Value-Based Purchasing Program Overview
Maida Soghikian, MDGrand Rounds
Scripps Green Hospital November 28, 2012
IQR and VBP Evolution and History
• Background and Introduction– Inpatient Quality Reporting Program– Value-Based Purchasing Program
• CMS FY13 VBP Final Scores• Process Measures Analysis
– Core Measure All or None Bundles– Value-Based Purchasing Program Measures
• Status of FY14 VBP Performance– Current data collection– Addition of Outcome Measures
• CMS VBP in FY16 and Beyond
Presentation Overview
2
IQR and VBP Evolution and History
• 2001 – Department of Health and Human Services developed Hospital Inpatient Quality Reporting (IQR) Program which requires hospitals to submit quality measures.– Conditions include: acute myocardial infarction (AMI), heart
failure (HF), pneumonia (PNE), surgical care improvement project (SCIP)
– Indicators include: process measures and patient experience 30-day mortality and readmission rates, patient safety indicators
• Eligible hospitals that do not participate will receive an annual market basket update with a 2.0 percentage point reduction.
IQR Program
4
VBP Program:Background
5
• Congress authorized the hospital inpatientValue-Based Purchasing (VBP) Programthrough the Affordable Care Act.– Built on the Hospital IQR measure reporting
infrastructure. – Uses Hospital IQR measures that have had results
published on Hospital Compare* for at least one year– Funded by a 1% reduction from participating hospitals’
base operating diagnosis-related group (DRG) payments for FY 2013, increasing to 2% by FY 2017
* http://www.hospitalcompare.hhs.gov/
VBP Program:Purpose
6
• VBP Program seeks to encourage hospitals to improve the quality and safety of care for Medicare beneficiaries and all patients receive during acute-care inpatient stays by:
1) Eliminating or reducing occurrence of adverse events2) Adopting evidence-based care standards and
protocols that result in the best outcomes for the most patients
3) Improve patients’ experience of care
7
*Six Domains:
1) Clinical Care
2) Person- and Caregiver-Centered Experience and Outcomes
3) Safety
4) Efficiency and Cost Reduction
5) Care Coordination
6) Community/ Population Health
CMS Shift for Quality Measurement:
Clinical Process Measures Outcomes and Efficiency Measures(not risk-adjusted) (risk-adjusted)
2013 2014 2015 2016
1.00% 1.25% 1.50% 1.75%
1 Process of Care 70% 45% 20%
2 Patient Experience 30% 30% 30%
3 Outcome - 25% 30%
4 Efficiency:Medicare Spending per Beneficiary - - 20%
VBP Fiscal Year
Reclassification of Domains:
National Quality Strategy*
% Program Contribution
VBP Program:Domain Overview
• BASELINE Performance Period:– July 2009 – March 2010
• FY13 Performance Period:– July 2011 – March 2012
• Payment Impact Period:– October 2012 – September 2013
FY13 VBP: Performance Periods
8
Final Points
14
• Each measure is worth 10 points– CMS takes the higher of either the achievement or
improvement points – FY13 VBP: 12 process measures (120 total points)
FY14 VBP: 13 process measures (130 total points) Add urinary catheter on post operative day 1 or 2
• Measures with fewer than 10 reported cases are considered to have insufficient data and will not be scored for that hospital.
16
CMS FY13 VBP:Process of Care
Bench-mark
Achieve-ment
Threshold
Baseline %
Current%
Achieve-ment Points
Improve-ment Points
Final Points
1 Fibrinolytic therapy within 30 minutes 91.91% 65.48% - - - - Insufficient Data
2 PCI within 90 minutes 100.00% 91.86% - - - - Insufficient Data
Heart Failure 3 Discharge instructions 100.00% 90.77% 92.67% 100.00% 10 9 10
4 Blood cultures in ED before antibiotic 100.00% 96.43% 97.56% - - - Insufficient Data
5 Appropriate antibiotic selection 99.58% 92.77% 93.22% 97.73% 7 7 7
6 Prophylactic antibiotic received within one hour prior to surgical incision 99.98% 97.35% 99.00% 100.00% 10 9 10
7 Prophylactic antibiotic selection for surgical patients 100.00% 97.66% 99.67% 100.00% 10 9 10
8 Prophylactic antibiotics discontinued within 24 hours after surgery end time 99.68% 95.07% 94.79% 99.67% 9 9 9
9 Cardiac surgery patients with controlled 6AM postoperative serum glucose 99.63% 94.28% 100.00% 98.85% 8 0 8
10 Recommended VTE prophylaxis ordered 100.00% 95.00% 98.18% 100.00% 10 9 10
11 Received appropriate VTE prophylaxis within 24 hours prior - 24 hours after surgery 99.85% 93.07% 96.36% 100.00% 10 9 10
12 Patients on beta blocker therapy prior to admit who received a beta blocker during perioperative period 100.00% 93.99% 96.90% 98.97% 8 6 8
91.11%
Clinical Process of Care MeasuresNational Baseline
Performance Period: July 2011 - March 2012
Green
Heart Attack
Pneumonia
Surgical Care Improvement
Project
Score:
17
* Patient experience data is adjusted by CMS for certain patient-mix variables. These include: service line, age, response percentile, and self-reported level of education, health, and primary language.
CMS FY13 VBP:Patient Experience of Care
Benchmark
Achieve-ment
ThresholdFloor Baseline
%Current
%
Achieve-ment Points
Improve-ment Points
Final Points
1 Nurses always communicated well 84.70% 75.18% 38.98% 79% 81% 6 4 6
2 Doctors always communicated well 88.95% 79.42% 51.51% 83% 86% 7 5 7
3 Patients always received help quickly from hospital staff 77.69% 61.82% 30.25% 63% 67% 3 2 3
4 Patients' pain was always well controlled 77.90% 68.75% 34.76% 70% 75% 6 6 6
5 Staff always explained about medicines before giving them to patients 70.42% 59.28% 29.27% 63% 66% 6 4 6
6 Patients' rooms and bathrooms were always kept clean and quiet 77.64% 62.80% 36.88% 63% 65% 2 1 2
7 Patients were definitely given information about what to do during their recovery at home 89.09% 81.93% 50.47% 81% 85% 4 4 4
8 Patients who gave their hospital a rating of 9 or higher on a scale of 0 to 10 82.52% 66.02% 29.32% 79% 81% 9 7 9
20
63.00%
Patient Experience of Care*National Baseline
Performance Period: July 2011 - March 2012
Green
Score: Consistency Points:
CMS FY13 VBP:FINAL Scores*
Total VBP Score:State Average = 52.83%
National Average = 55.46%
18
Encinitas Green La Jolla Mercy
Process 87% 91% 74% 62%
Patient Experience** 42% 63% 50% 25%
Total VBP Score 74% 83% 67% 51%
FINAL VBP ScoresFY13 VBP
* Source: CMS Hospital Value Based Purchasing - Actual Percentage Summary Report, released 10/31/12. ** Patient experience data is adjusted by CMS for certain patient-mix variables. These include: service line, age, response percentile, and self-reported level of education, health, and primary language.
• FY13 VBP Data Collection Periods:– Baseline Performance: July 2009 – March 2010– Current Performance: July 2011 – March 2012
• October 31, 2012: – CMS sent hospitals the Actual Payment Percentage
Summary Report
• January 1, 2013: – Incorporate 1% reduction and value-based incentive
payment simultaneously
CMS FY13 VBP: Performance Periods and Timeline
19
ACTUAL POTENTIAL*
1 FINAL VBP Scores 74% 83% 67% 51% - -
2 ESTIMATED FY13 IPPS Operating Payments $24,110,800 $47,430,600 $47,576,100 $70,942,000 $190,059,500 $190,059,500
3 1% Reduction (Pay-In Amount into VBP Pool) ($241,108) ($474,306) ($475,761) ($709,420) ($1,900,595) ($1,900,595)
4 1% Reduction + Value-based Incentive(Total Payment from VBP Pool) $325,606 $720,512 $581,702 $661,801 $2,289,621 $3,491,393
5 Net Loss/Gain $84,498 $246,206 $105,941 ($47,619) $389,026 $1,590,798
6 Total Reimbursement for FY13 IPPS Operating Payments $24,195,298 $47,676,806 $47,682,041 $70,894,381 $190,448,526 $191,650,298
Scripps HospitalsMeasure Encinitas Green La Jolla Mercy
CMS FY13 VBP:Estimated Financial Impact
*POTENTIAL reimbursement: if all sites had VBP score of 100%
20
Example for an FY13 Claim:
1 FINAL VBP Score Based on performance period: July 2011 - March 2012 83%
2 Operating Payment Claim Billed to Medicare For inpatient stay in FY13 $100.00
3 1% Reduction Pay-in amount into VBP pool ($1.00)
4 1% Reduction + Value-based Incentive Total payment from VBP pool $1.52
5 Net Loss/Gain - $0.52
6 Total Reimbursement for Claim - $100.52
GreenMeasure Measure Description
21
CMS FY13 VBP:Example for Green
Core Measures System-wide:All or None Bundle Scores
0%
20%
40%
60%
80%
100%
FY 03 FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11 FY 12
Bund
le Com
pliance (%
) Heart Attack
Heart Failure
Pneumonia
SCIP
23
Core Measures System-wide:Heart Attack Bundle Scores
50%
60%
70%
80%
90%
100%
2005 2006 2007 2008 2009 2010 2011 2012
Bund
le Com
pliance (%
) Scripps
Top Decile
Top Quartile
Median
Bottom Quartile
Bottom Decile
24
# Hospitals for percentile ranks
= 540
Core Measures System-wide: Heart Failure Bundle Scores
0%
20%
40%
60%
80%
100%
2005 2006 2007 2008 2009 2010 2011 2012
Bund
le Com
pliance (%
)
Scripps
Top Decile
Top Quartile
Median
Bottom Quartile
Bottom Decile
25
# Hospitals for percentile ranks
= 582
Core Measures System-wide: Pneumonia Bundle Scores
0%
20%
40%
60%
80%
100%
2005 2006 2007 2008 2009 2010 2011 2012
Bund
le Com
pliance (%
)
Scripps
Top Decile
Top Quartile
Median
Bottom Quartile
Bottom Decile
26
# Hospitals for percentile ranks
= 586
Core Measures System-wide: SCIP Bundle Scores
20%
40%
60%
80%
100%
2006 2007 2008 2009 2010 2011 2012
Bund
le Com
pliance (%
)
Scripps
Top Decile
Top Quartile
Median
Bottom Quartile
Bottom Decile
27
# Hospitals for percentile ranks
= 588
Scripps Health Yearly Goals
Baseline performance*
(FY14 VBP Benchmarks)
FY13 Goal
(FY14 VBP Benchmarks)
72.5% 75.3% 76.6% 78%
3-year Goal = 78% Systemwide (National Predicted Top Decile)
FY14 Goal
(FY15 VBP Benchmarks)
FY15 Goal
(FY16 VBP Benchmarks)
29 *Based on system aggregate scores for the performance period of April to July 2012.
VBP Process Scores:System-wide Performance Objectives
Legend:= M aximum of either achievement or improvement points= Current performance meeting FY12 Value-Based Purchasing Goal= Current performance below FY12 Value-Based Purchasing Goal
FY12 VBP Board Objective(using CMS FY13 Targets)
Bench-mark
Achieve-ment
Threshold
Current%
Current n
Final Points
Current%
Current n
Final Points
Current%
Current n
Final Points
Current%
Current n
Final Points
Current%
Current n
Final Points
1 Fibrinolytic therapy within 30 minutes 91.9% 65.5% - 0 Insuff icient Data
- 0 Insuff icient Data
- 0 Insuff icient Data
- 0 Insuff icient Data
- 0 Insuff icient Data
2 PCI within 90 minutes 100.0% 91.9% 95.4% 151 6 97.1% 34 6 100.0% 7 Insuff icient Data 97.0% 33 6 94.0% 84 6
Heart Failure 3 Discharge instructions 100.0% 90.8% 99.3% 1018 9 98.8% 171 8 100.0% 221 10 99.5% 187 9 99.1% 439 9
4 Blood cultures in ED before antibiotic 100.0% 96.4% 99.2% 770 8 99.5% 216 8 100.0% 8 Insuff icient Data 100.0% 148 10 98.8% 406 6
5 Appropriate antibiotic selection 99.6% 92.8% 99.0% 480 9 99.0% 99 9 98.2% 55 8 98.8% 85 9 99.2% 241 9
6Prophylactic antibiotic received within one hour prior to surgical incision 100.0% 97.4% 99.6% 1984 8 100.0% 313 10 99.8% 406 9 99.8% 538 9 99.2% 727 7
7Prophylactic antibiotic selection for surgical patients 100.0% 97.7% 99.5% 1991 8 99.4% 314 7 100.0% 407 10 99.1% 540 6 99.7% 730 8
8Prophylactic antibiotics discontinued within 24 hours after surgery end time 99.7% 95.1% 99.1% 1895 8 99.7% 297 9 99.0% 399 8 99.2% 503 9 98.9% 696 8
9Cardiac surgery patients with controlled 6AM postoperative serum glucose 99.6% 94.3% 96.0% 446 3 - 0 Insuff icient
Data99.2% 123 9 96.5% 173 4 92.7% 150 1
10 Recommended VTE prophylaxis ordered 100.0% 95.0% 99.1% 1948 8 100.0% 387 10 100.0% 368 10 98.3% 470 6 98.6% 723 7
11Received appropriate VTE prophylaxis within 24 hours prior - 24 hours after surgery 99.9% 93.1% 98.5% 1948 8 100.0% 387 10 100.0% 368 10 97.2% 470 7 97.8% 723 7
12Patients on beta blocker therapy prior to admit who received a beta blocker during perioperative period 100.0% 94.0% 98.7% 797 8 100.0% 91 10 99.3% 139 8 99.6% 266 9 97.3% 301 6
Surgical Care Improvement
Project
FY12 Score Goal
FY12-to-date Score 91.1% 76.4% 67.3%
National Baseline
Heart Attack
Performance Period: FY12 (August 2011 - July 2012)
Scripps Hospitals Encinitas Green La Jolla Mercy
75.5%
65.9% 65.9%67.7%90.6%67.0%
87.0%
Value-Based Purchasing Measures:Clinical Process of Care
Pneumonia
31
Bench-mark
Achieve-ment
Threshold
Current%
Current n
Final PointsBench-mark
Achieve-ment
Threshold
Current%
Current n
Final Points
1 Fibrinolytic therapy within 30 minutes 91.91% 65.48% - 0 Insuff icient Data 96.30% 80.66% - 0 Insuff icient
Data
2 PCI within 90 minutes 100.00% 91.86% 100.00% 7 Insuff icient Data 100.00% 93.44% - 0 Insuff icient
Data
Heart Failure 3 Discharge instructions 100.00% 90.77% 100.00% 221 10 100.00% 92.66% 100.00% 22 10
4 Blood cultures in ED before antibiotic 100.00% 96.43% 100.00% 8 Insuff icient Data 100.00% 97.30% - 0 Insuff icient
Data
5 Appropriate antibiotic selection 99.58% 92.77% 98.18% 55 8 100.00% 94.46% 100.00% 7 10
6Prophylactic antibiotic received within one hour prior to surgical incision 99.98% 97.35% 99.75% 406 9 100.00% 98.07% 96.88% 32 0
7 Prophylactic antibiotic selection for surgical patients 100.00% 97.66% 100.00% 407 10 100.00% 98.13% 100.00% 32 10
8Prophylactic antibiotics discontinued within 24 hours after surgery end time 99.68% 95.07% 99.00% 399 8 99.96% 96.63% 96.88% 32 1
9Cardiac surgery patients with controlled 6AM postoperative serum glucose 99.63% 94.28% 99.19% 123 9 100.00% 96.34% 100.00% 8 10
10Postoperative urinary catheter removal on post operative day 1 or day 2
n/a n/a n/a n/a n/a 99.89% 92.86% 100.00% 34 10
11 Recommended VTE prophylaxis ordered 100.00% 95.00% 100.00% 368 10 100.00% 95.65% 100.00% 8 10
12Received appropriate VTE prophylaxis within 24 hours prior - 24 hours after surgery 99.85% 93.07% 100.00% 368 10 100.00% 94.62% 100.00% 33 10
13Patients on beta blocker therapy prior to admit who received a beta blocker during perioperative period 100.00% 93.99% 99.28% 139 8 99.83% 94.92% 100.00% 33 10
Heart Attack
Pneumonia
Surgical Care Improvement
Project
90.6%
National Baseline
Green
91.1%
Value-Based Purchasing Measures:Clinical Process of Care
National Baseline
Green
FY13 Score ACTUAL
Performance Period: FY12 (August 2011 - July 2012)
Performance Period: FY13 (August 2012)
FY12 Score ACTUAL
FY12 Score GOAL 91.00%
81.00%
FY13 Score GOAL
Green’s Performance:CMS FY13 vs. FY14 Targets
CMS FY13 VBP CMS FY14 VBP
32
Green’s Performance:Indicator Drilldown
Site performance
National performance
Gap between top decile and median scores
decreases and the VBP achievement range narrows
FY13: 97.4% - 100%FY14: 98.1% - 100%
SCIP Antibiotic within 1 hourGreen’s score: 9 (99.8%) 0 (96.9% = 1 OFI*)
33 *OFI = Opportunity for improvement
ACTUAL Performance Period: Apr 2012 – Dec 2012 CURRENT Performance Period: Apr 2012 – Sep 2012
35
CMS FY14 VBP Performance:Update for Green
Bench-mark
Achieve-ment
Threshold
Current%
Current n Final Points
1 Fibrinolytic therapy within 30 minutes 96.30% 80.66% - 0 Insufficient Data
2 PCI within 90 minutes 100.00% 93.44% 100.00% 5 Insufficient Data
Heart Failure 3 Discharge instructions 100.00% 92.66% 100.00% 114 10
4 Blood cultures in ED before antibiotic 100.00% 97.30% 100.00% 1 Insufficient Data
5 Appropriate antibiotic selection 100.00% 94.46% 100.00% 26 10
6 Prophylactic antibiotic received within one hour prior to surgical incision 100.00% 98.07% 99.04% 208 5
7 Prophylactic antibiotic selection for surgical patients 100.00% 98.13% 100.00% 208 10
8 Prophylactic antibiotics discontinued within 24 hours after surgery end time 99.96% 96.63% 98.04% 204 4
9 Cardiac surgery patients with controlled 6AM postoperative serum glucose 100.00% 96.34% 100.00% 60 10
10 Postoperative urinary catheter removal on post operative day 1 or day 2 99.89% 92.86% 100.00% 210 10
11 Recommended VTE prophylaxis ordered 100.00% 95.65% 100.00% 71 10
12 Received appropriate VTE prophylaxis within 24 hours prior - 24 hours after surgery 100.00% 94.62% 100.00% 198 10
13 Patients on beta blocker therapy prior to admit who received a beta blocker during perioperative period 99.83% 94.92% 100.00% 198 10
Score: 89.00%
Heart Attack
Pneumonia
Surgical Care Improvement
Project
Value-Based Purchasing Measures:Clinical Process of Care
National Baseline
Performance Period: FY13 (Apr 2012 - Sep 2012)
Green
Outcome:Current Performance
38
B = Better than U.S. National RateN = No different than U.S. National RateW = Worse than U.S. National Rate
Performance Data Collection Period
Heart Attack 86.4% (N)
Heart Failure 91.2% (N)
Pneumonia 89.9% (N)
0.89 (W)
PSI 6: Iatrogenic pneumothorax 0.42 (N)
PSI 12: Postoperative VTE 5.88 (N)
PSI 14: Postoperative wound dehiscence 0.41 (N)
PSI 15: Accidental Puncture or Laceration 2.84 (W)
PSI 3: Pressure Ulcer 0.01PSI 7: Central Venous Catheter-Related Bloodstream Infections 0.28
PSI 8: Postoperative Hip Fracture 0.06
PSI 13: Postoperative Sepsis 17.95
1.35 (W) Jul 2011 - Mar 2012
AHRQ PSI-90 Composite for selected indicators(n = # outcomes)
30-day Mortality Rate (displayed as survival rate)
Central line-associated blood stream infection (shown as a Standardized Infection Ratio)
Green
Part of PSI-90 Composite
Part of PSI-90 Composite
Part of PSI-90 Composite
PSI-90 Measures:
NOT Publicly Reported
PSI-90 Measures:
Publicly Reported
not included 0.00 0.44 not included
Jul 2009 - Jun 2011
0.62not included 0.45 0.62 0.45
90.21% 88.18% 90.42% 88.27% 90.42% 88.27%
Jul 2008 - Jun 201190.42% 88.61% 90.03% 88.15% 90.03% 88.15%
BenchmarkAchieve-
mentThreshold
86.73% 84.77% 86.24% 84.75% 86.24% 84.75%
Achieve-ment
ThresholdBenchmark Benchmark
OUTCOME MEASURES2014 National
Baseline2015 National
Baseline2016 National
BaselineAchieve-
mentThreshold
40
*Six Domains:
1) Clinical Care
2) Person- and Caregiver-Centered Experience and Outcomes
3) Safety
4) Efficiency and Cost Reduction
5) Care Coordination
6) Community/ Population Health
CMS Shift for Quality Measurement:
Clinical Process Measures Outcomes and Efficiency Measures(not risk-adjusted) (risk-adjusted)
2013 2014 2015 2016
1.00% 1.25% 1.50% 1.75%
1 Process of Care 70% 45% 20%
2 Patient Experience 30% 30% 30%
3 Outcome - 25% 30%
4 Efficiency:Medicare Spending per Beneficiary - - 20%
VBP Fiscal Year
Reclassification of Domains:
National Quality Strategy*
% Program Contribution
VBP Program:Domain Overview
VBP FY16:Example of Reclassification
PROPOSED FY 2015 Domain
PROPOSED FY 2016 Domain
Clinical Care
Care Coordination
Clinical Care
Clinical Care
Patient Experience of Care
Person- and Caregiver-Centered Experience
and Outcomes
Clinical Care
Safety
Safety
Efficiency Efficiency and Cost Reduction
Pneumonia
Heart Failure - Discharge instructions
Heart Attack
30-day Mortality - Heart Attack, Heart Failure, Pneumonia
Clinical Process of Care
OutcomePSI-90 Composite - Patient safety for selected indicators
Central line-associated blood stream infection
Medicare spending per beneficiary
PROPOSED FY 2015 Measures
HCAHPS Questions
Surgical Care Improvement Project
41
SUMMARY
• The CMS VBP is how Medicare is paying us from here on out
• The top performers make money the poor performers have money taken away
• SGH is performing well but did not receive full opportunity payment
• Even 1 OFI impacts our final score• The bar keeps increasing as the nation
improves and as the measures evolve
Bench-mark
Achieve-ment
Threshold
Current%
Current n Final Points Bench-
mark
Achieve-ment
Threshold
Current%
Current n Final Points
1 Fibrinolytic therapy within 30 minutes 91.91% 65.48% - 0 Insufficient Data 96.30% 80.66% - 0 Insufficient
Data
2 PCI within 90 minutes 100.00% 91.86% 100.00% 7 Insufficient Data 100.00% 93.44% 100.00% 2 Insufficient
Data
Heart Failure 3 Discharge instructions 100.00% 90.77% 100.00% 221 10 100.00% 92.66% 100.00% 40 10
4 Blood cultures in ED before antibiotic 100.00% 96.43% 100.00% 8 Insufficient Data 100.00% 97.30% - 0 Insufficient
Data
5 Appropriate antibiotic selection 99.58% 92.77% 98.18% 55 8 100.00% 94.46% 100.00% 9 10
6 Prophylactic antibiotic received within one hour prior to surgical incision 99.98% 97.35% 99.75% 406 9 100.00% 98.07% 98.65% 74 3
7 Prophylactic antibiotic selection for surgical patients 100.00% 97.66% 100.00% 407 10 100.00% 98.13% 100.00% 74 10
8 Prophylactic antibiotics discontinued within 24 hours after surgery end time 99.68% 95.07% 99.00% 399 8 99.96% 96.63% 98.65% 74 6
9 Cardiac surgery patients with controlled 6AM postoperative serum glucose 99.63% 94.28% 99.19% 123 9 100.00% 96.34% 100.00% 18 10
10 Postoperative urinary catheter removal on post operative day 1 or day 2 n/a n/a n/a n/a n/a 99.89% 92.86% 100.00% 75 10
11 Recommended VTE prophylaxis ordered 100.00% 95.00% 100.00% 368 10 100.00% 95.65% 100.00% 21 10
12 Received appropriate VTE prophylaxis within 24 hours prior - 24 hours after surgery 99.85% 93.07% 100.00% 368 10 100.00% 94.62% 100.00% 70 10
13 Patients on beta blocker therapy prior to admit who received a beta blocker during perioperative period 100.00% 93.99% 99.28% 139 8 99.83% 94.92% 100.00% 70 10
National Baseline
Green
Heart Attack
Pneumonia
Surgical Care Improvement
Project
Value-Based Purchasing Measures:Clinical Process of Care
National Baseline
Green
FY13 Score ACTUAL
Performance Period: FY12 (August 2011 - July 2012)
Performance Period: FY13 (August - September 2012)
FY12 Score ACTUAL
FY12 Score GOAL 91.0%89.0%
FY13 Score GOAL
91.1%90.6%
CMS FY13 VBP Targets CMS FY14 VBP Targets
44
FY12 vs FY13 VBP Board Objective for Green
VBP Board Objective:Indicator Drilldown for Green
Site performance
National performance
Gap between top decile and median scores
decreases and the VBP achievement range narrows
FY13: 97.35% - 100%FY14: 98.07% - 100%
SCIP Antibiotic within 1 hourGreen’s score: 9 (99.75%) 3 (98.65% = 1 OFI*)
45 *OFI = Opportunity for improvement
46
VBP Program:Performance Periods Overview
2013 VBP 2014 VBP 2015 VBP
1.00% 1.25% 1.50%weight 70% 45% 20%
All except AMI-10 Jul 1, 2011 - Mar 31, 2012 Apr 1, 2012 - Dec 31, 2012 Jan 1, 2013 - Dec 31, 2013
Only AMI-10 - - Apr 1, 2013 - Dec 31, 2013
weight 30% 30% 30%HCAHPS Jul 1, 2011 - Mar 31, 2012 Apr 1, 2012 - Dec 31, 2012 Jan 1, 2013 - Dec 31, 2013
weight 0% 25% 30%Mortality - Jul 1, 2011 - Jun 30, 2012 Oct 1, 2012 - Jun 30, 2013
AHRQ - - Oct 15, 2012 - Jun 30, 2013
CLABSI - - Jan 26, 2013 - Dec 31, 2013
weight 0% 0% 20%MSPB - - May 1, 2013 - Dec 31, 2013
Efficiency
VBP Fiscal Year
Outcome
Patient Experience of Care
Process of Care
% Program Contribution
Medicare Spending per Beneficiary (MSPB):• CMS claims based efficiency measure• Evaluates cost to Medicare of services performed by
hospitals and other healthcare providers during an MSPB episode– Start Date = 3 days prior to an inpatient index admission– End Date = 30 days post-hospital discharge
MSPB Measure =Hospital’s Average MSPB Amount
National Median MSPB Amount
Risk-adjusted Spending for All Episodes# Episodes MSPB Amount =
Efficiency:Medicare Spending per Beneficiary
47
• Price-standardization– Removes sources of variation that are due to
geographic payment differences– Variables: wage index, geographic practice
cost differences, disproportionate share hospital (DSH) payments for the poor and uninsured population
• Risk-adjustment– Accounts for variation due to patient health
status– Variables: age and severity of illness
Efficiency:Measure Methodology
48
Performance Period: May 2011 – December 2011
* Source: CMS Hospital-Specific Report, released September 2012
AchievementThreshold Benchmark Encinitas Green La Jolla Mercy
# Eligible Admissions - - 1,062 1,413 1,686 3,034
Cost per case(Risk-adjusted) ≈ $18,307 ≈ $14,495 $18,666 $17,112 $17,931 $19,312
MSPB Score Median ≈ 0.99
Mean of Top Decile ≈ 0.81
1.02 0.93 0.98 1.05
Scripps PerformanceVBP Performance Standards
Efficiency:Site Performance
49