Hospital Transformation Performance Program (HTPP): SBIRT Measure Overview

Transcription

1 Hospital Transformation Performance Program (HTPP): SBIRT Measure Overview Screening, Brief Intervention, and Referral to Treatment (SBIRT) in the Emergency Department (ED) Sara Kleinschmit, MSc: OHA Policy Analyst Michael Oyster, LPC, CADC III: OHA SBIRT Coordinator 15 November 2016 Background HTPP is an incentive measure program for DRG hospitals in Oregon Mandated by Oregon s 2013 HB 2216 (Years 1 2) and 2015 HB 2395 (Years 3 6) Established Hospital Performance Metrics Advisory Committee (analogous to CCO Metrics & Scoring Committee) 28 participating hospitals Subject to CMS approval through OHA s 1115 Medicaid waiver 1

2 Timing, Years 1 3 Initially approved by CMS for two years CMS approved a one year extension for Year 3 Year 1: Oct 2013 Sep 2014 Report published and payments distributed April 2015 Year 2: Oct 2014 Sep 2015 Payments distributed and report published June 2016 Year 3: Oct 2015 Sep 2016 Payments and report due June 2017 Timing, Years 4+ Oregon legislature approved Years 3 6; CMS approved Year 3, but must separately approve Years 4 6 Included in OHA s 1115 Demonstration renewal OHA currently in discussions with CMS regarding years 4 6 Current measurement year (Year 4) is Oct 2016 Sep

3 Funding Funding is provided by the Hospital Provider Assessment In first two years, equal to 1% of federal financial participation (capped at $150 million per year) In subsequent years, equal to 0.5% of federal financial participation, per Oregon HB 2395 (estimated to be $80 $100 million) Incentive Payments Payments contingent upon meeting benchmarks or improvement targets Hospitals achieving 75% of the measures for which they are eligible receive a floor payment of $500,000 The remaining funds are distributed based upon performance on individual measures Payments to individual hospitals weighted by proportion of Medicaid patients and days 3

4 Hospital Performance Metrics Advisory Committee Charged with identifying measures and targets Initial list of measures had to be approved by CMS Should align with goals of Health System Transformation and CCOs Performance Metrics.aspx Hospital Metrics Technical Advisory Group (H TAG) A work group of the Hospital Performance Metrics Advisory Committee Charged with developing recommendations for operationalizing and implementing the hospital incentive measures that are part of the HTPP Venue to update hospitals on the program Meets via webinar the second Tuesday of every month, from 10am 12pm Metrics Technical Advisory Group.aspx 4

5 HTPP Years 1 3 Measures Measures Eligible for Payment 1. Hospital Wide All Cause Readmissions (NQF 1789) 2. Hypoglycemia in inpatients receiving insulin 3. Excessive anticoagulation with Warfarin 4. Adverse Drug Events due to opioids 5. HCAHPS, Staff always explained medicines (NQF 0166) 6. HCAHPS, Staff gave patient discharge information (NQF 0166) 7. CLABSI in all tracked units (NQF 0139) 8. CAUTI in all tracked units (NQF 00754) 9. Emergency Department Information Exchange (EDIE) 10. Follow up after hospitalization for mental illness (adapted from NQF 0576) 11. Screening for alcohol and drug misuse, brief intervention, and referral to treatment (SBIRT) in the emergency department 9 HTPP SBIRT Measure The ED can be an effective place to screen and refer patients for substance use services One study found that 26% of patients screened in the ED exceeded the low risk limits set by the National Institute of Alcohol Abuse and Alcoholism 1 1 Academic ED SBIRT Research Collaborative. The Impact of Screening, brief intervention and referral for treatment (SBIRT) on Emergency Department patients alcohol use. Annals of Emergency Medicine. 2007; 50: emergency alcohol.pdf. 5

6 SBIRT in the ED overview The measure has two parts: 1. Screening rate Hospitals currently submit data for either the brief screen or the full screen There are separate benchmarks for each screening type (brief versus full screen) 2. Brief intervention rate Not publically reported in Year 1 or 2 reports Will be publically reported in Year 3 report Only Part 1, Screening rate, has a benchmark / improvement target that must be achieved to qualify for payment 11 SBIRT in the ED equations Brief Screening = Full Screening = Patients in the ED age 12+ screened for alcohol and other substance use using an age appropriate, OHA approved brief screening tool **All emergency department patients age 12+** Patients in the ED age 12+ screened for alcohol and other substance use using an age appropriate, OHA approved full screening tool **All emergency department patients age 12+** 12 6

7 SBIRT in the ED equations (2) Part 2, Brief intervention rate (no benchmark) = ED patients age 12+ who received a brief intervention ED patients age 12+ who screen positive for unhealthy alcohol or drug use on full screen seen in ED SBIRT Flow and Reporting SBIRT Flow: Reporting Example 75 receive a brief screen (busy day, didn t get to everyone) 50 screen positive on brief screen 48 receive a full screen (again, busy, don t get to all) 25 screen positive on full screen 15 receive brief intervention (again, busy, don t get to all) 14 7

8 Experience SBIRT Flow and Reporting (2) Reporting 100 seen in ED Screen denominator (BOTH types) 75 receive a brief screen Brief screen numerator 50 screen positive on brief screen 48 receive a full screen Full screen numerator 25 screen positive on full screen Brief intervention denominator 15 receive brief intervention Brief intervention numerator Screening (brief): 75/100 = 75.0% Screening (full): 48/100 = 48.0% Brief Intervention: 15/25 = 60.0% 15 SBIRT: Long-Term Vision Where we are Hospitals report and are held accountable for benchmarks on either the brief or the full screen AND Report on the brief intervention (no benchmark) Hospitals are creating new workflows, documentation modules, and improving processes over time Future Vision Process where all hospitals will be required to report on full SBIRT process This would begin with a requirement to report on both screening rates (brief and full) using OHA-approved tools for both screens Benchmark likely to move to a composite which incorporates performance on both rates Reporting on the brief intervention would continue 16 8

9 SBIRT: Long-Term Vision How Get There Working closely with OAHHS and H-TAG Updating our documentation to make sure it is appropriate / applicable for use in emergency department settings Creating SBIRT ED Toolkit (updated, ED specific metric documentation) Working with OAHHS on additional education / technical assistance 17 Michael Oyster, LPC, CADC III Licensed Professional Counselor (LPC) Certified Alcohol & Drug Counselor (CADC III) Over 20 years in community mental health and substance abuse treatment services More recently focusing on Collaboration between Patient-Center Primary Care Homes and community behavioral health providers Assisting in establishing referral procedures from medical settings to detox and residential treatment Assisting in establishing referral processes from substance abuse treatment to psychiatric hospitalization 9

10 OHA Approved Screening Tools To receive credit for the HTPP metric, OHAapproved screening tools must be used for both the brief and the full screens List of OHA-AMH approved screening tools available at: Contact Michael to submit a new tool for OHA review (Michael.W.Oyster@state.or.us) Adolescent Screening The SBIRT metric is for those age 12+ Screening for adolescents brings special considerations Ensuring confidentiality Using appropriate screening tool (more on next slide) Brief education / conversation with all 10

11 Adolescent Screening (2) Considerations: Ensure that an age appropriate screening tool is used Appropriateness / need for a brief screen? I.e., if using CRAFFT, can a separate brief screen still be used, or should that step be skipped in all instances? Age to move from CRAFFT (adolescent tool) to adult tool, like AUDIT or CAGE? Adolescent Screening counting for purposes of metric Since there isn t a separate brief screen for adolescents, and hospitals currently only report either the brief or full screening rates Hospitals are allowed to count the CRAFFT in the numerator for either the brief or the full screen In future years (when hospitals report on entire SBIRT process), OHA will issue guidance on where to count the CRAFFT within the continuum of the SBIRT process This will be after consulting further with the H-TAG and partners 11

12 Newly Approved Adolescent Screening Tools Two new adolescent screening tools have been added to the approved list for the OHA SBIRT metrics CRAFFT 2.0 (see Note the original CRAFFT remains on the list of approved screening tools; hospitals are not required to move to the CRAFFT 2.0 to receive credit for the measure Screening to Brief Intervention (S2BI) (see pdf) Like the CRAFFT, hospitals will be allowed to count the S2BI as either a brief or full screen in HTPP Year 4 HTPP SBIRT Billing The HTPP metric is NOT claims based (hospitals report directly from EMR, etc.) However, hospitals can still bill for some SBIRT services, depending upon the payer 12

13 Qualifications Licensed Providers Physicians Physician Assistants Under general supervision, auxiliary providers (incident-to) Nurse Practitioners Licensed Psychologists Licensed Clinical Social Workers Students: Medical, physician assistant, nursing; addictions, counseling, social work, psychology Medical Assistants MAs Nurses Registered Nurses Health Educators Wellness Coaches Certified Alcohol & Drug Counselors CADCs Qualified Mental Health Professionals & Assistants QMHPs QMHAs HTPP Resources (1) Program Structure, measure specifications, technical guidance documents Baseline Data.aspx OHA approved SBIRT screening tools tools.aspx Year 2 Performance Report Committee information, Charter, Bylaws Performance Metrics.aspx 13

14 HTPP Resources (2) Questions regarding the metric OHA support on SBIRT process Michael Oyster: ~Michael is available to work with hospitals regarding best practice, reviewing your process flows, SBIRT specific training, etc.~ Questions? 28 14