4Q17 Core Measures and 2Q18 MBQIP Data
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1 4Q17 Core Measures and 2Q18 MBQIP Data August 17, 2018 Joshua Salander, MBA, PMP Consultant
2 Reports delivery 4Q17 reports were sent via on August 12, 2018 Quarterly Reports Quarterly Trend Charts 2
3 MICAHQN Reports Schedule Qtr CMS Data Deadline* Data Provided By* 1st Qtr August 15 August 31 2nd Qtr November 15 November 30 3rd Qtr February 15 February 28 4th Qtr May 15 May 31 3
4 FY2019 IPPS Final Rule Issued on 8/2/18 Home Page: Service-Payment/AcuteInpatientPPS/FY2019-IPPS-Final-Rule- Home-Page.html Fact Sheet: Disclaimer: This is informational only. You should review the Final Rule to determine specific impacts to your hospital. Persevion LLC is not liable for the accuracy of this information or how it pertains to your hospital. 4
5 FY2019 IPPS Final Rule Interoperability Meaningful Use (MU) = Promoting Interoperability (PI) 90 Day Reporting periods for CY19 & CY20 Performance Based Scoring Methodology New e-prescribing Measures Query of PDMP (optional in 2019, required in 2020) Verify Opioid Treatment Agreement (optional in 2019 and 2020) Changes/removal of existing measures 2015 Edition of CEHRT required effective in 2019 Removal of eight ecqms effective in submission deadline is 2/29/20 Disclaimer: This is informational only. You should review the Final Rule to determine specific impacts to your hospital. Persevion LLC is not liable for the accuracy of this information or how it pertains to your hospital. 5
6 FY2019 IPPS Final Rule Transparency Online posting of standard charges in machine readable format Update information at least annually Request for information regarding challenges that exist for patients due to insufficient price transparency Disclaimer: This is informational only. You should review the Final Rule to determine specific impacts to your hospital. Persevion LLC is not liable for the accuracy of this information or how it pertains to your hospital. 6
7 FY2019 IPPS Final Rule Meaningful Measures Hospital Inpatient Quality Reporting (IQR) Program Removal of 18 measures, de-duplicate 21 measures Chart abstracted, ecqms, Claims-based, Structural, etc. Value-Based Purchasing Hospital-Acquired Conditions (HAC) Reduction Readmissions Reduction Programs Disclaimer: This is informational only. You should review the Final Rule to determine specific impacts to your hospital. Persevion LLC is not liable for the accuracy of this information or how it pertains to your hospital. 7
8 FY2019 IPPS Final Rule Burden Reduction easing burden by easing documentation requirements and providing flexibility in several areas, while maintaining important patient and program integrity protections. Disclaimer: This is informational only. You should review the Final Rule to determine specific impacts to your hospital. Persevion LLC is not liable for the accuracy of this information or how it pertains to your hospital. 8
9 FY2019 IPPS Final Rule Next Steps Determine how the rule affects you (only 2593 pages ) Consult with stakeholders (internal & external) Perform gap analysis Implement changes for new requirements Disclaimer: This is informational only. You should review the Final Rule to determine specific impacts to your hospital. Persevion LLC is not liable for the accuracy of this information or how it pertains to your hospital. 9
10 CY2019 Medicare PFS Proposed Rule Published on 7/27/18 Comment Period Closing Date 9/10/18 Fact sheet: Home Page: Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS P.html Disclaimer: This is informational only. You should review the Rule to determine specific impacts to your hospital. Persevion LLC is not liable for the accuracy of this information or how it pertains to your hospital. 10
11 CY2019 OPPS Proposed Rule Published on 7/31/18 Comment Period Closing Date 9/24/18 Fact sheet: Home Page: Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient- Regulations-and-Notices-Items/CMS-1695-P.html Disclaimer: This is informational only. You should review the Final Rule to determine specific impacts to your hospital. Persevion LLC is not liable for the accuracy of this information or how it pertains to your hospital. 11
12 Summary of 4Q17 MICAHQN Core Measures Performance Source for National CAH, National CAH 90th Percentile, and National performances: Telligen Reports IMM2 (highest 4Q performance since trending started in 1Q13, better than national) OP1 (consistent performance, better than national) OP2 (consistent performance, better than national, slightly lower than CAH national) OP3 (unexpected performance in 4Q17 (increase in time), worse than national) OP4 (consistent performance, better than national) OP5 (consistent performance, better than national) OP18 (adjusted expected performance ranges) a and b five quarters unexpected performance (increase in time), worse than CAH national, better than National) c and d are consistent with expected ranges based on adjustments OP20 (three quarters consecutively decreased time, better than national) ED1 (decrease in time, worse than CAH national, better than national) ED2 (a and b both showed increase in time, worse than national) 12
13 Median Time 135 OP18a - Median Time from ED Arrival to ED Departure for Discharged ED Patients - Overall MICAHQN Overall UCL LCL 13
14 Median Time 125 OP18b - Median Time from ED Arrival to ED Departure for Discharged ED Patients - Reporting Measure MICAHQN Overall UCL LCL 14
15 OP18b Data Comparison 4Q15 4Q17 Dx Code Description Denominator Median Dx Code Description Denominator Median R07.89 Chest Pain J20.9 Acute Bronchitis R07.9 Chest Pain J06.9 Upper Respiratory Infection N39.0 UTI R07.89 Chest Pain R07.9 Chest Pain J06.9 Upper Respiratory Infection N39.0 UTI J20.9 Acute Bronchitis
16 OP18b Data Comparison Principal Dx Code Dx Code Description 4Q15 4Q17 % Change R07.89 R07.9 J06.9 N39.0 J20.9 Chest Pain % Chest Pain % Upper Respiratory Infection % UTI % Acute Bronchitis % 16
17 Summary of 2Q18 MBQIP Performance Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports EDTC-1 (consistent performance) Best Quarter 4Q17 98% EDTC-2 (four quarters consecutively that rate has increased) Best Quarter 3Q16, 4Q16 98% EDTC-3 (two quarters that rate has increased) Best Quarter 2Q18 98% EDTC-4 (three quarters that rate has increased) Best Quarter 2Q18 97% EDTC-5 (consistent performance) Best Quarter 2Q18 96% EDTC-6 (consistent performance) Best Quarter 1Q18, 2Q18 95% EDTC-7 (two quarters that rate has increased) Best Quarter 4Q16, 2Q18 98% EDTC-Overall (consistent performance) Best Quarter 4Q17, 2Q18 88% 17
18 MBQIP Graphs
19 % 69% 93% 93% 93% 95% 96% 96% 96% 96% 98% 98% EDTC-1 Administrative Communication 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% Hospital Q MICAHQN (97%) Q Q National (96%) Q Q th Percentile National () Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 19
20 EDTC-1: Administrative Communication 95.0% 90.0% 85.0% 80.0% 75.0% MICAHQN Overall UCL LCL 20
21 76% 79% 80% 87% 91% 91% 93% 93% 93% 96% 98% 98% 98% EDTC - 2 Patient Information 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Hospital Q MICAHQN (97%) Q Q National (95%) Q Q th Percentile National () Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 21
22 EDTC-2: Patient Information 95% 90% 85% 80% 75% MICAHQN Overall UCL LCL 22
23 84% 87% 89% 93% 93% 93% 95% 96% 96% 98% 98% 98% 98% 98% 98% 98% 98% 98% EDTC - 3 Vital Signs 95% 90% 85% 80% 75% Hospital Q MICAHQN (98%) Q Q National (95%) Q Q th Percentile National () Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 23
24 Median Time EDTC-3: Vital Signs 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% MICAHQN Overall UCL LCL 24
25 76% 82% 87% 89% 93% 93% 93% 93% 93% 93% 95% 96% 96% 96% 98% 98% 98% EDTC - 4 Medication Information 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Hospital Q MICAHQN (97%) Q Q National (93%) Q Q th Percentile National () Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 25
26 Median Time EDTC-4: Medication Information 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% MICAHQN Overall UCL LCL 26
27 68% 76% 87% 90% 93% 93% 93% 93% 93% 95% 98% 98% 98% 98% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% EDTC - 5 Physician or Practitioner Generated Information Hospital Q MICAHQN (96%) Q Q National (94%) Q Q th Percentile National () Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 27
28 Rate EDTC-5: Practitioner Information 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% MICAHQN Overall UCL LCL 28
29 71% 80% 82% 87% 87% 89% 89% 90% 91% 93% 93% 93% 96% 98% 98% 98% 98% 98% 98% 98% 98% 98% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% EDTC - 6 Nurse Generated Information Hospital Q MICAHQN (95%) Q Q National (90%) Q Q th Percentile National () Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 29
30 Rate EDTC-6: Nurse Information 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% MICAHQN Overall UCL LCL 30
31 80% 87% 93% 93% 95% 96% 98% 98% 98% EDTC - 7 Procedures and Tests 98% 96% 94% 92% 90% 88% 86% 84% 82% 80% 78% 76% 74% 72% 70% 68% 66% 64% 62% 60% 58% 56% 54% 52% 50% Hospital Q MICAHQN (98%) Q Q National (96%) Q Q th Percentile National () Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 31
32 Rate EDTC-7: Procedures and Tests 95.0% 90.0% 85.0% 80.0% 75.0% MICAHQN Overall UCL LCL 32
33 62% 64% 65% 66% 67% 67% 69% 70% 71% 82% 87% 87% 89% 90% 91% 93% 93% 93% 93% 93% 96% 96% 96% 98% 98% 98% 98% 98% 98% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% All EDTC Measures Hospital Q MICAHQN (88%) Q Q National (81%) Q Q th Percentile National () Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 33
34 Median Time All EDTC Measure 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% MICAHQN Overall UCL LCL 34
35 Core Measure Graphs
36 Rate 90.0% OP AMI/CP Rate Based Measures - 4Q % 97.0% 98.3% 97.1% 97.2% 96.4% 97.3% 96.9% 80.0% 70.0% 60.0% 50.0% 52.9% 56.3% 40.0% 30.0% 20.0% 10.0% 0.0% Fibrinolytic Therapy Received Within 30 Minutes Aspirin at Arrival - Overall Rate Aspirin at Arrival - AMI Aspirin at Arrival - Chest Pain MICAHQN Rate CAH Only Rate Rural Only Rate 36
37 Rate OP2 - Fibrinolytic Therapy Received Within 30 Minutes 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% MICAHQN Overall UCL LCL 37
38 Rate OP4a - Aspirin at Arrival - Overall Rate 99.0% 98.0% 97.0% 96.0% 95.0% 94.0% 93.0% MICAHQN Overall UCL LCL 38
39 Rate OP4b - Aspirin at Arrival - AMI 99.0% 98.0% 97.0% 96.0% 95.0% 94.0% 93.0% 92.0% 91.0% MICAHQN Overall UCL LCL 39
40 Rate OP4c - Aspirin at Arrival - Chest Pain 99.0% 98.0% 97.0% 96.0% 95.0% 94.0% MICAHQN Overall UCL LCL 40
41 0.0% 25.0% 33.3% 50.0% 66.7% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% OP-2: Fibrinolytic Therapy Received Within 30 Minutes Hospital Q MICAHQN (52.9%) Q Q CAH National (51%) Q Q CAH 90th Percentile National () Q Q National (57%) Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 41
42 75.0% 85.7% 88.2% 89.7% 92.3% 92.9% 93.8% 94.1% 95.7% 96.2% 96.4% 97.6% 98.2% OP-4a: Aspirin at Arrival - Overall Rate 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Hospital Q MICAHQN (97.2%) Q Q CAH National (95%) Q Q CAH 90th Percentile National () Q Q National (95%) Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 42
43 71.4% 80.0% 81.8% 85.7% 91.3% OP-4b: Aspirin at Arrival - AMI 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Hospital Q MICAHQN (97.2%) 43
44 81.8% 85.7% 87.0% 92.3% 93.3% 94.7% 95.7% 96.3% OP-4c: Aspirin at Arrival - Chest Pain 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Hospital Q MICAHQN (97.3%) 44
45 OP AMI/CP Continuous Measures - 4Q17 Median Time to ECG - Chest Pain Median Time to ECG - AMI Median Time to ECG - Overall Rate Median Time to Transfer to Another Facility for Acute Coronary Intervention - QI Measure Median Time to Transfer to Another Facility for Acute Coronary Intervention - Reporting Measure Median Time to Transfer to Another Facility for Acute Coronary Intervention - Overall Median Time to Fibrinolysis Rural Only Values CAH Only Values MICAHQN Values Median Time 45
46 Median Time 45 OP1 - Median Time to Fibrinolysis MICAHQN Overall UCL LCL 46
47 Median Time 120 OP3a - Median Time to Transfer to Another Facility for Acute Coronary Intervention - Overall MICAHQN Overall UCL LCL 47
48 Median Time 120 OP3b - Median Time to Transfer to Another Facility for Acute Coronary Intervention - Reporting Measure MICAHQN Overall UCL LCL 48
49 Median Time 120 OP3c - Median Time to Transfer to Another Facility for Acute Coronary Intervention - QI Measure MICAHQN Overall UCL LCL 49
50 Median Time 9 OP5a - Median Time to ECG - Overall Rate MICAHQN Overall UCL LCL 50
51 Median Time 9 OP5b - Median Time to ECG - AMI MICAHQN Overall UCL LCL 51
52 Median Time 9 OP5c - Median Time to ECG - Chest Pain MICAHQN Overall UCL LCL 52
53 OP-1: Median Time to Fibrinolysis Hospital Q Q CAH National (32 minutes) Q Q National (34 minutes) Q MICAHQN (30 minutes) Q Q CAH 90th Percentile National (17 minutes) Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 53
54 OP-3a: Median Time to Transfer to Another Facility for Acute Coronary Intervention - Overall Hospital Q MICAHQN (99 minutes) 54
55 OP-3b: Median Time to Transfer to Another Facility for Acute Coronary Intervention - Reporting Measure Hospital Q Q CAH National (65 minutes) Q Q National (61 minutes) Q MICAHQN (99.5 minutes) Q Q CAH 90th Percentile National (34 minutes) Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 55
56 OP-3c: Median Time to Transfer to Another Facility for Acute Coronary Intervention - QI Measure Hospital Q MICAHQN (83 minutes) 56
57 OP-5a: Median Time to ECG - Overall Rate Hospital Q Q CAH National (8 minutes) Q Q National (8 minutes) Q MICAHQN (7 minutes) Q Q CAH 90th Percentile National (3 minutes) Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 57
58 OP-5b: Median Time to ECG - AMI Hospital Q MICAHQN (7 minutes) 58
59 OP-5c: Median Time to ECG - Chest Pain Hospital Q MICAHQN (6 minutes) 59
60 OP Emergency Department Throughput - 4Q17 Door to Diagnostic Evaluation by a Qualified Medical Professional Median Time from ED Arrival to ED Departure for Discharged ED Patients - Transfer Patients Median Time from ED Arrival to ED Departure for Discharged ED Patients - Psychiatric/Mental Health Patients Median Time from ED Arrival to ED Departure for Discharged ED Patients - Reporting Measure Median Time from ED Arrival to ED Departure for Discharged ED Patients - Overall Rural Only Values CAH Only Values MICAHQN Values Median Time 60
61 Median Time 135 OP18a - Median Time from ED Arrival to ED Departure for Discharged ED Patients - Overall MICAHQN Overall UCL LCL 61
62 Median Time 125 OP18b - Median Time from ED Arrival to ED Departure for Discharged ED Patients - Reporting Measure MICAHQN Overall UCL LCL 62
63 Median Time 250 OP18c - Median Time from ED Arrival to ED Departure for Discharged ED Patients - Psychiatric/Mental Health Patients MICAHQN Overall UCL LCL 63
64 Median Time 250 OP18d - Median Time from ED Arrival to ED Departure for Discharged ED Patients - Transfer Patients MICAHQN Overall UCL LCL 64
65 Median Time 30 OP20 - Door to Diagnostic Evaluation by a Qualified Medical Professional MICAHQN Overall UCL LCL 65
66 OP-18a: Median Time from ED Arrival to ED Departure for Discharged ED Patients - Overall Hospital Q MICAHQN (126 minutes) 66
67 OP-18b: Median Time from ED Arrival to ED Departure for Discharged ED Patients - Reporting Measure Hospital Q Q CAH National (105 minutes) Q Q National (134 minutes) Q MICAHQN (116 minutes) Q Q CAH 90th Percentile National (78 minutes) Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 67
68 OP-18c: Median Time from ED Arrival to ED Departure for Discharged ED Patients - Psychiatric/Mental Health Patients Hospital Q MICAHQN (191 minutes) 68
69 OP-18d: Median Time from ED Arrival to ED Departure for Discharged ED Patients - Transfer Patients Hospital Q MICAHQN (216 minutes) 69
70 OP-20: Door to Diagnostic Evaluation by a Qualified Medical Professional Hospital Q Q CAH National (16 minutes) Q Q National (19 minutes) Q MICAHQN (14 minutes) Q Q CAH 90th Percentile National (7 minutes) 70
71 IP Emergency Department - 4Q17 Admit Decision Time to ED Departure Time for Admitted Patients - Psychiatric/Mental Health Patients Admit Decision Time to ED Departure Time for Admitted Patients - Reporting Measure Admit Decision Time to ED Departure Time for Admitted Patients - Overall Rate Median Time from ED Arrival to ED Departure for Admitted ED Patients - Psychiatric/Mental Health Patients Median Time from ED Arrival to ED Departure for Admitted ED Patients - Reporting Measure Median Time from ED Arrival to ED Departure for Admitted ED Patients - Overall Rate Rural Only Values CAH Only Values MICAHQN Values Median Time 71
72 Median Time 260 ED-1a - Median Time from ED Arrival to ED Departure for Admitted ED Patients - Overall Rate Q17 2Q17 3Q17 4Q17 CAH Only Rural Only MICAHQN 72
73 Median Time 260 ED-1b - Median Time from ED Arrival to ED Departure for Admitted ED Patients - Reporting Measure Q17 2Q17 3Q17 4Q17 CAH Only Rural Only MICAHQN 73
74 Median Time 300 ED-1c - Median Time from ED Arrival to ED Departure for Admitted ED Patients - Psychiatric/Mental Health Patients Q17 2Q17 3Q17 4Q17 CAH Only Rural Only MICAHQN 74
75 Median Time 180 ED-2a - Admit Decision Time to ED Departure Time for Admitted Patients - Overall Rate Q17 2Q17 3Q17 4Q17 CAH Only Rural Only MICAHQN 75
76 Median Time 180 ED-2b - Admit Decision Time to ED Departure Time for Admitted Patients - Reporting Measure Q17 2Q17 3Q17 4Q17 CAH Only Rural Only MICAHQN 76
77 Median Time 250 ED-2c - Admit Decision Time to ED Departure Time for Admitted Patients - Psychiatric/Mental Health Patients Q17 2Q17 3Q17 4Q17 CAH Only Rural Only MICAHQN 77
78 ED-1a: Median Time from ED Arrival to ED Departure for Admitted ED Patients - Overall Rate Hospital Q MICAHQN (231 minutes) 78
79 ED-1b: Median Time from ED Arrival to ED Departure for Admitted ED Patients - Reporting Measure Hospital Q Q CAH National (189 minutes) Q Q National (253 minutes) Q MICAHQN (231 minutes) Q Q CAH 90th Percentile National (110 minutes) Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 79
80 ED-1c: Median Time from ED Arrival to ED Departure for Admitted ED Patients - Psychiatric/Mental Health Patients Hospital Q MICAHQN (239 minutes) 80
81 ED-2a: Admit Decision Time to ED Departure Time for Admitted Patients - Overall Rate Hospital Q MICAHQN (148 minutes) 81
82 ED-2b: Admit Decision Time to ED Departure Time for Admitted Patients - Reporting Measure Hospital Q Q CAH National (44 minutes) Q Q National (85 minutes) Q MICAHQN (148 minutes) Q Q CAH 90th Percentile National (6 minutes) Source for National CAH, National CAH 90 th Percentile, and National performances: Telligen Reports 82
83 ED-2c: Admit Decision Time to ED Departure Time for Admitted Patients - Psychiatric/Mental Health Patients Hospital Q MICAHQN (148 minutes) 83
84 Thank you! Joshua Salander, MBA, PMP Consultant (989)
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