pay for performance: a medicare priority
DESCRIPTION
Pay for Performance: A Medicare Priority. Rewarding the right care for every person, every time Center for Medicare and Medicaid Services. Agenda. Pay for Performance (P4P) and the CMS Quality Agenda P4P: the next step to improving quality CMS P4P Demonstrations Challenges. - PowerPoint PPT PresentationTRANSCRIPT
Pay for Pay for Performance:Performance:A Medicare A Medicare
PriorityPriorityRewarding the right care for Rewarding the right care for every person, every timeevery person, every time
Center for Medicare and Center for Medicare and Medicaid ServicesMedicaid Services
AgendaAgenda
Pay for Performance (P4P) and the Pay for Performance (P4P) and the CMS Quality Agenda CMS Quality Agenda
P4P: the next step to improving P4P: the next step to improving qualityquality
CMS P4P DemonstrationsCMS P4P Demonstrations Challenges Challenges
Why Pay for Why Pay for Performance?Performance?
Rising costs driving focus to quality, Rising costs driving focus to quality, valuevalue
Current system rewards quantity, not Current system rewards quantity, not qualityquality
Private sector initiativesPrivate sector initiatives Public sector interestPublic sector interest
CongressCongress Administration and HHS / CMS leadership Administration and HHS / CMS leadership States States
CMS Vision: Quality CMS Vision: Quality ImprovementImprovement
Provide leadership in improving Provide leadership in improving American health careAmerican health care
The right care for every personThe right care for every personevery timeevery time
Safe, effective, timely, patient-Safe, effective, timely, patient-centered, efficient and equitablecentered, efficient and equitable(IOM recommendations)(IOM recommendations)
Partners are keyPartners are key
CMS Quality InitiativesCMS Quality Initiatives
HospitalsHospitals Physician OfficesPhysician Offices
Nursing HomesNursing Homes Home Health CareHome Health Care End-stage Renal Disease Treatment End-stage Renal Disease Treatment
(ESRD)(ESRD)
P4P: The Next Step in P4P: The Next Step in Improving QualityImproving Quality
Data collection infrastructure in Data collection infrastructure in placeplace
Pay for reporting encouraged Pay for reporting encouraged some providerssome providers
Quality data now readily Quality data now readily availableavailable
P4P Issues for CMSP4P Issues for CMS What to rewardWhat to reward
Relative qualityRelative quality Absolute thresholdAbsolute threshold ImprovementImprovement
How to finance incentivesHow to finance incentives Across-the-board reduction to create Across-the-board reduction to create
poolpool Offsetting penaltiesOffsetting penalties Offsetting savingsOffsetting savings
P4P Benefits for P4P Benefits for ProvidersProviders
BenefitsBenefits Rewards superior performance and Rewards superior performance and
encourages overall improvementencourages overall improvement Aligns financial model to professional Aligns financial model to professional
goals of quality improvementgoals of quality improvement Focus on volume is diminished as focus Focus on volume is diminished as focus
on quality is heightenedon quality is heightened
Current CMS Current CMS Demonstrations and P4P Demonstrations and P4P
ActivitiesActivities Hospital Voluntary ReportingHospital Voluntary Reporting Premier Hospital Quality Incentive Premier Hospital Quality Incentive
DemonstrationDemonstration Physician Voluntary Reporting Program Physician Voluntary Reporting Program
(PVRP)(PVRP) Physician Group Practice DemonstrationPhysician Group Practice Demonstration Section 649 MCMP DemonstrationSection 649 MCMP Demonstration Chronic Care / Nursing Home P4P Chronic Care / Nursing Home P4P Section 646 Medicare Health Care Quality Section 646 Medicare Health Care Quality
Demo.Demo.
Current CMS Current CMS Demonstrations and P4P Demonstrations and P4P
ActivitiesActivities Home Health P4P (in development)Home Health P4P (in development) ESRD Bundled Payment DemonstrationESRD Bundled Payment Demonstration Section 721 Chronic Care Improvement Section 721 Chronic Care Improvement
ProgramProgram Care Management for High Cost Care Management for High Cost
BeneficiariesBeneficiaries
Home Health Home Health P4PP4P
What’s nextWhat’s next
HHA Current Status and HHA Current Status and PreparednessPreparedness
Deficit Reduction Act:Deficit Reduction Act: HHAs shall submit to the Secretary HHAs shall submit to the Secretary
such data that the Secretary such data that the Secretary determines are appropriate for the determines are appropriate for the measurement of health care quality. measurement of health care quality.
The Secretary shall establish The Secretary shall establish procedures for making data procedures for making data submitted under subclause (II) submitted under subclause (II) available to the public.available to the public.
HHA Current Status and HHA Current Status and PreparednessPreparedness
Deficit Reduction Act:Deficit Reduction Act: HHAs shall submit to the Secretary HHAs shall submit to the Secretary
such data that the Secretary such data that the Secretary determines are appropriate for the determines are appropriate for the measurement of health care quality. measurement of health care quality.
The Secretary shall establish The Secretary shall establish procedures for making data procedures for making data submitted under subclause (II) submitted under subclause (II) available to the public.available to the public.
HHA Current Status and HHA Current Status and PreparednessPreparedness
Deficit Reduction Act:Deficit Reduction Act: HHAs shall submit to the Secretary HHAs shall submit to the Secretary
such data that the Secretary such data that the Secretary determines are appropriate for the determines are appropriate for the measurement of health care quality. measurement of health care quality.
The Secretary shall establish The Secretary shall establish procedures for making data procedures for making data submitted under subclause (II) submitted under subclause (II) available to the public.available to the public.
What Does DRA Mean for What Does DRA Mean for HHAs?HHAs?
CMS, MedPac and AHRQCMS, MedPac and AHRQ11 agree that agree that the current Outcome and the current Outcome and Assessment Information Set (OASIS) Assessment Information Set (OASIS) provide qualitative information on provide qualitative information on how home health agencies provide how home health agencies provide care.care.
(1) July 27, 2005 Medicare Payment Advisory Commission (MedPac) testimony before the Senate Committee on Finance, U. S. Senate on pay for performance in Medicare
What Does DRA Mean for What Does DRA Mean for HHAs?HHAs?
CMS shall continue to utilize the CMS shall continue to utilize the Home Health CompareHome Health Compare22 website website whereby home health agencies are whereby home health agencies are listed geographically, so consumers listed geographically, so consumers can search for all Medicare-can search for all Medicare-approved home health providers that approved home health providers that serve their city or zip code and then serve their city or zip code and then find the agencies offering the types find the agencies offering the types of services they need.of services they need.
(2) http://www.medicare.gov/HHCompare/Home/
DRA To-Do ListDRA To-Do List
Define the reporting period for DRA Define the reporting period for DRA that allows payments to be adjusted that allows payments to be adjusted
Conduct the data analysis necessary Conduct the data analysis necessary to develop the list of HHAs eligible to develop the list of HHAs eligible for the 2% market basket increasefor the 2% market basket increase
Ensure that HHAs not represented Ensure that HHAs not represented by OASIS data are not penalized.by OASIS data are not penalized.
Beyond DRABeyond DRAPay-for-PerformancePay-for-Performance
In order to support and implement a In order to support and implement a P4P Program in Home Health, we P4P Program in Home Health, we are focusing on 4 areas of work:are focusing on 4 areas of work: Performance ModelPerformance Model Payment MethodologyPayment Methodology Data InfrastructureData Infrastructure Program Transparency and Public Program Transparency and Public
ReportingReporting
Next Steps: Pay-for-Next Steps: Pay-for-PerformancePerformance
Performance Model:Performance Model: What type of performance model will be What type of performance model will be
applied to P4P?applied to P4P? Achievement (Quality Improvement)Achievement (Quality Improvement) Attainment (Threshold/Benchmarks)Attainment (Threshold/Benchmarks) Achievement + AttainmentAchievement + Attainment
MedPac Report on value-based MedPac Report on value-based purchasing – June 2007purchasing – June 2007
Performance ModelPerformance Model
Achievement:Achievement: Establishes an expectation of performance Establishes an expectation of performance
improvement based on HHA performance improvement based on HHA performance on identified set of OASIS outcome on identified set of OASIS outcome measures, past performance, etc:measures, past performance, etc:
For example: For example: Incentive payments based on a specific Incentive payments based on a specific
percentage improvement within one or more percentage improvement within one or more quality measures:quality measures:
HHAs would only be rewarded if a significant HHAs would only be rewarded if a significant number of their patient base experienced number of their patient base experienced improvement in their ability to manage oral improvement in their ability to manage oral medications.medications.
Performance ModelPerformance Model
Attainment:Attainment: Establishes an threshold of performance Establishes an threshold of performance
based on averages (national, geographic, based on averages (national, geographic, home health agency characteristics, or other home health agency characteristics, or other demographic).demographic).
For example:For example: Incentive payments on reaching a threshold Incentive payments on reaching a threshold
relative to an HHA’s within a specific quality relative to an HHA’s within a specific quality measure:measure:
HHAs would only be rewarded if their patient base (on HHAs would only be rewarded if their patient base (on average) is able to manage oral medications at the same average) is able to manage oral medications at the same risk-adjusted rate as their industry peers.risk-adjusted rate as their industry peers.
Next Steps: Pay-for-Next Steps: Pay-for-PerformancePerformance
Payment Methodology:Payment Methodology: What type of payment methodology will What type of payment methodology will
be applied to P4P?be applied to P4P? Awaiting MedPac report Awaiting MedPac report
recommendationsrecommendations Awaiting Congressional actionAwaiting Congressional action
Next Steps: Pay-for-Next Steps: Pay-for-PerformancePerformance
Data Infrastructure:Data Infrastructure: Data collection tool – OASISData collection tool – OASIS
Update current measuresUpdate current measures Expand to collect additional outcome and Expand to collect additional outcome and
process measuresprocess measures Patient experience of care dataPatient experience of care data Maintain QIES data repository contract Maintain QIES data repository contract
and measureand measure Plan for future Integrated Data Plan for future Integrated Data
Repository (IDR)Repository (IDR)
Next Steps: Pay-for-Next Steps: Pay-for-PerformancePerformance
Program Transparency and Public Program Transparency and Public Reporting:Reporting: Nationally endorsed measuresNationally endorsed measures
ExpansionExpansion DRA:DRA:
The Secretary shall establish procedures for The Secretary shall establish procedures for making data submitted under subclause (II) making data submitted under subclause (II) available to the public.available to the public.
Home Health P4P Home Health P4P DemonstrationDemonstration
Anticipated voluntary, implemented Anticipated voluntary, implemented on a state-wide basison a state-wide basis
Budget-neutralBudget-neutral Home Health Quality AllianceHome Health Quality Alliance
Industry stakeholdersIndustry stakeholders ConsumersConsumers Payers and Health PlanPayers and Health Plan
Home Health Measures Home Health Measures ExpansionExpansion
CMS will work with stakeholdersCMS will work with stakeholders
Focus is on measuring patient Focus is on measuring patient experience, outcomes and efficiencyexperience, outcomes and efficiency
In ConclusionIn Conclusion Medicare increasing focus on qualityMedicare increasing focus on quality P4P is here to stay - widespread supportP4P is here to stay - widespread support Multiple demonstration projects Multiple demonstration projects
underway / in developmentunderway / in development Early results confirm improved quality Early results confirm improved quality
outcomes using P4Poutcomes using P4P P4P can help preserve the Medicare P4P can help preserve the Medicare
trust fundtrust fund Partners are key to success – CMS Partners are key to success – CMS
needs everyoneneeds everyone
““We are seeing that pay-for-We are seeing that pay-for-performance works. We are seeing performance works. We are seeing increased quality of care for patients, increased quality of care for patients, which will mean fewer costly which will mean fewer costly complications – exactly what we complications – exactly what we should be paying for in Medicare.”should be paying for in Medicare.”
Mark B. McClellan, MD, PhD Mark B. McClellan, MD, PhD
CMS AdministratorCMS Administrator