exploring the value equationcoruralhealth-wpengine.netdna-ssl.com/wp-content/uploads/...performance...
TRANSCRIPT
Exploring the Value Equation
Hospital Strength INDEX
October 17, 2018
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 2
A Framework for Understanding
and Assessing Rural Provider Performance
Series 1
IDNsState
Assoc.
DeptHealth
RuralHosp.
Univ.
CMMI
Nat’lAssoc.
Utilized today by Tennessee and Colorado to provide rural-relevant analytics to all rural facilities. Previously leveraged state-wide in Iowa, California, Arkansas and Oklahoma.
Leveraged by DoH in Ohio, Maine, New Mexico and Mississippi as cornerstone of rural health programming.
Cornerstone for monitoring performance across 25 Montana CAHs participating in a 3-year innovation program.
Trusted by Critical Access and Rural & Community Hospitals nationwide as a comprehensive and objective tool for measuring performance.
Utilized by NRHA and NOSORH for advocacy efforts and basis of annual award programs.
Used by leading health systems to better understand individual facility performance as well as to compare with systems with similar rural investments.
Penn State and Michigan State rely on INDEX analytics as foundation for state-wide rural programming. Other participating universities have been, Wisconsin and University of Nevada.
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 3
Hospital Strength INDEX®
Provides a comprehensive and objective assessment of all rural and
Critical Access Hospitals.
Offers the first national rating system to include the roughly 1,300
Critical Access Hospitals and 900 Rural & Community Hospitals.
Benchmarks performance to peers nationally using percentile ranks.
Aggregates CMS data for more than 50 rural-relevant indicators
organized into 8 Performance Pillars.
Provides transparent and actionable performance metrics, updated
three times per year.
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 4
Performance Pillars Span Market, Value, and Finance
Market
Inpatient Market
Share
Inpatient Market
Share
Outpatient
Market Share
Diagnostics
Market Share
Emergency
Market Share
Other OP
Surgery Market
Share
Value
Quality
Emergency (ED)
Outpatient (OP)
Immunization
(IMM)
Outcomes
HF Readmission
PN Readmission
Hospital-Wide
Readmission
Proprietary
Mortality Score
Patient
Perspective
All Domains
Cost
Adjusted IP
Costs
Adjusted OP
Costs
Charges
Adjusted IP
Charges
Adjusted OP
Charges
Finance
Financial
Stability
Capital
Efficiency
See Full Methodology
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 5
INDEX Reports
Performance Summary Pillar Report Indicator Report
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 6
CO CAH Network Performance to Peers
Market Value Finance
Overall INDEX
Score
IP Market
Share
OP Market
ShareQuality Outcomes Patient Sat. Cost Charges
Financial
Stability
CO CAH
Median 54 50 78 86 59 70 16 44 73
All U.S. CAH
Median 51 40 46 62 49 65 36 64 51
CO CAH
Network vs.
US CAHs
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 7
The Value Equation
Value
Quality
Cost
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 8
The Numerator of Value
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 9
Quality Deep-Dive – The Numerator
OP20 Med Time ED Door to Doc
OP21 Med Time Pain Mgmt Long
BoneOP22 Patients Left
w/o Being Seen IMM2 Flu VaccineIMM3 Healthcare Staff Flu Vaccine
CO CAHMedian
14 min
(0-29 min)
39 min
(38-81 min)0%
87%
(48-100%)
98%
(93-100%)
U.S. CAH Median
17 min 44 min 1% 91% 92%
INDEX Quality Pillar
ED1b Med Time ED Arrival to Admit
OP4 Aspirin at Arrival
OP5 Med Time to ECG
OP18b Med Time ED Arr to Depart
CO CAH Median
86%ile165 min
(102-234 min)
98%
(91-100%)
10 min
(5-11 min)
103 min
(80-116 min)
U.S. CAH Median
62%ile 202 min 97% 7 min 105 min
Source: Hospital Compare – Process of Care Core Measures Q2 2017
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 10
Outcomes Deep-Dive – The Numerator
30-Day HF Readmit
30-Day PN Readmit
30-Day PN Mortality
30-Day HF Mortality
Hosp-Wide Readmit
Hosp All-Cause Mort Score*
CO CAHMedian
21.6%
(20.6-23%)
16.5%
(15.5-18.1%)
16.0%
(13.6-20.6%)
12.8%
(11.5-15.4%)
15.0%
(14.2-15.9%)
-1.53
(-5.33-1.53)
U.S. CAH Median 21.5% 16.6% 15.9% 12.4% 15.2% -1.0
*Hospital Risk-Adjusted All-Cause Mortality Score. A positive score indicates all-cause mortality rate is lower than expected based upon your cases and patient mix. A negative score indicates all-cause mortality rate is higher than expected.
Source: Hospital Compare – Mortality/Readmissions (July 2013-June 2016), MedPAR 2016 Final Rule (October 2015-September 2016)
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 11
Patient Perspectives Deep-Dive – The Numerator
INDEX Patient Perspectives
PillarDefinitely
Recommend Rating 9 or 10 CleanlinessNurse
CommunicationDoctor
Communication
CO CAH Median
70%ile77%
(60-87%)
79%
(67-87%)
80%
(70-96%)
83%
(76-90%)
86%
(76-92%)
U.S. CAH Median
65%ile 75% 77% 81% 84% 86%
Responsiveness Pain ManagementMedications Well
ExplainedDischarge
Instructions Quietness
CO CAH Median
79%
(69-83%)
74%
(63-91%)
69%
(54-75%)
89%
(78-94%)
70%
(58-80%)
U.S. CAH Median
77% 74% 69% 89% 67%
Source: Hospital Compare – HCAHPS Q2 2017
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 12
2018 National Rural Health Day Preview
Quality• Estes Park• Mt San Rafael• Rio Grande• Sedgwick County• Spanish Peaks• Yuma District
Outcomes• Aspen Valley• East Morgan• Estes Park• Grand River• Pikes Peak• Sedgwick County• Spanish Peaks
Patient Perspectives• Aspen Valley• Colorado Canyons• East Morgan• Estes Park• Gunnison Valley• Pagosa Springs• Wray Community
National Rural Health DayNovember 15, 2018
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 13
The Denominator of Value
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 14
Cost Variation
• Productivity
• Skill Mix
• Tenure
• Unions
• Agency Staff
• Benefits
• Centralized Services
• Marketing
• Cost Report
Optimization
• Level of
“Systemness”
• GPO
• Physician Preference
• Clinical Variation
• Volumes
• Contracted Services
• Contract Rollover
• EHR
• Telemedicine
• Rural Connectivity
• Technology
Advances
• “Keeping up with
the Jones”
Staffing Corporate Allocations Medical Supplies Technology
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 15
Reimbursement Hurdles to Value
Cost-Based Reimbursement at Odds with Value
Payments as a Percentage of Charge
Fee for Service
Collections/Revenue Cycle
Bundled Payments
ACO / Shared Savings
Alternative Payment Models
Value Based Purchasing
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 16
Reimbursement Maze
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 17
Cost & Charge Analysis
DRG 192 - COPD
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 18
Cost & Charge Analysis
DRG 195 – Simple Pneumonia
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 19
Cost & Charge Analysis
DRG 690 – Kidney & UTI
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 20
Cost & Charge Analysis
CT Scan
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 21
Cost & Charge Analysis
ED Level III
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 22
Cost & Charge Analysis
Colonoscopy
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 23
Value Based Purchasing / Alternative Payments
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 24
Quality/Efficiency will Impact Bottom Line
CMS Value-Based Purchasing
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 25
How Would Colorado CAHs Perform under VBP?
If 2020 CMS VBP rules were in effect, CO CAHs could expect:
$1.1M Medicare revenue (2%) withheld across all CAHs
$2.5M maximum reimbursement across all CAHs with 100%ile performance across all measures
$1.1M expected reimbursement across all CAHs based upon performance
$1.4M Left on the TableHCAHPS Deep-Dive*
Measure Modeled Revenue Forfeited
Overall Satisfaction $15,657
Discharge Instructions $15,657
Quietness & Cleanliness $15,657
Nurse Communication $15,657
Doctor Communication $10,960
Medication Explanation $9,394
Staff Responsiveness $6,263
TOTAL $89,245
*For one Colorado CAH
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 26
Advocacy for Critical Access VBP Principles (NRHA)
Small, rural hospitals should be included in a robust, rural relevant quality performance
measurement program
Mandate a sophisticated statistical analysis to ensure that low volumes do not significantly
reduce measure reliability
The small, rural measurement system should be adaptable for multiple uses: insurers,
regulatory agencies, etc.
Measurement system should include:
Clinical processes
Patient Safety
Patient Satisfaction
Adequate Technical Assistance should be funded to ease implementation of performance
measurement programs
Data Warehouse: non-proprietary
Only upside – no further erosion of reimbursement
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 27
The Rural Health Safety Net is Under Pressure
Rural Hospital Payor Mix is 55%
Governmental2
Rural Non-Rural
83 Rural Hospital
Closures Since 20101
1 Univ. North Carolina Sheps Center, February 20182 CMS Healthcare Cost Report Information System (HCRIS), Q3 2017. Operating margin is computed in accordance with Flex Monitoring Team guidance. Hospitals for which data are unavailable or identified as outliers are excluded.
© 2018 The Chartis Group, LLC. All Rights Reserved. Page 28
Troy Brown
Manager, Chartis Center for Rural Health(207) 518-6707