Utilizing CASPER Reports to Succeed in a Value Based Purchasing Environment: Focus on Immunizations

Transcription

1 Utilizing CASPER Reports to Succeed in a Value Based Purchasing Environment: Focus on Immunizations PRESENTER: Diane Link, RN, MHA BlackTree Healthcare Consulting March 21, 2017

2 Welcome and Reminders Welcome! Q & As at end of presentation *2 to mute your line; *2 to unmute Utilize chat for questions and sharing 2

3 futu Utilizing Home Health CASPER Data: Improving Outcomes for Immunizations March 2017

4 Learning Outcomes Identify data sources available to identify immunizations Identify why immunization important Identify immunization requirements and related OASIS questions Identify process improvement areas to improve immunization outcomes 4

5 CASPER Reports: Overview

6 Accessing Casper Reports Access: CMS OASIS QIES System Welcome Page Click CASPER Reporting Enter Log In CASPER Topics Page Toolbar: Reports 6

7 Accessing CASPER Reports 7

8 CASPER Report Options

9 9

10 Why Is Immunization Important?

11 Healthy People 2020 Influenza immunization to >18 years Target = 70% ( % over %) Influenza immunizations to all eligible healthcare personnel Target 90% ( %) Pneumococcal immunizations to all eligible persons Target 90% ( %) Shingles immunizations for adults Target = 30% ( %) 11

12 Immunization Rates Impact Outcomes Functional Outcomes Improvement breathing Rehospitalization Rates Emergency Room Utilization 12

13 Quality Reporting Five Star Ratings Currently influenza received during flu season is reported 1/19/17 MLN Connect Provider call presented proposal to remove influenza from 5 star rating and replace with ED use without hospitalization. Announcement is expected 3/17 on Open Door Call Value Based Purchasing Influenza vaccine received during current flu season Pneumococcal vaccine ever received 13

14 Understanding the OASIS Immunization Requirements

15 M1041 and M1046 Influenza 15

16 M1041 Influenza M1041 A care episode is one that includes both SOC/ROC and Transfer/Discharge. Therefore when completing this item at transfer or discharge only look back to the most recent SOC or ROC to determine if the patient was receiving services between Oct and March 31 DATA sources Clinical record Interview 16

17 M1046 Influenza M if YOUR agency provided the influenza vaccine during this episode of care 2 if your agency provided the flu vaccine for this year s flu season prior to this home health episode, (example if SOC/ROC for this episode is in January but your agency provided the vaccine for this flu season during a previous home health episode in October. You can also respond 2 if your agency provided the flu vaccine during a roster billing situation (flu clinic that your agency sponsored) 3 If the patient or caregiver reports (or documents available) that the patient received the influenza vaccine for this season was provided prior to October 1 4 if the patient and/or healthcare proxy refused the vaccine Option 4 is only if patient was offered the vaccine and he/she refused 17

18 M1046 Influenza M if influenza vaccine is contraindicated for medical reasons 6 if age/condition guidelines indicate that influenza vaccine is not indicated for this patient. Severe, life threatening allergies to flu vaccine History of Guillan Barre Syndrome Egg allergies only if severe then should be given in medical center 7 CDC declared shortage of vaccine 8 patient did not receive vaccine due to reason other than 4 7 including if the assessing clinician is unable to determine whether the patient received the vaccine 18

19 M1051 Pneumococcal Vaccine Identifies whether patient EVER received pneumococcal vaccination Response 0 if patient has never received the vaccine or if assessing clinician is unable to determine whether the patient has ever received the vaccine. DATA Sources: Clinical Record Interview patient/caregivers 19

20 M1056 Pneumococcal Vaccine Explains why the patient has never received the pneumococcal vaccination 1 patient/healthcare proxy refused the vaccine 2 Pneumococcal vaccine administration is medically contraindicated for this patient including anaphylactic hypersensitivity, acute febrile illness, bone marrow transplant past 12 months or receiving chemotherapy and/or radiation therapy past 2 weeks 3 CDC age/condition guidelines is not indicated (severe allergies vaccine and any diphtheria toxoid vaccine 4 If agency did not provide the vaccine due to reason other than response 1 3 including situations where the assessing clinician is unable to determine 20

21 Herpes Zoster Shingles Vaccination (VBP) Required to collect data on beneficiaries aged 60+ At HH SOC how many Medicare beneficiaries report ever receiving the shingles vaccine? Of those who at SOC report to have NEVER received the shingles vaccine: Offered the vaccine by HHA prior to HH discharge, transfer or death Received the vaccine from HHA prior to HH discharge, transfer or death Received the vaccine from another provider prior to HH discharge, transfer or death Contraindications Declined vaccine due to allergy Declined vaccine due to compromised immune system (HIV, cancer tx) Declined the vaccine due to additional medical illness or contraindication Reasons for Declining the vaccine: Decline due to the following: Religious beliefs, financial reason, lack of access to vaccine, no reason provided, other reason indicated list below 21

22 Performance Improvement Project: How To Get Started 22

23 Developing a PIP Team Members Executive Sponsor QA representative Clinical leadership representative Clinical nurse Clinical therapist One additional clinical or nonclinical member Ad Lib members Selection Criteria to Consider Commitment to PIP Open minded Communication skills Out of the box thinking Informal leader 23

24 Develop Charter 24

25 Brainstorming Identify perceived clinician barriers: To data collection To documentation Other Identify perceived patient barriers: To responding to questions To receiving immunizations 25

26 Cause and Effect Diagram Identify perceived patient barriers to receiving immunization Cost Not covered Myths Access to Doesn t matter I am allergic I got sick anyway I don t need it Make me sick MD didn t have transportation Poor Outcomes 26

27 Next Step Collect data on reason for not receiving immunization by type of immunization OASIS data Interview of staff Interview of patients Research CDC website Advisory Committee on Immunization Practices Resources State Health and Human Services Analyze Data 27

28 Barriers to Immunization: Fact vs Myth It s all in the communication 28

29 Influenza Immunization Influenza is not a serious illness/not worth the risk People age 65 and older at high risk of flu related complications 70 to 85% of seasonal flu related deaths occur in people over % of seasonal flu related hospitalizations (65+) I don t like the side effects from the flu shots Mild side effects include soreness, tenderness or redness at injection site Mild headache, muscle aches, fever and nausea may occur All of these are temporary (hours to few days) influenza is much worst including high fever, cough, sore throat, body aches, headaches that can last up to 3 weeks. I got the flu last year after getting the shot Flu vaccine is only effective against influenza not other viruses You may have been pre exposed to influenza Some times you may still get the flu but it will be a milder case 29

30 Pneumococcal Immunization I feel healthy and I never get sick CDC recommends all adults 65+ or those under 64 with increased risk Studies show that 75% of pneumococcal disease are prevented by the vaccine I have XYZ disease now and I can t handle thinking about other things Pneumococcal pneumonia kills about 1 in 20 people who get it Pneumococcal bacteremia and meningitis kills about 1 in 6 who get it I have XYZ respiratory problem and this might make it worse Adults with chronic conditions(lung disease and DM) are at increased risk for developing complications from pneumococcal disease. Safe for all adults except those with allergic reactions in the past to vaccine or immunosuppressed It cost too much Medicare part B covers 100% 30

31 Shingles I don t need it 1 in 3 people 60+ get shingles with 1 in 6 having severe pain (post herpetic neuralgia) vaccine reduces risk by 67% People 60+ should get shingles vaccination whether or not they recall having chickenpox (99% of Americans aged 40+ have had the chickenpox) Shingles can lead to other complications involving the eyes or more rare pneumonia, hearing problems, blindness, brain inflammation and death Zostavax (shingles vaccine) reduced risk of shingles by 51% I had shingles already Even if you already had shingles the vaccine may prevent future occurrences of the disease It cost to much Medicare Part D may have a copay depending on your plan Not covered by Part B Most Private health insurance cover the price 31

32 Implementation 32

33 Tips to Improve Immunization Rates Key Words Develop script for staff to use in response to denial reasons Discuss link between immunization and other functional outcomes Provide printed education materials Use CDC website as resource Start education for influenza season early Staff immunization Executive support Serve patients that are vulnerable Healthcare providers at higher risk for flu Transmit by contact actually contagious one day prior to symptoms Provide free flu shots Cost savings over days missed work Have process in place for patient protection if not receiving vaccine 33

34 Resources Center for Disease Control and Prevention Association for Professionals in Infection Control and Epidemiology Healthy People Immunization Action Coalition HHQI Home Health Quality Insights Immunization & Infection Prevention 2015 Update 34

35 Questions? Diane Link RN, MHA Director Clinical Services (610) ext 775 Cell (443)

36 Questions and Discussion Questions for our speaker Via phone or chat *2 to mute your line; *2 to unmute 36

37 Nursing Contact Hour Evaluation will be sent via to all attendees (SurveyMonkey) Certificates will be ed within 3 5 business days 37

38 Next Learning Opportunity Tuesday, April 18, :00 4:00 p.m. CT Utilizing Your CASPER Reports in the QAPI Process: Focus Acute Care Hospitalization Register here: 67e16354e43755e940f 38

39 Contact Information Paula Sitzman, RN, BSN Sally May, RN, BSN, CH GCN Quality Improvement Advisor Senior Quality Improvement Specialist a.hcqis.org a.hcqis.org CIMRO of Nebraska Quality Health Associates of North Dakota 1200 Libra Drive, Suite North Broadway Lincoln, Nebraska Minot, ND P: 402/ , Ext. 512 P: 701/ This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11S0W GPQIN ND HHIP 07/