postop Wound Dehiscence
PSI #15 Accidental Puncture or Laceration
7.55%
22.46%
18.64%
4.73%
7.12%
3.44%
2.80%
7.09%
0.86%
1.52%
23.78%
Medicare Spending
Per Beneficiary
Medicare Spending Per
Beneficiary
• Hospital measure, reported as a ratio
• Total Parts A and B spending for 3 days
prior to hospital admission to 30 days post
discharge
• Prices standardized and risk adjusted for
patient population
• Exclusions: Medicare Advantage,
transfers, deaths, statistical outliers
3 Time Periods
1-3 Days
prior to
Admission
Admission
30 Days after
Discharge
7 Claims Types
Home Health
Hospice
Outpatient
Inpatient
Skilled Nursing Facility
Durable Medical
Carrier
Home Health
Hospice
Outpatient
Inpatient
Skilled Nursing Facility Home Health
Durable Medical
Hospice
Carrier
Outpatient
Inpatient
Skilled Nursing Facility
Durable Medical
Carrier
MSPB ratio
• MSPB Amount is the average spending
after controlling patients’ health status
and regional variation in Medicare
payments
Table 1: MSPB Measure for
HEARTCARE REGIONAL MEDICAL CENTER
Your Hospital’s MSPB
Measure*
1.08
*This information will be posted on Hospital Compare
for hospitals with 25 or more eligible admissions.
MSPB Ratio
• Average MSPB Measure, calculated in
the fifth row, is the MSPB Amount
divided by the U.S. National Median
MSPB Amount in the fourth row
National Distribution of the
MSPB Measure Across All
Hospitals in the Nation
FY2014 Mortality Measures
30 Day Mortality
• Every file has discharge patient level files
• These results were obtained by
combining all PPS hospitals eligible for
FY2014 VBP
• Discharges were for FY2014
performance period (Jan-Dec 2012 discharges)
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Sepsis Key Points
• Leading cause of death in U.S.
hospitals, striking 750,000 Americans
• Overall hospital mortality rate of 28%
• Transition to serious illness may occur
during the critical "golden hours"
• Focus is on early recognition and
treatment of sepsis
Minnesota Sepsis Mortality
SepsisPopulation
Attributed 2000
Deaths
1999-2005
11,907
4,622,379
Crude
SepsisAttributed
Mortality
(Annual Deaths
per 100,000)
Age-Adjusted
42.9
Sepsis-Attributed
Mortality
(Annual Deaths per
100,000; 95% CI)
41.0 (40.2 - 41.8)
Premier QUEST collaborative report,
Year 4, March 2013
Strategies to Reduce
Inpatient Mortality
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Look upstream at EMS/ER care
Sepsis
Rapid Response teams
Ventilator Associated events
End of Life Care
Seeing Sepsis
• Collaborative lead by Minnesota Hospital
Association
• 7 hospitals
• Physician simulcast on March 13, 12-1pm
Seeing Sepsis - Kickoff
• April 2, 2014
• Day-long Simulcast
• Developed for all hospital quality
leaders, ED managers, nursing leaders
and other staff
• Presenters will include national experts
and from Minnesota’s own hospitals
Seeing Sepis Kickoff
Content
• Overview of the LEAPT Seeing Sepsis
project
• Will include best practices on early
detection, transfer and treatment of
severe sepsis and septic shock
• Education on the toolkit created for the
Sepsis LEAPT project that was piloted
by 7 hospitals.
Trustee Presentation
Trustee Presentation
• Presented by Jennifer Lundblad and
Vicki Tang Olson at MHA Winter
Trustee Conference
• PowerPoint presentation so you can
use with your board
Stratis Health is a nonprofit organization that leads
collaboration and innovation in health care quality and safety,
and serves as a trusted expert in facilitating improvement for
people and communities.
www.stratishealth.org
Prepared by Stratis Health, the Medicare Quality Improvement Organization for Minnesota, under contract with the Centers for Medicare & Medicaid Services (CMS), an
agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-MN-C7-14-09 012014