Medicare Hospital Acquired Conditions Reduction Program Andrew B. Wheeler Vice President of Federal Finance

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1 Medicare Hospital Acquired Conditions Reduction Program Andrew B. Wheeler Vice President of Federal Finance

2 Value-Based Hospital Acquired Purchasing Conditions FFY 2018 FFY AHRQ Claims Based Measures 15% weight CDC chart abstracted measures 85% weight Patient Safety Indicator Composite Ratio - PSI-90 - Recalibrated for FFY 2018 Decubitus ulcer PSI 3 Iatrogenic pneumothorax PSI 6 Postop hip fracture PSI 8 Periop hemorrhage or hematoma rate PSI 9 Postop acute kidney injury requiring dialysis PSI 10 Postop respiratory failure PSI 11 Postop PE or DVT PSI 12 Postop sepsis PSI 13 Postop wound dehiscence PSI 14 Accidental puncture or laceration PSI 15 Central Line Associated Blood Stream Infection Catheter Associated Urinary Tract Infection Surgical Site Infection Pooled Colon / Abdominal Hysterectomy Clostridium Difficile Methicillin-resistant Staphylococcus Aureus 2

3 Hospital Acquired Conditions - Calculations Not budget neutral Top 75 percent of hospitals receive no penalty, bottom 25 percent of hospitals receive a 1 percent penalty Decile rankings through FFY 2017 Z-score began in FFY

4 Domain 1 Scoring HAC performance ratios for all program-eligible hospitals are assigned z-scores based on how far their measure performance is from the national average. Using publicly available data, the tables and graphs below demonstrate how measures will be assigned a z-score under the HAC program. PSI-90: Patient Safety Indicator Composite Performance Detail (v5.0.1) Patient Safety Indicator Measure 1 (Combined into PSI-90 Composite Ratio) Measure Weight PSI 15: Accidental Puncture or Laceration 43.9% PSI 12: Postop PE Or DVT 33.8% PSI 6: Iatrogenic Pneumothorax 7.5% PSI 13: Postop Sepsis 5.7% PSI 7: Central Venous Catheter-Related Blood 3.8% PSI 3: Pressure Ulcer 3.3% PSI 14: Postop Wound Dehiscence 1.8% PSI 8: Postop Hip Fracture 0.2% [PROXY for v6.0] PSI-90 Composite Ratio 1 (Sum of Weighted Performance Ratios) PSI-90 Composite Ratio National Mean Standard Deviation / PSI-90 Z-Score (Also Domain 1 Score) A negative z-score REDUCES the chance of receiving a HAC penalty. Domain 1 Scoring Summary Ratio 1 Ratio 2 Domain 1 Score 5 PSI-90: Patient Safety Indicator Composite

5 Domain 2 Scoring HAI_1: Central Line Associated Blood Stream Infection (CLABSI) (ICU + Select Wards) Performance Detail Standardized Infection Ratio (SIR) 1 Number of Observed CLABSI Infections 2.00 Number of Expected CLABSI Infections 1.05 National Mean Standard Deviation Base SIR SIR CLABSI Z-Score A positive z-score INCREASES the 5th Percentile Mean 95th Percentile chance of receiving a HAC penalty CLABSI SIR HAI_2: Catheter Associated Urinary Tract Infection (CAUTI) (ICU + Select Wards) Performance Detail Standardized Infection Ratio (SIR) 1 Number of Observed CAUTI Infections 2.00 Number of Expected CAUTI Infections SIR National Mean Standard Deviation Base SIR CAUTI Z-Score A negative z-score REDUCES the chance of receiving a HAC penalty. 5th Percentile Mean th Percentile CAUTI SIR Surgical Site Infection (SSI) Pooled Standardized Infection Ratio (SIR) Performance Detail SIR 1 Observed SSI: Colon Infections + Observed SSI: Abdominal Hysterectomy Infections Expected SSI: Colon Infections + Expected SSI: Abdominal Hysterectomy Infections SIR National Mean Standard Deviation SSI Z-Score A negative z-score REDUCES the chance of receiving a HAC penalty. Base SIR th Percentile Mean th Percentile SSI Pooled SIR 5

6 Domain 2 Scoring Cont d. HAI_5: Methicillin-resistant Staphylococcus Aureus (MRSA) Performance Detail Standardized Infection Ratio (SIR) 1 Number of Observed MRSA Infections 0.00 Number of Expected MRSA Infections SIR National Mean Standard Deviation MRSA Z-Score A negative z-score REDUCES the chance of receiving a HAC penalty. HAI_6: Clostridium difficile (C.diff.) Performance Detail Standardized Infection Ratio (SIR) 1 Number of Observed C.Diff. Infections Number of Expected C.Diff. Infections SIR National Mean Standard Deviation Base SIR C.diff Z-Score A negative z-score REDUCES the chance of receiving a HAC penalty. 5th Percentile Mean th Percentile C.diff SIR Domain 2 Scoring Summary SIR 1 SIR Z-Score Domain 2 Score HAI_1a: Central Line Associated Blood Stream Infection (CLABSI) (ICUonly) FFY 2018 HAI_2a: Catheter Associated Urinary Tract Infection (CAUTI) (ICU-only) Surgical Site Infection (SSI) Pooled Standardized Infection Ratio (SIR) * HAI_5: Methicillin-resistant Staphylococcus Aureus (MRSA) HAI_6: Clostridium difficile (C.diff.)

7 Calculating HAC Adjustment Estimated Program Performance Raw Score Domain Weight Weighted Domain Score Domain 1 - AHRQ Claims Based Measure X 15% Raw Score Domain Weight Weighted Domain Score Domain 2 - CDC Chart Abstracted Measures X 85% Total HAC Score (Sum of Weighted Domain Scores) Estimated Program Impact Percentile 2 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% % Penalty No Payment Penalty 0% Hospital Revenue Exposure Estimate: Estimated FFY 2018 Revenue $17,818,639 Revenue at Risk For Payment Reduction (1%) $178,200 Total HAC Score Performance Summary: Estimated Total HAC Score Lowest Total HAC Score Receiving Payment Penalty HAC Payment Penalty Determination: 2 Hospital Estimated to be in the Top (worst) Quartile? Estimated HAC Program Payment Impact $0 No Total HAC Score 7

8 Andrew B. Wheeler (573) x