The Local Health Performance Incentive Program: Year 3. Office of Public Health Practice

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1 The Local Health Performance Incentive Program: Year 3 Office of Public Health Practice

2 Background & General Program Overview Christopher Davis, PhD Office of Public Health Practice

3 3 Background In 2012 NYS amended Article 6 of Public Health Law Included the creation of the statewide performance based incentive program Allows DOH to set performance standards for core public health services $1 million appropriated for incentive awards

4 4 Year 1 Performance Incentive Year 1 focused on General Communicable Disease Timeliness of reports Completeness of reports Goal was to impact public health by ensuring public health investigations were complete and conducted ASAP Designed to only award a handful of top performing counties Every county greatly surpassed expectations Decided to award all counties, with amount of awards varying by population size. Lowest scoring county was 98%.

5 5 Year 2 In Year 2, DOH chose to focus on Sexually Transmitted Disease (STD) measures Adequate Treatment of Gonorrhea Completeness of Electronic Syphilis Serology Registry Continuation of Year 1 Communicable Disease Measures» Sustain performance results achieved in Designed to award a handful of counties Results greatly exceeded expectations once again Awarded 93% of counties

6 Each year DOH program focus area provided local training and Technical assistance For Year 1 and 2 LHD Training & Technical Assistance Live webinar w/archive One-to-One Training & T.A. provided by BSTDPE Monthly summary tables posted to Health Commerce System LHD-specific line-listed CDESS data Resources: FAQ document, e-syphilis Serology Manual, STD clinical consultation Plan to offer similar assistance for year 3. 6

7 7 Year 3 Two Parts Environmental Health (EH) In conjunction with 2015 ipad/tablet distribution, move LHDs toward electronic inspection submittals to improve the timeliness, completeness, and data quality of inspection submittals. STD Maintain efforts to ensure that syphilis serology reports are complete and that gonorrhea is treated as per CDC guidelines.

8 8 Participation Full-service LHDs that deliver EH services must participate in both parts of the incentive program to be eligible to receive award. LHDs that do not deliver EH services can compete for portion of awards to support performance on STD measures.

9 9 Measurement Three key measures Proportion of EH inspections submitted electronically Proportion of adequately treated gonorrhea cases Proportion of syphilis investigations with a complete E-Syphilis serology record

10 10 Scoring NYSDOH will use proportion of EH inspections submitted electronically and reports that meet or exceed minimum goals in each STD performance area and enter data into weighted formula, as follows: County Goal Achievement Score=[54*(proportion of EH eforms submittals)+12*(proportion of gonorrhea cases receiving adequate treatment)+6*(proportion of syphilis serology record meeting completeness goal//72*100%

11 11 Award Eligibility Counties Providing EH Services Each LHD will get base award according to when they started using electronic inspection technology. Each LHD that then meets minimum performance goals will be eligible for additional award, based on burden of active operations. Counties without EH Services LHD meeting minimum performance goals will be eligible for additional award, based on population size.

12 12 Performance Awards for EH LHDs Annual Active Operations Number of LHDs in Size Group Number of Awards Available Amount ($) of Each Award Total $ Amount < , , < , ,000 > , ,000

13 13 Performance Awards for LHDs without EH Population Group Number of LHDs in Size Group Number of Awards Available Amount ($) of Each Award Total $ Amount <75, ,000 75,000 75, , ,000

14 14 Year 3 Timeline Activity Nov 2015 Dec Jan 2016 Feb Mar Apr May June July Aug Sep Launch Initiative X Performance Period X X X X X X X Data analyzed and award formula applied Results announced at NYSACHO meeting X X X X

15 15 Environmental Health Claudine Jones Rafferty Division of Environmental Health Protection

16 16 Environmental Health Incentive Focus Submittal of electronic inspection reports (eforms) for EH regulatory inspection and protection programs Goal Maximize the proportion of eforms submitted to ehips Counties must exceed baseline to be eligible for performance award

17 17 Environmental Health Awards 3 Levels of Base Financial Awards: Early Adopters Phase 1 Implementation (2013) Emerging Users Phase 2 Implementation (2014) New Users All Other LHDs

18 18 Environmental Health Awards Early Adopters Phase 1 Implementation (2013) Voluntary Participation LHDs Provided Own Equipment Nine (9) LHDs Initially Indicated Interest

19 19 Environmental Health Awards Emerging Users Phase 2 Implementation (2014) Voluntary Participation LHDs Provided Own Equipment Broader LHD Participation & Use of eforms

20 20 Environmental Health Awards New Users DOH Survey of Interested LHDs DOH Encouraged Participation DOH Purchase of Equipment for LHDs All LHDs Indicate Interest in eforms Implementation

21 21 EH Base Financial Awards LHD User Category Participation Level Base Award Amount Phase 1 Early Adopter Phase 2 Emerging User Statewide New User eforms Used for 1/3 of Environmental Inspections Prior to 2014 eforms Use Initiated But in Lesser Quantities Prior to 2015 eforms Participation Indicated DOH (or LHD) Equipment $10, $3, $1,500.00

22 22 Environmental Health Incentive Overall Objectives Encourage and Incentivize LHDs to Use eforms for Inspection Submittals Improve Inspection Data Quality in ehips for Enhanced Regulatory Oversight Minimize LHD Burden of Data Entry and In-Office Time

23 23 Sexually Transmitted Disease Alison Muse Bureau of STD Prevention and Epidemiology

24 24 Sexually Transmitted Diseases Continue Year 2 Performance Measures Adequate Treatment of N. gonorrhoeae infections Completeness of Electronic Syphilis Serology Registry

25 Adequate Treatment of Gonorrhea 25 Presidential EO 13676: National Strategy to Combat Antibiotic Resistant Bacteria Delay emergence of cephalosporin-resistant N. gonorrhoeae Promote adherence to recommended treatment

26 CDC Updated Treatment Guidelines Uncomplicated Gonococcal Infections of Cervix, Urethra & Rectum Recommended Dual Therapy 26 Ceftriaxone 250 mg in a single IM dose PLUS Azithromycin 1 g orally in a single dose Administered together on the same day MMWR 2015;64 (No. RR-3):

27 27 CDC Updated Treatment Guidelines Uncomplicated Gonococcal Infections of Cervix, Urethra & Rectum Alternative # 1: Ceftriaxone unavailable Cefixime 400 mg in a single oral dose PLUS Azithromycin 1 g orally in a single dose Administered together on the same day MMWR 2015;64 (No. RR-3):

28 CDC Updated Treatment Guidelines Uncomplicated Gonococcal Infections of Cervix, Urethra & Rectum Alternative # 2: Cephalosporin-allergy Gemifloxacin 320 mg orally in a single dose PLUS Azithromycin 2 g orally in a single dose OR Gentamicin 240 mg IM single dose PLUS Azithromycin 2 g orally in a single dose 28 MMWR 2015;64 (No. RR 3):

29 Adequate Treatment of N. gonorrhoeae Denominator: All reported cases of gonorrhea Numerator: # reported cases meeting criteria for adequate treatment as follows: Treatment type & dosage for each of two antibiotics Antibiotics reflect recommended dual regimen in 2015 CDC STD Treatment Guidelines A valid date of treatment for each antibiotic Same date of administration for each of 2 drugs * Based on documentation in CDESS supplemental 29

30 CDESS Supplemental Modifications Provider and patient factors influence treatment and may be beyond LHD control. For example: Drug allergy Patient lost to follow up Non-NYS Provider i.e., no treatment information available CDESS supplemental has been amended to permit LHDs to document these extenuating circumstances Records excluded from performance measurement calculation

31 Completeness of E-Syphilis Serology Registry CDESS Module established in 2008 Centralized repository Patient-specific history of syphilis testing & treatment, regardless of case definition status Allows LHDs to view and transfer records across jurisdictions Promotes security of patient information Increases timeliness of investigation 31

32 Completeness of E-Syphilis Serology Registry Denominator: Numerator: All ECLRS lab results for syphilis, includes cases and non-cases # ECLRS lab results transferred to a syphilis serology record AND complete data for the following fields:» Specimen collection date» Laboratory analysis date» Test type and results for non-treponemal and treponemal tests» Specimen source» Accession number/reporting laboratory * Based on documentation in CDESS supplemental 32

33 33 Goals for STD Ensure that 85% of gonorrhea cases will be adequately treated according to CDC guidelines Ensure that 90% of syphilis investigations will have a complete serology record Counties must meet or exceed both of these goals to be eligible for a performance award

34 STD Performance Indicator Adequate Treatment of Gonorrhea 1 Completeness of e- Syphilis Serology Registry Year 3 Performance Indicator Goal 85% 90% Year 2 PI Baseline 79% 99% # LHDs >= Baseline Same day treatment with Ceftriaxone and Azithromycin 34

35 Resources CDESS CDESS Help LHD Performance Page Performance incentive proposal, FAQs, Reports Archived Webinar on Syphilis Serology Registry 3ec647d146de87ece6cb7789cdc Submit Questions/TA Requests to: 35

36 FAQ and Question & Answer Session

37 ehips Data Submittals Question 1. What constitutes a manual entry? 2. If an eform is used to submit an initial inspection report, and the LHD modifies or updates the inspection entry, manually, in ehips, does that change the submittal to be recorded as a manual entry? Response 1. Manual Entry means the service was keyed in by person (i.e., manually). 2. No. Any service initially submitted via either an eform or Scannable Form cannot be classified as a manual entry, even if the record is subsequently updated manually.

38 ehips Data Submittals Question 3. Are entries for complaint investigations, which are performed manually in ehips, being counted as manual entries? Response 3. No. The only service types being included in the counts for the Year 3 Incentive include: inspection, reinspection and pre-operational inspection. Field visit, HACCP, sanitary survey complaint, incident or illness investigation are not included or counted as service types.

39 ehips Data Submittals Question 4. Water program staff may occasionally enter field services at a regulated facility, if it relates to the water supply operation; will those services be counted as a manual entry for this incentive program? Response 4. It may depend on the service types being entered by your water program staff. The counted service types (i.e., inspection, reinspection and preoperational inspection) are not routinely used by the water program.

40 ehips Data Submittals Question 5. When will the eform be available for the Healthy Neighborhood Program (HNP)? 6. What happens if the eform for HNP is not made available during the incentive period? Response 5. An eform for the HNP is being developed and is targeted to be available in January In this case, no HNP eform submittals will be counted under the incentive.

41 ehips Data Submittals Question 8. How will the HNP eform submittals be counted, once the form becomes available? 9. What if I have any further questions about eforms or the Environmental Health portion of the incentive? Response 8. Any eform submittals for HNP services performed during the incentive period will be counted and included in the final count of all eform submittals. 9. Questions relating to eforms or the EH incentive should be submitted to: ehips@health.ny.gov

42 Additional Questions? 42