quality incentive programs - ibm...answer as many questions as we can during q&a at the end of...
TRANSCRIPT
Quality Incentive Programs
By: Amy Yearwood RN, BSN
Physicians Network Quality Manager
Huntsville Hospital
Housekeeping
1. Using the control panel - Use the control panel on the right side of your screen to minimize and expand this panel by clicking on the arrow in the upper right corner.
2. Ask Questions - You can submit questions using the Question section located near the bottom of the control panel. We will take time to answer as many questions as we can during Q&A at the end of the presentation. If your question was not answered, we will respond to you individually after the event.
3. After the webinar - We want your feedback! Please take the short survey at the completion of the webinar. Also, all registrants will receive a copy of the presentation, and the recording for on-demand replay.
Objectives
• Huntsville Hospital’s merit-based incentive contracts
• Learn the performance categories Huntsville Hospital uses in their incentive contracts
• Learn which specialties have merit-based incentive contracts
Who is Huntsville Hospital?
• 941 bed community-based not-for-profit hospital in
North Central Alabama
• State’s second largest hospital
• 24-Physicians Network-owned practices with 76+
providers
What Specialties do we have?
HH Pediatric IntensivistsHH Surgical Associates - Huntsville
HH Physicians Care Lowell DriveHH Physicians Care Madison
HH Pediatric HospitalistsNorth Alabama Hospitalists
TN Valley Gynecological Oncology Associates
HH Maternal Fetal Medicine
Huntsville Surgical Associates (Trauma)
Hazel Green Pediatrics
HH Lung Center
HH Physicians Care Hampton Cove
HH Walk in Clinic at Airport Road
HH Endocrinology & Diabetes Clinic HH Neurology Associates
St. Jude’s Clinic at Huntsville Hospital
HH Pediatric NeurologyTN Valley Pediatric Surgery
HH Digestive Disease Center
Huntsville Hospital Spine and Neuro
HH Surgical Associates of Madison
HH Physicians Care Bailey CoveHH Physicians Care Gurley
OB/ED Hospitalist
Core Protocol for Incentives
• Specialty
• Quality
• Service
• Financial
HH Surgical AssociatesQuality-Principal Weight = 50%Surgical site infections rate less than the comparative general surgeons on staff.
Compliance with hospital approved and suggested Operation Room Policies and Procedures:Including but not limited to: Service-Principal Weight=25%In the last 12 months, when you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?
Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider?
In the last 12 months, how often did you see this provider within 15 minutes of your appointment time?
Financial Performance -Principal Weight=25%Meet budgeted expenses Achieve coding accuracySubmit charge data within 7 days
Pediatric- NeurologyQuality- Principal Weight
Achieve 60% CPOE MU 2 Goal is 60%Achieve 50% ePrescribingMU 2 Goal is 50%Provide patient-specific educational materialMU 2 Goal is 10%
Provide a summary of care for transition outMU 2 Goal is 10%
Service- Principal Weight
Achieve overall patient satisfaction
Financial Performance- Principal Weight
Achieve coding accuracy
HospitalistsQuality-Principal Weight=50%
30 day Readmission rate:Readmission as an admission to a hospital within 30 days of a discharge from the same or another hospital.
Risk adjusted mortality index (compared to large hospitals)
VTE Prophylaxis (ICARE)
LOS average observed vs. expected (compared to large hospitals)
Participate in the High Value Care Team Initiatives30 day Readmission rate for COPD
Service-Principal Weight=25%How well the hospitalist kept the patient informed about the care and treatment
How well the hospitalist coordinated care
How well the hospitalist program was explained
Financial Performance -Principal Weight=15%Meet the wRVUs for the National Region of MGMA ( 2014 Report) 4,141
Achieve coding accuracy
Reduce cost per case as compared to other Internal Medicine physicians at HH
Manage the program within national benchmarks for provider subsidy ($156,063.00 2014 SHM)
Attend the quarterly meetings (each meeting is worth 25% of the payout)
Complete the ProAssurance Seminar
HH Neurological Associates Quality-Principal WeightAchieve 60% CPOE
Achieve 50% ePrescribing
All prescriptions written must include the medication name, dosage, route, directions and PRN indication if necessary
Provide patient-specific educational material
Service-Principal Weight
In the last 12 months, how often did the provider explain things in a way that was easy to understand?(Clear Communication by provider)In the last 12 months, how often did the provider listen carefully to you?(Provider listened carefully to you)
Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider?(Provider overall rating)
Financial Performance -Principal Weight
Achieve coding accuracy
Hazel Green- PediatricsQuality & Efficiency Outcome ScorecardPrincipal Weight=50%
Provide HPV vaccine for children that meet the recommended guidelines within 9 months after the start of the series
Provide reminders for the 11 and 12 year olds of their preventative visit
Receive PKU results within 4 weeks
Service-Principal Weight=25%
In the last 12 months, when you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?
Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider?
In the last 12 months, how often did you see this provider within 15 minutes of your appointment time?
Financial Performance -Principal Weight=25%
Meet budgeted expenses
Achieve coding accuracy
Submit charge data within 7 days
Digestive Disease CenterQuality & Efficiency Outcome ScorecardPrincipal Weight=50%Body Mass Index ("BMI)" documentation completed and education of patients’ proper BMI completed 95% of the time
Achieve adenoma detection rate of 15% for colon cancer screening patients
Achieve colonoscopy withdrawal time of at least 6 minutes in 90% of patients undergoing screening colonoscopiesColon cancer screening documentation completed at least 90% of the time
Completion of medical records in the office and hospital accordance with medical staff bylaws
Routine continuing education provided for clinical staff in the endoscopy labs located at HH, Madison Hospital, Madison Office, Huntsville office
Service-Principal Weight=25%Started as Employed Practice 1/1/2015
Financial Performance -Principal Weight=25%
Meet budgeted expensesAchieve coding accuracySubmit charge data within 7 days
Primary CareQuality & Efficiency Outcome ScorecardPrincipal Weight=50%Diabetic Foot Exam completion
Physician Composite Star Rating for Blue Advantage, Humana and HealthSpring- 3 stars
BP Control- Increase the percentage of individuals 18-65 years of age with a diagnosis of hypertension whose BP was adequately controlled (<140/90) during the previous 12 months. 65 or older BP was adequately controlled (≤ 150/90)
Breast Cancer Screening-members who are female between 50-74 years of age who had a mammogram to screen for breast cancer during the measurement year or the prior year.
Colorectal Cancer Screening-members who are between 50-75 years of age who had appropriate screening for colorectal cancer.
A1c Control- Diabetes, provider must ensure that eligible patients most recent A1c is no greater than 8.
Red, White & Blue Medicare Wellness visits
Reduce COPD Readmissions less than or equal to 6%Provider must exceed the performance standard for their assigned member population. The readmission rate = (# of readmissions) /(# of admissions).This includes inpatient admissions to any facility exclusive of psychiatry, maternity, SNF and rehabilitation visits
Completion of Medicare & Medicare Advantage Forms
Service-Principal Weight=25%In the last 12 months, when you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?
Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider?
In the last 12months, how often did this provider spend enough time with you?
Financial Performance -Principal Weight=25%Meet budgeted expenses
Achieve coding accuracy
Medical Records completed within 7 days
How HH meets the challenges of
measuring and reporting quality
• Currently participate in Meaningful Use.
• HH monitors each provider’s quality based on specialty.
• Quality incentive contracts are in place with most of the employed providers and renewed each year.
• Reviewing new EMRs for better workflow, documentation and reporting capabilities.
• Collect patient satisfaction results to drive practice improvements.
• In the process of applying for National Committee for Quality Assurance (NCQA) recognition for Patient Centered Medical Home (PCMH).
• Reviews are coordinated with payers to see each provider’s quality outcomes to make necessary adjustments for the future.
WHAT WILL DETERMINE YOUR FUTURE WITH THE MEDICARE ACCESS & CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) REAUTHORIZATION ACT OF 2015 (MACRA)
How are you aligned with an incentive payment system?
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html
Additional Resources
