On January 31, 2012, Health Affairs, a peer-reviewed monthly journal, released a six page Health Policy Brief providing an update of where the US healthcare industry is in its rapid evolution towards accountable care type organizations.
The .pdf of the policy brief can be downloaded here.
The value of this paper is not limited to just the historical overview provided. The authors also give a general overview of some of the ongoing issues of the ACO model (small savings, anti-trust issues, enrollment, etc...).
Readers looking to for deep technical details of ACOs will be disappointed with this paper. However, those looking for a general overview of the current status of the ACO evolution will find this paper informative.
Showing posts with label Healthcare Reform. Show all posts
Showing posts with label Healthcare Reform. Show all posts
Monday, February 6, 2012
Tuesday, December 20, 2011
CMS Approves ACO for Central Indiana
Yesterday, CMS announced that 32 applications for Pioneer ACO from health systems across the country have been approved. The Franciscan Alliance was approved for the Indianapolis and Central Indiana region.
The press release from the Franciscan Alliance can be found here: http://stfrancisnews.blogspot.com/2011/12/franciscan-alliance-selected-to.html
The press release fact sheet from CMS announcing the 32 Pioneer ACOs can be found here: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4225
Over the past several months, the concept and model of an ACO has changed several times. This announcement is specifically for the Pioneer ACO model. Applications for the Advanced Payment Model is not due to CMS until Jan 2012.
This link will take you to a general resource about the Pioneer ACO Model: http://innovations.cms.gov/initiatives/aco/pioneer/
This link will take you to a general resource about the Advanced Payment ACO Model: http://innovations.cms.gov/initiatives/aco/advance-payment/
The most recent final rules from CMS concerning ACOs was published Oct 20, 2011. That document can be downloaded here: http://www.gpo.gov/fdsys/pkg/FR-2011-11-02/pdf/2011-27461.pdf
Healthcare quality professionals will be most interested in the list of 33 quality measures that will impact payments to ACOs. That list is on page 67889, or the 88th page into this above document.
The press release from the Franciscan Alliance can be found here: http://stfrancisnews.blogspot.com/2011/12/franciscan-alliance-selected-to.html
The press release fact sheet from CMS announcing the 32 Pioneer ACOs can be found here: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4225
Over the past several months, the concept and model of an ACO has changed several times. This announcement is specifically for the Pioneer ACO model. Applications for the Advanced Payment Model is not due to CMS until Jan 2012.
This link will take you to a general resource about the Pioneer ACO Model: http://innovations.cms.gov/initiatives/aco/pioneer/
This link will take you to a general resource about the Advanced Payment ACO Model: http://innovations.cms.gov/initiatives/aco/advance-payment/
The most recent final rules from CMS concerning ACOs was published Oct 20, 2011. That document can be downloaded here: http://www.gpo.gov/fdsys/pkg/FR-2011-11-02/pdf/2011-27461.pdf
Healthcare quality professionals will be most interested in the list of 33 quality measures that will impact payments to ACOs. That list is on page 67889, or the 88th page into this above document.
Sunday, July 31, 2011
Indiana's State Level Baldrige Program
Until last week, Indiana was one of the few remaining states without a Baldrige based award program. However, through the efforts of various interested groups and individuals throughout the state, and in collaboration with the Ohio Partnership for Excellence (OPE), Ohio's Baldrige based program, Indiana is no longer without.
Reflective of the strategy of the National Baldrige program to develop strong regional programs rather than each state having an independent program, Ohio recently announced its expansion into Indiana and West Virginia.
Although the details of the Indiana program is still being worked out, several Indiana individuals and organizations have already been involved with the OPE in previous years. In fact, Schneck Medical Center (Seymour, IN) will be presenting at OPE's "2011 Quest for Success" Conference coming up in September.
Link to Ohio Partnership for Excellence: http://www.partnershipohio.org/
Link to details of expansion into Indiana: http://www.partnershipohio.org/html/apply/apply_program_IN_&_WV.htm
The full text of the OPE press release follows:
Reflective of the strategy of the National Baldrige program to develop strong regional programs rather than each state having an independent program, Ohio recently announced its expansion into Indiana and West Virginia.
Although the details of the Indiana program is still being worked out, several Indiana individuals and organizations have already been involved with the OPE in previous years. In fact, Schneck Medical Center (Seymour, IN) will be presenting at OPE's "2011 Quest for Success" Conference coming up in September.
Link to Ohio Partnership for Excellence: http://www.partnershipohio.org/
Link to details of expansion into Indiana: http://www.partnershipohio.org/html/apply/apply_program_IN_&_WV.htm
The full text of the OPE press release follows:
Press Release
July 26, 2011
FOR IMMEDIATE RELEASE
Ohio Partnership for Excellence to Expand Programs to Indiana & West Virginia
COLUMBUS, OH – The Ohio Partnership for Excellence (OPE) is now approved to offer its Baldrige-based programs to organizations in Indiana and West Virginia. The Alliance for Performance Excellence approved the expansion after a nation-wide competitive process that included proposals from a number of states. The Alliance is a non-profit network of national, state and local Baldrige-based award programs, associated with the American Society for Quality and the U.S. Department of Commerce's National Institute of Standards & Technology that administers the Malcolm Baldrige National Quality Award.
OPE is Ohio's Baldrige-based award program that administers and presents the Ohio Awards for Excellence, including the Governor's Award for Excellence. OPE partners with organizations using the internationally-recognized Baldrige Criteria for Performance Excellence. OPE’s primary product is a comprehensive organizational assessment that helps leaders better understand and prioritize key strengths and opportunities for improvement. While the assessment lays the foundation, OPE’s main focus is on organizational learning, resource optimization and continuous improvement.
Under the visionary leadership of OPE's Board Chairman Frank Pérez, former President & CEO of the Kettering Health Network in Dayton and Paul Worstell, former President of PRO-TEC Coating Company in Leipsic, OPE has worked tirelessly to develop a strategy which will give Indiana and West Virginia organizations the same great opportunities OPE has afforded Ohioans for more than a decade. With this decision, OPE will grow into a regionalized program throughout all three states.
The mission of OPE is to cultivate performance excellence and continuous improvement among business, education, government, healthcare and non-profit organizations. By providing a framework for performance excellence through the Baldrige Criteria, organizations have a greater focus on customers, process management, work systems and organization-wide results. These organizations typically see lower costs, improved productivity and rises in both employee and customer satisfaction.
This year's OPE Award recipients will be honored at the annual Quest for Success Conference - “Harvesting Excellence” to be held on September 19-20 at Cherry Valley Lodge, Newark, Ohio. The two-day conference will feature four of the seven 2010 Malcolm Baldrige National Quality Award recipients and will provide numerous opportunities to learn about role-model performance management practices, share great ideas with colleagues, and benchmark world-class results.
For additional information please visit the OPE website at www.partnershipohio.org or contact Al Faber, President/CEO, Ohio Partnership for Excellence, 829 Bethel Road, #212, Columbus, OH 43214 or phone (614) 425-7157.
Saturday, April 30, 2011
CMS Announces final details of Value Based Purchasing for Inpatient Acute Care
On April 29th, CMS announced the final rules of its upcoming Value Based Purchasing program for Inpatient Acute Care. This long anticipated program transitions the inpatient care provided to Medicare beneficaries from "pay for reporting" to "pay for performance".
The HHS press release itself is of little value to the healthcare quality professional. You can view it here: http://www.hhs.gov/news/press/2011pres/04/20110429a.html. However, it links to a CMS press release that contained more details. You can view it here: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=3947.
Although these rules become effective with fiscal year 2013, CMS also released the list of measures for 2014 as well.
The following are excerpts from the CMS press release:
PERFORMANCE SCORING:
Performance Period: CMS has established a performance period that runs from July 1, 2011 through March 31, 2012, for the FY 2013 Hospital VBP payment determination. CMS anticipates that in future program years, if it becomes feasible, it may propose to use a full year as the performance period.
Scoring Methods: CMS will score each hospital based on achievement and improvement ranges for each applicable measure. A hospital’s score on each measure will be the higher of an achievement score in the performance period or an improvement score, which is determined by comparing the hospital’s score in the performance period with its score during a baseline period.
For scoring on achievement, hospitals will be measured based on how much their current performance differs from all other hospitals’ baseline period performance. Points will then be awarded based on the hospital’s performance compared to the threshold and benchmark scores for all hospitals. Points will only be awarded for achievement if the hospital’s performance during the performance period exceeds a minimum rate called the “threshold,” which is defined by CMS as the 50th percentile of hospital scores during the baseline period.
For scoring on improvement, hospitals will be assessed based on how much their current performance changes from their own baseline period performance. Points will then be awarded based on how much distance they cover between that baseline and the benchmark score. Points will only be awarded for improvement if the hospital’s performance improved from their performance during the baseline period.
Finally, CMS will calculate a Total Performance Score (TPS) for each hospital by combining the greater of its achievement or improvement points on each measure to determine a score for each domain, multiplying each domain score by the proposed domain weight and adding the weighted scores together. In FY 2013, the clinical process of care domain will be weighted at 70 percent and the patient experience of care domain will be weighted at 30 percent.
Incentive Payment Calculations: CMS will utilize a linear exchange function to calculate the percentage of value-based incentive payment earned by each hospital. Those hospitals that receive higher Total Performance Scores will receive higher incentive payments than those that receive lower Total Performance Scores. CMS will notify each hospital of the estimated amount of its value-based incentive payment for FY 2013 through its QualityNet account at least 60 days prior to Oct. 1, 2012. CMS will notify each hospital of the exact amount of its value-based incentive payment on Nov. 1, 2012.
FISCAL YEAR 2013 MEASURES
Clinical Process of Care Measures
AMI-7a - Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival
AMI-8a - Primary PCI Received Within 90 Minutes of Hospital Arrival
HF-1 - Discharge Instructions
PN-3b - Blood Cultures Performed in the ED Prior to Initial Antibiotic Received in Hospital
PN-6 - Initial Antibiotic Selection for CAP in Immunocompetent Patient
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 6AM Postoperative Serum Glucose
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 Venous Thromboembolism Prophylaxis Ordered
SCIP-VTE-2 - Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery
Patient Experience of Care Measures (HCAHPS)
· Communication with Nurses
· Communication with Doctors
· Responsiveness of Hospital Staff
· Pain Management
· Communication About Medicines
· Cleanliness and Quietness of Hospital Environment
· Discharge Information
· Overall Rating of Hospital
ADDITIONAL MEASURES FINALIZED FOR FY2014
Mortality Measures:
· Mortality-30-AMI: Acute Myocardial Infarction (AMI) 30-day Mortality Rate
· Mortality-30-HF: Heart Failure (HF) 30-day Mortality Rate
· Mortality-30-PN: Pneumonia (PN) 30-Day Mortality Rate
Hospital Acquired Condition Measures:
· Foreign Object Retained After Surgery
· Air Embolism
· Blood Incompatibility
· Pressure Ulcer Stages III & IV
· Falls and Trauma: (Includes: Fracture, Dislocation, Intracranial Injury, Crushing Injury, Burn, Electric Shock)
· Vascular Catheter-Associated Infections
· Catheter-Associated Urinary Tract Infection (UTI)
· Manifestations of Poor Glycemic Control
AHRQ Patient Safety Indicators (PSIs), Inpatient Quality Indicators (IQIs), and Composite Measures:
· Complication/patient safety for selected indicators (composite)
· Mortality for selected medical conditions (composite)
The HHS press release itself is of little value to the healthcare quality professional. You can view it here: http://www.hhs.gov/news/press/2011pres/04/20110429a.html. However, it links to a CMS press release that contained more details. You can view it here: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=3947.
Although these rules become effective with fiscal year 2013, CMS also released the list of measures for 2014 as well.
The following are excerpts from the CMS press release:
PERFORMANCE SCORING:
Performance Period: CMS has established a performance period that runs from July 1, 2011 through March 31, 2012, for the FY 2013 Hospital VBP payment determination. CMS anticipates that in future program years, if it becomes feasible, it may propose to use a full year as the performance period.
Scoring Methods: CMS will score each hospital based on achievement and improvement ranges for each applicable measure. A hospital’s score on each measure will be the higher of an achievement score in the performance period or an improvement score, which is determined by comparing the hospital’s score in the performance period with its score during a baseline period.
For scoring on achievement, hospitals will be measured based on how much their current performance differs from all other hospitals’ baseline period performance. Points will then be awarded based on the hospital’s performance compared to the threshold and benchmark scores for all hospitals. Points will only be awarded for achievement if the hospital’s performance during the performance period exceeds a minimum rate called the “threshold,” which is defined by CMS as the 50th percentile of hospital scores during the baseline period.
For scoring on improvement, hospitals will be assessed based on how much their current performance changes from their own baseline period performance. Points will then be awarded based on how much distance they cover between that baseline and the benchmark score. Points will only be awarded for improvement if the hospital’s performance improved from their performance during the baseline period.
Finally, CMS will calculate a Total Performance Score (TPS) for each hospital by combining the greater of its achievement or improvement points on each measure to determine a score for each domain, multiplying each domain score by the proposed domain weight and adding the weighted scores together. In FY 2013, the clinical process of care domain will be weighted at 70 percent and the patient experience of care domain will be weighted at 30 percent.
Incentive Payment Calculations: CMS will utilize a linear exchange function to calculate the percentage of value-based incentive payment earned by each hospital. Those hospitals that receive higher Total Performance Scores will receive higher incentive payments than those that receive lower Total Performance Scores. CMS will notify each hospital of the estimated amount of its value-based incentive payment for FY 2013 through its QualityNet account at least 60 days prior to Oct. 1, 2012. CMS will notify each hospital of the exact amount of its value-based incentive payment on Nov. 1, 2012.
FISCAL YEAR 2013 MEASURES
Clinical Process of Care Measures
AMI-7a - Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival
AMI-8a - Primary PCI Received Within 90 Minutes of Hospital Arrival
HF-1 - Discharge Instructions
PN-3b - Blood Cultures Performed in the ED Prior to Initial Antibiotic Received in Hospital
PN-6 - Initial Antibiotic Selection for CAP in Immunocompetent Patient
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 6AM Postoperative Serum Glucose
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 Venous Thromboembolism Prophylaxis Ordered
SCIP-VTE-2 - Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery
Patient Experience of Care Measures (HCAHPS)
· Communication with Nurses
· Communication with Doctors
· Responsiveness of Hospital Staff
· Pain Management
· Communication About Medicines
· Cleanliness and Quietness of Hospital Environment
· Discharge Information
· Overall Rating of Hospital
ADDITIONAL MEASURES FINALIZED FOR FY2014
Mortality Measures:
· Mortality-30-AMI: Acute Myocardial Infarction (AMI) 30-day Mortality Rate
· Mortality-30-HF: Heart Failure (HF) 30-day Mortality Rate
· Mortality-30-PN: Pneumonia (PN) 30-Day Mortality Rate
Hospital Acquired Condition Measures:
· Foreign Object Retained After Surgery
· Air Embolism
· Blood Incompatibility
· Pressure Ulcer Stages III & IV
· Falls and Trauma: (Includes: Fracture, Dislocation, Intracranial Injury, Crushing Injury, Burn, Electric Shock)
· Vascular Catheter-Associated Infections
· Catheter-Associated Urinary Tract Infection (UTI)
· Manifestations of Poor Glycemic Control
AHRQ Patient Safety Indicators (PSIs), Inpatient Quality Indicators (IQIs), and Composite Measures:
· Complication/patient safety for selected indicators (composite)
· Mortality for selected medical conditions (composite)
Sunday, April 17, 2011
Unadjusted "Fall and Trauma" Rates for Hospitals in Indiana
On April 6, 2011, CMS released a spreadsheet linked to its Hospital Compare website showing the frequency of the eight (8) Hospital Acquired Conditions (HAC) in hospitals participating in the Medicare Program. This data set is of Medicare beneficiaries only, is not risk adjusted for the severity of the patients, and is based on administrative data only for patients discharged between Oct 1, 2008 to June 30, 2010.
The data can be downloaded from CMS here.
The table below shows the performance of the listed Indiana hospitals for the "Fall and Trauma" measure sorted from high to low.
| Hospital name | Rate (per 1,000 discharges) | Number of eligible discharges (Denominator) | Number of HACs (Numerator) | National HAC rate (per 1,000 discharges) |
|---|---|---|---|---|
| UNITY MEDICAL AND SURGICAL HOSPITAL | 7.634 | 131 | 1 | 0.564 |
| RIVERVIEW HOSPITAL | 2.428 | 3707 | 9 | 0.564 |
| THE HEART HOSPITAL AT DEACONESS GATEWAY LLC | 1.878 | 1065 | 2 | 0.564 |
| SAINT CATHERINE REGIONAL HOSPITAL | 1.641 | 1219 | 2 | 0.564 |
| FAYETTE REGIONAL HEALTH SYSTEM | 1.553 | 1932 | 3 | 0.564 |
| REID HOSPITAL & HEALTH CARE SERVICES | 1.257 | 9549 | 12 | 0.564 |
| FRANCISCAN PHYSICIANS HOSPITAL LLC | 1.233 | 811 | 1 | 0.564 |
| MEMORIAL HOSPITAL OF SOUTH BEND | 1.205 | 9955 | 12 | 0.564 |
| ST. CLARE MEDICAL CENTER | 1.179 | 1697 | 2 | 0.564 |
| WITHAM HEALTH SERVICES | 1.174 | 1704 | 2 | 0.564 |
| KOSCIUSKO COMMUNITY HOSPITAL | 1.084 | 2767 | 3 | 0.564 |
| PARKVIEW HUNTINGTON HOSPITAL | 1.065 | 939 | 1 | 0.564 |
| INDIANA UNIVERSITY HEALTH ARNETT HOSPITAL | 1.02 | 4904 | 5 | 0.564 |
| MARION GENERAL HOSPITAL | 0.962 | 4158 | 4 | 0.564 |
| HENRY COUNTY MEMORIAL HOSPITAL | 0.957 | 3134 | 3 | 0.564 |
| BLUFFTON REGIONAL MEDICAL CENTER | 0.944 | 2118 | 2 | 0.564 |
| CLARK MEMORIAL HOSPITAL | 0.932 | 8581 | 8 | 0.564 |
| INDIANA UNIVERSITY HEALTH NORTH HOSPITAL | 0.906 | 3313 | 3 | 0.564 |
| COMMUNITY HOSPITAL NORTH | 0.9 | 6664 | 6 | 0.564 |
| ST. FRANCIS HOSPITAL - BEECH GROVE | 0.853 | 9377 | 8 | 0.564 |
| THE ORTHOPAEDIC HOSPITAL | 0.788 | 1269 | 1 | 0.564 |
| ST. VINCENT CARMEL HOSPITAL, INC. | 0.767 | 2609 | 2 | 0.564 |
| ST. MARGARET MERCY - DYER | 0.725 | 5515 | 4 | 0.564 |
| WESTVIEW HOSPITAL | 0.7 | 1429 | 1 | 0.564 |
| INDIANA UNIVERSITY HEALTH WEST HOSPITAL | 0.689 | 4352 | 3 | 0.564 |
| ELKHART GENERAL HOSPITAL | 0.676 | 8879 | 6 | 0.564 |
| GOOD SAMARITAN HOSPITAL | 0.641 | 6241 | 4 | 0.564 |
| DEARBORN COUNTY HOSPITAL | 0.617 | 3239 | 2 | 0.564 |
| DUPONT HOSPITAL LLC | 0.603 | 1658 | 1 | 0.564 |
| BALL MEMORIAL HOSPITAL INC | 0.591 | 11840 | 7 | 0.564 |
| METHODIST HOSPITALS, INC | 0.588 | 13602 | 8 | 0.564 |
| ST. CATHERINE HOSPITAL, INC | 0.576 | 5211 | 3 | 0.564 |
| INDIANA ORTHOPAEDIC HOSPITAL LLC | 0.565 | 1770 | 1 | 0.564 |
| COMMUNITY HOSPITAL | 0.557 | 16165 | 9 | 0.564 |
| COMMUNITY HOSPITAL SOUTH, INC. | 0.549 | 5468 | 3 | 0.564 |
| SAINT ANTHONY MEDICAL CENTER | 0.545 | 9179 | 5 | 0.564 |
| SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND | 0.541 | 11100 | 6 | 0.564 |
| LUTHERAN HOSPITAL OF INDIANA | 0.535 | 13088 | 7 | 0.564 |
| INDIANA HEART HOSPITAL, THE | 0.528 | 3791 | 2 | 0.564 |
| ST. MARY'S MEDICAL CENTER OF EVANSVILLE INC | 0.514 | 11672 | 6 | 0.564 |
| GOSHEN GENERAL HOSPITAL | 0.489 | 4088 | 2 | 0.564 |
| PORTER HOSPITAL, LLC, VALPARAISO HOSP CAMPUS | 0.481 | 10389 | 5 | 0.564 |
| PARKVIEW HOSPITAL | 0.465 | 10748 | 5 | 0.564 |
| MAJOR HOSPITAL | 0.457 | 2189 | 1 | 0.564 |
| BLOOMINGTON HOSPITAL | 0.445 | 8981 | 4 | 0.564 |
| ST. FRANCIS HOSPITAL - MOORESVILLE | 0.435 | 2299 | 1 | 0.564 |
| DEACONESS HOSPITAL INC | 0.422 | 18959 | 8 | 0.564 |
| SCHNECK MEDICAL CENTER | 0.421 | 2378 | 1 | 0.564 |
| JOHNSON MEMORIAL HOSPITAL | 0.421 | 2378 | 1 | 0.564 |
| TERRE HAUTE REGIONAL HOSPITAL | 0.411 | 4861 | 2 | 0.564 |
| MEMORIAL HOSPITAL AND HEALTH CARE CENTER | 0.385 | 5190 | 2 | 0.564 |
| UNION HOSPITAL INC | 0.383 | 13057 | 5 | 0.564 |
| ST. JOSEPH HOSPITAL | 0.381 | 2626 | 1 | 0.564 |
| FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES | 0.375 | 10678 | 4 | 0.564 |
| WILLIAM N WISHARD MEMORIAL HOSPITAL | 0.368 | 5431 | 2 | 0.564 |
| ST. VINCENT HOSPITALS AND HEALTH SERVICES | 0.358 | 19569 | 7 | 0.564 |
| CLARIAN HEALTH PARTNERS, INCORPORATED | 0.321 | 28027 | 9 | 0.564 |
| ST. FRANCIS HOSPITAL - INDIANAPOLIS | 0.313 | 6388 | 2 | 0.564 |
| COLUMBUS REGIONAL HOSPITAL | 0.296 | 6766 | 2 | 0.564 |
| THE KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICES | 0.28 | 3574 | 1 | 0.564 |
| ST. ELIZABETH EAST | 0.244 | 4090 | 1 | 0.564 |
| COMMUNITY HOSPITAL EAST | 0.244 | 8195 | 2 | 0.564 |
| LA PORTE HOSPITAL AND HEALTH SERVICES | 0.235 | 4263 | 1 | 0.564 |
| ST. MARGARET MERCY HEALTHCARE CENTERS - HAMMOND | 0.228 | 8754 | 2 | 0.564 |
| ST. MARY MEDICAL CENTER, INC. | 0.224 | 8912 | 2 | 0.564 |
| ST. ELIZABETH CENTRAL | 0.219 | 4558 | 1 | 0.564 |
| COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY | 0.179 | 5601 | 1 | 0.564 |
| SAINT JOHN'S HEALTH SYSTEM | 0.169 | 5918 | 1 | 0.564 |
| SAINT ANTHONY MEMORIAL HEALTH CENTER | 0 | 5335 | 0 | 0.564 |
| KENTUCKIANA MEDICAL CENTER LLC | 0 | 619 | 0 | 0.564 |
| MEMORIAL HOSPITAL | 0 | 1480 | 0 | 0.564 |
| HENDRICKS REGIONAL HEALTH | 0 | 3423 | 0 | 0.564 |
| DAVIESS COMMUNITY HOSPITAL | 0 | 1727 | 0 | 0.564 |
| HOWARD REGIONAL HEALTH SYSTEM | 0 | 4148 | 0 | 0.564 |
| PHYSICIANS' MEDICAL CENTER LLC | 0 | 180 | 0 | 0.564 |
| SURGICAL HOSPITAL OF MUNSTER | 0 | 31 | 0 | 0.564 |
| ST. JOSEPH HOSPITAL & HEALTH CENTER, INC | 0 | 3856 | 0 | 0.564 |
| PINNACLE HOSPITAL | 0 | 542 | 0 | 0.564 |
| HANCOCK REGIONAL HOSPITAL | 0 | 2989 | 0 | 0.564 |
| MONROE HOSPITAL | 0 | 1335 | 0 | 0.564 |
| ST. VINCENT HEART CENTER OF INDIANA, LLC | 0 | 5756 | 0 | 0.564 |
| WOMEN'S HOSPITAL, THE | 0 | 114 | 0 | 0.564 |
| PARKVIEW WHITLEY HOSPITAL | 0 | 807 | 0 | 0.564 |
| STARKE MEMORIAL HOSPITAL | 0 | 785 | 0 | 0.564 |
| PARKVIEW NOBLE HOSPITAL | 0 | 1175 | 0 | 0.564 |
| SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH | 0 | 1773 | 0 | 0.564 |
| DEKALB MEMORIAL HOSPITAL INC | 0 | 1100 | 0 | 0.564 |
| MORGAN HOSPITAL AND MEDICAL CENTER | 0 | 1472 | 0 | 0.564 |
| ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC | 0 | 1039 | 0 | 0.564 |
ACOs are here! ...but will it be everywhere?
Details of the long awaited CMS ACO proposed rules were released on March 31, 2011 and posted in the April 7, 2011 edition of the Federal Register.
The Federal Register entry can be found here.
The Centers for Medicare and Medicaid Services also simultaneously posted fact sheets and other resources about the proposed ACOs rules:
- Summary of Proposed Rules.
- Summary of the 65 ACO Performance Measures
- Other Federal Agencies Addressing the Legal Issues of ACO Participation
- The Press Release Announcing the ACO Rules
- CMS Fact Sheet about what Providers Need to Know of ACOs
No doubt there will be significant commentary provided by healthcare organizations throughout the country over the next few months. The comment period closes on June 6, 2011. ACO final rules go into effect January 1, 2012.
Sunday, January 16, 2011
FAQ on ACOs
Discussions of Accountable Care Organizations (ACOs) are sure to dominate the minds of hospital and health plan administrators in the next few months/years. The establishment of these entities will likely impact the work and expectations of health care quality professionals. Kaiser Health News recently posted an ACO FAQ list. You can find it here.
This FAQ provides thoughts to the following questions:
- What is an accountable care organization?
- When will ACOs begin operating?
- Why did Congress include ACOs in the law?
- How would ACOs be paid?
- How will an ACO be different for patients?
- Who's in charge — hospitals, doctors or insurers?
- If I don't like HMOs, why should I consider an ACO?
- What can go wrong?
- Are there any possible legal concerns?
Monday, January 10, 2011
CMS Proposes Value Based Purchasing Program Rules for Hospital Inpatient
On Friday, CMS announced its highly anticipated proposed rules for its new hospital value based purchasing program. The pdf of the proposed rules can be found here: http://www.ofr.gov/OFRUpload/OFRData/2011-00454_PI.pdf
(Note: this link will not likely become live until 1/13/2011).
Although these are "new" proposed rules, there are really no surprises in terms of payment methodology. The amount "at risk" due to poor performance is probably lower than what was initially expected (ie: 1-2% rather than 4-5%).
The following are excerpts from the CMS press release and fact sheet that may be of interest:
AMI-2: Aspirin Prescribed at Discharge
AMI-7a: Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival
AMI-8a: Primary PCI Received Within 90 Minutes of Hospital Arrival
HF-1: Discharge Instructions
HF-2: Evaluation of LVS Function
HF-3: ACEI or ARB for LVSD
PN-2: Pneumococcal Vaccination
PN-3b: Blood Cultures Performed in the ED Prior to Initial Antibiotic Received in Hospital
PN-6: Initial Antibiotic Selection for CAP in Immunocompetent Patient
PN-7: Influenza Vaccination
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 6AM Postoperative Serum Glucose
SCIP-Card-2: Surgery Pts. on a Beta Blocker Prior to Arrival...
SCIP-VTE-1: Surgery Pts. with Recommended Venous Thromboembolism Prophylaxis Ordered
SCIP-VTE-2: Surgery Pts. Who Received Appropriate Venous Thromboembolism Prophylaxis...
HCAHPS: Communication with Nurses
HCAHPS: Communication with Doctors
HCAHPS: Responsiveness of Hospital Staff
HCAHPS: Pain Management
HACHPS: Communication About Medicines
HACHPS: Cleanliness and Quietness of Hospital Environment
HACHPS: Discharge Information
HACHPS: Overall Rating of Hospital
PROPOSED ADDITIONAL QUALITY MEASURES FOR FISCAL YEAR 2014
Mortality-30-AMI: Acute Myocardial Infarction (AMI) 30-day Mortality Rate
Mortality-30-HF: Heart Failure (HF) 30-day Mortality Rate
Mortality-30-PN: Pneumonia (PN) 30-Day Mortality Rate
Foreign Object Retained After Surgery
Air Embolism
Blood Incompatibility
Pressure Ulcer Stages III & IV
Falls and Trauma: (Includes: Fracture, Dislocation, Intracranial Injury, Crushing Injury, Burn, Electric Shock)
Vascular Catheter-Associated Infections
Catheter-Associated Urinary Tract Infection (UTI)
Manifestations of Poor Glycemic Control
PSI 06 – Iatrogenic pneumothorax, adult
PSI 11 – Post Operative Respiratory Failure
PSI 12 – Post Operative PE or DVT
PSI 14 – Post Operative would dehiscence
PSI 15 – Accidental puncture or laceration
IQI 11 – Abdominal aortic aneurysm (AAA) repair mortality rate (with or without volume)
IQI 19 – Hip fracture mortality rate
Complication/patient safety for selected indicators (composite)
Mortality for selected medical conditions (composite)
(Note: this link will not likely become live until 1/13/2011).
Although these are "new" proposed rules, there are really no surprises in terms of payment methodology. The amount "at risk" due to poor performance is probably lower than what was initially expected (ie: 1-2% rather than 4-5%).
The following are excerpts from the CMS press release and fact sheet that may be of interest:
- Under the program, hospitals that perform well on quality measures relating both to clinical process of care and to patient experience of care, or those making improvements in their performance on those measures, would receive higher payments.
- The financial incentives would be funded by a reduction in the base operating DRG payments for each discharge, which under the statute will be 1% in FY 2013, rising to 2% by FY 2017.
- CMS will accept comments on the hospital value-based purchasing Program proposed rule until March 8, 2010, and will respond to them in a final rule to be issued next year.
- For the FY 2013 hospital value-based purchasing program, CMS proposes to use 17 clinical process of care measures as well as 8 measures from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that document patients’ experience of care.
- CMS also proposes to adopt three mortality outcome measures, eight Hospital Acquired Condition (HAC) measures, and nine Agency for Healthcare Research and Quality (AHRQ) measures for the FY 2014 Hospital VBP program.
- Proposed Performance Period: As required by the Affordable Care Act, CMS is proposing a performance period that ends prior to the beginning of FY 2013, specifically from July 1, 2011 through March 31, 2012, for the FY 2013 hospital value-based purchasing payment determination. CMS anticipates that in future fiscal years, the Agency may propose to use a full year as the performance period. In addition, CMS is proposing to use an 18-month performance period for the three proposed mortality measures for the FY 2014 Hospital VBP payment determination, and expects to propose a performance period for the eight HAC and nine AHRQ measures in future rulemaking.
- Proposed Scoring Methods: CMS proposes to score each hospital on relative achievement and improvement ranges for each applicable measure. A hospital’s performance on each quality measure would be evaluated based on the higher of an achievement score in the performance period or an improvement score, which is determined by comparing the hospital’s score in the performance period with its score during a baseline period of performance. For each of the proposed clinical process and patient experience of care measures that apply to a hospital for FY 2013, CMS proposes that a hospital would earn 0-10 points for achievement based on where its performance for the measure fell within an achievement range, which is a scale between an achievement threshold and a benchmark. With regard to the improvement score, CMS proposes that a hospital would earn 0-9 points based on how much its performance on the measure during the performance period improved from its performance on the measure during the baseline period. Finally, CMS would calculate a Total Performance Score (TPS) for each hospital by combining its scores on all of the measures within each domain, multiplying its performance score on each domain by the proposed weight for the domain, and adding the weighted scores for the domains.
- Proposed Incentive Payment Calculations: CMS proposes to translate each hospital’s TPS into a value-based incentive payment using a linear exchange function. The linear exchange function provides the same marginal incentives to both lower- and higher-performing hospitals.
- CMS proposes to notify each hospital of the estimated amount of its value-based incentive payment for FY 2013 through its QualityNet account at least 60 days prior to Oct. 1, 2012. CMS proposes to notify each hospital of the exact amount of its value-based incentive payment on or about Nov. 1, 2012.
- CMS will accept public comments on the proposed rule through March 8, 2010 CMS will review all comments and respond to them in a final Hospital VBP rule scheduled to be released some time in 2011.
AMI-2: Aspirin Prescribed at Discharge
AMI-7a: Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival
AMI-8a: Primary PCI Received Within 90 Minutes of Hospital Arrival
HF-1: Discharge Instructions
HF-2: Evaluation of LVS Function
HF-3: ACEI or ARB for LVSD
PN-2: Pneumococcal Vaccination
PN-3b: Blood Cultures Performed in the ED Prior to Initial Antibiotic Received in Hospital
PN-6: Initial Antibiotic Selection for CAP in Immunocompetent Patient
PN-7: Influenza Vaccination
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 6AM Postoperative Serum Glucose
SCIP-Card-2: Surgery Pts. on a Beta Blocker Prior to Arrival...
SCIP-VTE-1: Surgery Pts. with Recommended Venous Thromboembolism Prophylaxis Ordered
SCIP-VTE-2: Surgery Pts. Who Received Appropriate Venous Thromboembolism Prophylaxis...
HCAHPS: Communication with Nurses
HCAHPS: Communication with Doctors
HCAHPS: Responsiveness of Hospital Staff
HCAHPS: Pain Management
HACHPS: Communication About Medicines
HACHPS: Cleanliness and Quietness of Hospital Environment
HACHPS: Discharge Information
HACHPS: Overall Rating of Hospital
PROPOSED ADDITIONAL QUALITY MEASURES FOR FISCAL YEAR 2014
Mortality-30-AMI: Acute Myocardial Infarction (AMI) 30-day Mortality Rate
Mortality-30-HF: Heart Failure (HF) 30-day Mortality Rate
Mortality-30-PN: Pneumonia (PN) 30-Day Mortality Rate
Foreign Object Retained After Surgery
Air Embolism
Blood Incompatibility
Pressure Ulcer Stages III & IV
Falls and Trauma: (Includes: Fracture, Dislocation, Intracranial Injury, Crushing Injury, Burn, Electric Shock)
Vascular Catheter-Associated Infections
Catheter-Associated Urinary Tract Infection (UTI)
Manifestations of Poor Glycemic Control
PSI 06 – Iatrogenic pneumothorax, adult
PSI 11 – Post Operative Respiratory Failure
PSI 12 – Post Operative PE or DVT
PSI 14 – Post Operative would dehiscence
PSI 15 – Accidental puncture or laceration
IQI 11 – Abdominal aortic aneurysm (AAA) repair mortality rate (with or without volume)
IQI 19 – Hip fracture mortality rate
Complication/patient safety for selected indicators (composite)
Mortality for selected medical conditions (composite)
Sunday, November 28, 2010
Berwick Testifies to the Senate Finance Committee
On November 17th, Donald Berwick testified before the Senate Finance Committee. As you can imagine, there was a lot of political tension surrounding this event.
The video of the entire senate hearing is here: http://finance.senate.gov/hearings/watch/?id=280ebc81-5056-a032-5254-1010c1e9b945
Berwick's prepared statement can be found here: http://finance.senate.gov/imo/media/doc/FINAL%20Donald%20Berwick%20Testimony%2011.15.101.pdf
Bacus' prepared opening statement can be found here: http://finance.senate.gov/imo/media/doc/11172010%20Baucus%20Hearing%20Statement%20Regarding%20New%20Patient%20Protections%20to%20Strengthen%20Medicare%20and%20Medicaid1.pdf
Grassley's prepared opening statement can be found here: http://finance.senate.gov/imo/media/doc/health%20care%2011-17-10%20hearing%20with%20Dr.pdf
Kaiser Health News, a program of the Kaiser Family Foundation, consolidated a resource page about Dr. Donald Berwick. It contains both what he has said as well as what others have said about him (and what he said). It can be found here: http://www.kaiserhealthnews.org/Stories/2010/June/30/Donald-Berwick-Resource-Guide.aspx
The video of the entire senate hearing is here: http://finance.senate.gov/hearings/watch/?id=280ebc81-5056-a032-5254-1010c1e9b945
Berwick's prepared statement can be found here: http://finance.senate.gov/imo/media/doc/FINAL%20Donald%20Berwick%20Testimony%2011.15.101.pdf
Bacus' prepared opening statement can be found here: http://finance.senate.gov/imo/media/doc/11172010%20Baucus%20Hearing%20Statement%20Regarding%20New%20Patient%20Protections%20to%20Strengthen%20Medicare%20and%20Medicaid1.pdf
Grassley's prepared opening statement can be found here: http://finance.senate.gov/imo/media/doc/health%20care%2011-17-10%20hearing%20with%20Dr.pdf
Kaiser Health News, a program of the Kaiser Family Foundation, consolidated a resource page about Dr. Donald Berwick. It contains both what he has said as well as what others have said about him (and what he said). It can be found here: http://www.kaiserhealthnews.org/Stories/2010/June/30/Donald-Berwick-Resource-Guide.aspx
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