Registry for Nursing Sensitive Patient Care - Is Everyone Doing It?

Hospitals participating in the Hospital Inpatient Quality Reporting Program (IQR) for FY2012 are required (among other structural measures) to report their participation status in a "Systematic Clinical Database Registry for Nursing Sensitive Care". Hospitals are not required to participate in a registry, but to qualify for the annual payment update, they must report if they participate in one or not.

The most recent data released by CMS in October 2011 show that 51 Indiana hospitals reported "yes", 43 reported "no", and 24 were listed as "Not Available". Of these 24, only one was not a critical access hospital.

The following is the list of all Indiana hospitals that responded "Yes" to participating in a registry of nursing sensitive care:


BALL MEMORIAL HOSPITAL INC
COLUMBUS REGIONAL HOSPITAL
COMMUNITY HOSPITAL
COMMUNITY HOSPITAL EAST
COMMUNITY HOSPITAL NORTH
COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY
COMMUNITY HOSPITAL SOUTH
DEACONESS HOSPITAL INC
DEKALB HEALTH
FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES
FRANCISCAN ST ANTHONY HEALTH - CROWN POINT
FRANCISCAN ST ANTHONY HEALTH - MICHIGAN CITY
FRANCISCAN ST ELIZABETH HEALTH - LAFAYETTE CENTRAL
FRANCISCAN ST ELIZABETH HEALTH - LAFAYETTE EAST
FRANCISCAN ST FRANCIS HEALTH - BEECH GROVE
FRANCISCAN ST FRANCIS HEALTH - INDIANAPOLIS
FRANCISCAN ST FRANCIS HEALTH - MOORESVILLE
GOOD SAMARITAN HOSPITAL
HANCOCK REGIONAL HOSPITAL
HENDRICKS REGIONAL HEALTH
HOWARD REGIONAL HEALTH SYSTEM
INDIANA UNIVERSITY HEALTH
INDIANA UNIVERSITY HEALTH ARNETT HOSPITAL
INDIANA UNIVERSITY HEALTH BLOOMINGTON HOSPITAL
INDIANA UNIVERSITY HEALTH NORTH HOSPITAL
INDIANA UNIVERSITY HEALTH WEST HOSPITAL
IU HEALTH GOSHEN HOSPITAL
KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICESTHE
LAPORTE HOSPITAL AND HEALTH SERVICES
LUTHERAN HOSPITAL OF INDIANA
MAJOR HOSPITAL
MARION GENERAL HOSPITAL
MEMORIAL HOSPITAL
MEMORIAL HOSPITAL AND HEALTH CARE CENTER
ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC
PARKVIEW HOSPITAL
PARKVIEW HUNTINGTON HOSPITAL
PARKVIEW LAGRANGE HOSPITAL
PARKVIEW NOBLE HOSPITAL
PARKVIEW WHITLEY HOSPITAL
REID HOSPITAL & HEALTH CARE SERVICES
SAINT JOSEPH REGIONAL MEDICAL CENTER
SAINT JOSEPH'S REGIONAL MEDICAL CENTER - PLYMOUTH
SCHNECK MEDICAL CENTER
ST CATHERINE HOSPITAL INC
ST MARY MEDICAL CENTER INC
ST MARY'S MEDICAL CENTER OF EVANSVILLE INC
ST VINCENT HOSPITAL & HEALTH SERVICES
TIPTON HOSPITAL
UNION HOSPITAL INC
WILLIAM N WISHARD MEMORIAL HOSPITAL

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:

• 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.

PROPOSED QUALITY MEASURES FY2013   
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)

Indiana Performs Well on HCAHPS

The following is a table of how States performed on the HCAHPS overall rating question from Jan 09 to Dec 09. The table is sorted from high to low based on the percentage of patients responding with a rating of 9 or 10 on this 10 point scale.

As you can see, the average of Indiana hospitals ranks 7th of all states for this question.

% State
73 SD
72 KS
72 LA
72 IA
71 NE
71 ME
71 IN
70 VT
70 ID
70 NH
70 WI
69 CO
69 UT
69 MN
69 NC
68 AL
68 MI
68 OK
68 KY
68 TX
68 SC
67 MO
67 MS
67 MA
67 OH
67 OR
67 TN
66 WA
66 AZ
66 AR
66 GA
65 CT
64 AK
64 WV
64 VA
64 PA
64 IL
64 RI
63 WY
63 MT
63 CA
62 DE
62 NV
62 ND
62 FL
61 MD
61 NM
60 NJ
59 HI
58 NY
58 DC

Indiana Hospitals HCAHPS Performance

The following is a table of the performance of Indiana hospitals (Jan 09 to Dec 09) on the HCAHPS overall rating question. The table is sorted from high to low based on the percentage of patients providing a response of 9 or 10 on this 10 point scale.

% Hospital and City
94 SURGICAL HOSPITAL OF MUNSTER of MUNSTER
89 INDIANA ORTHOPAEDIC HOSPITAL LLC of INDIANAPOLIS
87 ST VINCENT HEART CENTER OF INDIANA LLC of INDIANAPOLIS
87 WOMEN'S HOSPITAL THE of NEWBURGH
86 PHYSICIANS' MEDICAL CENTER LLC of NEW ALBANY
85 INDIANA HEART HOSPITAL THE of INDIANAPOLIS
82 HENDRICKS REGIONAL HEALTH of DANVILLE
80 CLARIAN NORTH MEDICAL CENTER of CARMEL
80 ST VINCENT CARMEL HOSPITAL INC of CARMEL
80 PARKVIEW LAGRANGE HOSPITAL of LAGRANGE
79 ST FRANCIS HOSPITAL MOORESVILLE of MOORESVILLE
79 SCHNECK MEDICAL CENTER of SEYMOUR
78 GOOD SAMARITAN HOSPITAL of VINCENNES
78 DEKALB MEMORIAL HOSPITAL INC of AUBURN
78 PARKVIEW WHITLEY HOSPITAL of COLUMBIA CITY
78 TIPTON HOSPITAL of TIPTON
78 PARKVIEW NOBLE HOSPITAL of KENDALLVILLE
78 DUPONT HOSPITAL LLC of FORT WAYNE
77 COMMUNITY HOSPITAL of MUNSTER
77 ST MARY'S MEDICAL CENTER OF EVANSVILLE INC of EVANSVILLE
77 MEMORIAL HOSPITAL AND HEALTH CARE CENTER of JASPER
77 MARGARET MARY COMMUNITY HOSPITAL INC of BATESVILLE
77 ST VINCENT FRANKFORT HOSPITAL INC of FRANKFORT
76 FRANCISCAN PHYSICIANS HOSPITAL LLC of MUNSTER
76 ST VINCENT DUNN HOSPITAL INC of BEDFORD
76 WITHAM HEALTH SERVICES of LEBANON
76 PARKVIEW HUNTINGTON HOSPITAL of HUNTINGTON
75 SAINT JOSEPH'S REGIONAL MEDICAL CENTER - PLYMOUTH of PLYMOUTH
75 THE ORTHOPAEDIC HOSPITAL OF LUTHERAN HEALTH NETWOR of FT WAYNE
75 ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC of FORT WAYNE
75 MEMORIAL HOSPITAL OF SOUTH BEND of SOUTH BEND
75 MONROE HOSPITAL of BLOOMINGTON
75 CLARIAN WEST MEDICAL CENTER of AVON
74 LUTHERAN HOSPITAL OF INDIANA of FORT WAYNE
74 BLUFFTON REGIONAL MEDICAL CENTER of BLUFFTON
74 COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY of ANDERSON
74 CLARK MEMORIAL HOSPITAL of JEFFERSONVILLE
74 ST VINCENT WILLIAMSPORT HOSPITAL INC of WILLIAMSPORT
74 GOSHEN GENERAL HOSPITAL of GOSHEN
74 ST VINCENT HOSPITAL & HEALTH SERVICES of INDIANAPOLIS
74 PARKVIEW HOSPITAL of FORT WAYNE
74 FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES of NEW ALBANY
73 JAY COUNTY HOSPITAL of PORTLAND
73 MAJOR HOSPITAL of SHELBYVILLE
73 ST MARY MEDICAL CENTER INC of HOBART
73 BEDFORD REGIONAL MEDICAL CENTER of BEDFORD
73 RIVERVIEW HOSPITAL of NOBLESVILLE
73 ST FRANCIS HOSPITAL AND HEALTH CENTERS-INDIANAPOLI of INDIANAPOLIS
73 ST VINCENT MERCY HOSPITAL of ELWOOD
73 ST JOSEPH HOSPITAL & HEALTH CENTER INC of KOKOMO
72 SAINT JOSEPH REGIONAL MEDICAL CENTER of MISHAWAKA
72 HARRISON COUNTY HOSPITAL of CORYDON
72 CLARIAN-ARNETT HEALTH SYSTEM INC of LAFAYETTE
72 WABASH COUNTY HOSPITAL of WABASH
71 CAMERON MEMORIAL COMMUNITY HOSPITAL INC of ANGOLA
71 GIBSON GENERAL HOSPITAL of PRINCETON
71 HANCOCK REGIONAL HOSPITAL of GREENFIELD
70 REID HOSPITAL & HEALTH CARE SERVICES of RICHMOND
70 FAYETTE REGIONAL HEALTH SYSTEM of CONNERSVILLE
70 TERRE HAUTE REGIONAL HOSPITAL of TERRE HAUTE
70 COLUMBUS REGIONAL HOSPITAL of COLUMBUS
70 SAINT JOHN'S HEALTH SYSTEM of ANDERSON
70 HENRY COUNTY MEMORIAL HOSPITAL of NEW CASTLE
70 ST VINCENT JENNINGS HOSPITAL INC of NORTH VERNON
69 COMMUNITY HOSPITAL NORTH of INDIANAPOLIS
69 SULLIVAN COUNTY COMMUNITY HOSPITAL of SULLIVAN
69 ST CATHERINE HOSPITAL INC of EAST CHICAGO
69 SAINT ANTHONY of CROWN POINT
69 MARION GENERAL HOSPITAL of MARION
68 ST ANTHONY MEMORIAL HEALTH CENTERS of MICHIGAN CITY
68 UNION HOSPITAL CLINTON of CLINTON
68 DEACONESS HOSPITAL INC of EVANSVILLE
68 ST ELIZABETH CENTRAL of LAFAYETTE
68 LAPORTE HOSPITAL AND HEALTH SERVICES of LA PORTE
68 JOHNSON MEMORIAL HOSPITAL of FRANKLIN
68 DAVIESS COMMUNITY HOSPITAL of WASHINGTON
68 KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICESTHE of MADISON
68 WILLIAM N WISHARD MEMORIAL HOSPITAL of INDIANAPOLIS
67 ST FRANCIS HOSPITAL AND HEALTH CENTERS of BEECH GROVE
67 WESTVIEW HOSPITAL of INDIANAPOLIS
67 BLOOMINGTON HOSPITAL of BLOOMINGTON
67 DECATUR COUNTY MEMORIAL HOSPITAL of GREENSBURG
67 BALL MEMORIAL HOSPITAL INC of MUNCIE
67 ST VINCENT CLAY HOSPITAL INC of BRAZIL
66 SCOTT COUNTY MEMORIAL HOSPITAL AKA SCOTT MEMORIAL of SCOTTSBURG
66 ELKHART GENERAL HOSPITAL of ELKHART
66 UNION HOSPITAL INC of TERRE HAUTE
66 ST JOSEPH HOSPITAL of FORT WAYNE
66 HOWARD REGIONAL HEALTH SYSTEM of KOKOMO
65 COMMUNITY HOSPITAL SOUTH of INDIANAPOLIS
64 DEARBORN COUNTY HOSPITAL of LAWRENCEBURG
64 MEMORIAL HOSPITAL of LOGANSPORT
63 ST VINCENT RANDOLPH HOSPITAL INC of WINCHESTER
63 CLARIAN HEALTH PARTNERS INC D/B/A METHODIST IU RIL of INDIANAPOLIS
62 KOSCIUSKO COMMUNITY HOSPITAL of WARSAW
61 ST MARGARET MERCY HEALTHCARE CENTERS of DYER
61 STARKE MEMORIAL HOSPITAL of KNOX
60 DUKES MEMORIAL HOSPITAL of PERU
60 ST ELIZABETH EAST of LAFAYETTE
59 COMMUNITY HOSPITAL EAST of INDIANAPOLIS
57 MORGAN HOSPITAL AND MEDICAL CENTER of MARTINSVILLE
55 ST CLARE MEDICAL CENTER of CRAWFORDSVILLE
55 PORTER VALPARAISO HOSPITAL of VALPARAISO
55 ST MARGARET MERCY HEALTHCARE CENTERS of HAMMOND
48 SAINT CATHERINE REGIONAL HOSPITAL of CHARLESTOWN
41 METHODIST HOSPITALS INC of GARY

Note that the following hospitals were tagged as "Survey results are not available for this reporting period".

WHITE COUNTY MEMORIAL HOSPITAL
UNITY MEDICAL AND SURGICAL HOSPITAL
THE HEART HOSPITAL AT DEACONESS GATEWAY LLC
ST MARY'S WARRICK HOSPITAL INC
PUTNAM COUNTY HOSPITAL
PINNACLE HOSPITAL
PERRY COUNTY MEMORIAL HOSPITAL
KENTUCKIANA MEDICAL CENTER LLC
JASPER COUNTY HOSPITAL
GREENE COUNTY GENERAL HOSPITAL
COMMUNITY HOSPITAL OF BREMEN INC
ADAMS MEMORIAL HOSPITAL

CMS Posts Final FY11 Inpatient Rules, Payment Updates, and RHQDAPU Measures.

On Friday afternoon, CMS issued a press release announcing that the final FY11 inpatient prospective payment system rules have been posted to the Federal Register.

Excerpts of the press release is cut and pasted below wiht items of interest to healthcare quality professionals in red:

"In today’s action, CMS is updating acute care hospital rates by 2.35 percent. This update reflects a market basket increase of 2.6 percent for inflation, which is a slight increase over the FY 2010 inflation rate. The final rule reduces the 2.6 percent inflation update by 0.25 percent, as required by the Affordable Care Act. Further, CMS will apply a “documentation and coding” adjustment of -2.9 percent. Hospital coding practices following adoption of the Medicare severity DRGs increased aggregate payments to hospitals, but did not reflect actual increases in patients’ severity of illness. Under legislation passed in 2007, CMS is required to recoup the entire amount of FY 2008 and 2009 excess spending due to changes in hospital coding practices no later than FY 2012. CMS has determined that a -5.8 percent adjustment is necessary to recoup these overpayments. The -2.9 percent adjustment for FY 2011 is one-half of this amount. CMS estimates that payments to general acute care hospitals for operating expenses in FY 2011 will decline by 0.4 percent, or $440 million, compared with FY 2010 under the final rule, taking into account all factors that would affect spending."

"The final rule adds 12 measures to the RHQDAPU set, and retires one current measure – Mortality for selected surgical procedures (composite). However, only 10 of the new measures – including rates of occurrence for 8 of 10 categories of conditions that are subject to the hospital-acquired conditions (HACs) policy ‑ will be considered in determining a hospital’s FY 2012 update. The remaining 2 measures to be reported in 2011 would be considered in determining the hospital’s FY 2013 update."

The 1877 page document can be found here: http://www.ofr.gov/OFRUpload/OFRData/2010-19092_PI.pdf

• Changes to RHQDAPU start on page 505.
• The list of 47 measures adopted for FY11 start on page 517.
• The list of 55 measures adopted for FY12 start on page 567.
• The list of 57 measures adopted for FY13 start on page 595.
• The list of 60 measures adopted for FY14 start on page 606.
• A list of future potential measures being considered for adoption into RHQDAPU starts on page 608.