Value-based Purchasing
Jude Odu
Senior Business Analyst, Health Care DataWorks
Detlev “Herb” Smaltz, PhD
Co-Founder & CEO, Health Care DataWorks
September 27, 2012
Speaker
Jude Odu
• Senior Business Analyst and Healthcare Subject Matter Expert
at Health Care DataWorks
• Former Supervisor for Clinical Analytics and Decision Support,
University Hospitals Case Medical Center, a multi-hospital
health system in Northeast Ohio
• 14+ years in long-term care, in acute care, and on
the payer side
• Instructor in healthcare informatics at
Ursuline College
• Master’s degree in Health Science, The George
Washington University
Speaker
Detlev H. (Herb) Smaltz, Ph.D., FHIMSS, FACHE
• Co-Chairman and CEO, Health Care DataWorks
• 21+ years experience in healthcare management
• Former CIO of The Ohio State University Wexner Medical
Center
• Fellow of the Healthcare Information & Management
Systems Society (FHIMSS)
• HIMSS Board of Directors (2002-2005) and Vice
Chair (2004-2005)
• Fellow in the American College of Healthcare
Executives (FACHE)
• Bachelor’s degree in MIS, University of Tampa,
MBA, The Ohio State University, and Ph.D.
in Information & Management Science,
Florida State University
Today’s Webinar
• Value-based Purchasing (VBP)
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What is it?
Who came up with it?
When does it happen?
Who does it affect?
Why should I care?
How do I recover reimbursements withheld through
this program?
WHAT IS VBP?
VBP Final Rule
• VBP was established by the Affordable Care Act of
2010 (ACA)
• Budget neutral payment changes begin October 1,
2012
– Reduce base operating payments for each discharge by
Year
Payment
Reduction
2013
2014
2015
2016
2017
1%
1.25%
1.5%
1.75%
2%
• Rewards for achievement or improvement
6
VBP Measures – FY 2013
Core Measures or Clinical Process of Care
Acute Myocardial Infarction
Fibrinolytic Therapy Received within 30 mins of Hospital Arrival
Primary PCl Received within 90 mins of Hospital Arrival
Congestive Heart Failure
Discharge instructions received
Pneumonia
Initial antibiotic selection for CAP in Immunocompetent patients
HCAHPS
Blood cultures before first antibiotic in ED
Healthcare Associated Infection (SCIP)
Patient Experience
Nurse Communication
Doctor Communication
Hospital Staff Responsiveness
Pain Management/Control
Medication Communication
Hospital Cleanliness and Quietness
Discharge Information
Overall Hospital Rating
Prophylactic antibiotic given 1 hour prior to incision
Appropriate antibiotic selection for Surgical Patients
Prophylactic antibiotic discontinued within 24 hours of surgery
Cardiac patients with Controlled 6 a.m. Postop. Serum Glucose
Surgical Infection Indicators
Beta blocker prior to admission and periop
Recommended VTE Prophylaxis ordered
Appropriate VTE Prophylaxis timing
2 Ways to Earn-Back
Improvement
Hospital Performance
Standards
Baseline: Hospital
performance for all 20 metrics
during the Baseline Period
Performance: Hospital
performance for all 20 metrics
during the Performance
Period
8
Timeline
Final Payment
Adjuster Delivered
Hospitals will be informed of
VBP payment at least 60 days in
advance of the payment year
Estimated Payment
Adjuster Delivered
Aug Nov
2009
July
2010
March
FY 2013 Baseline Period
2011
July
2012
2013
March
FY 2013 Performance Period
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2 Ways to Earn Back
Improvement
Hospital Performance
Standards
Baseline: Hospital
performance for all 20 metrics
during the Baseline Period
Performance: Hospital
performance for all 20 metrics
during the Performance
Period
or
Achievement
CMS Performance
Standards
Benchmark: Mean of
top decile performance
(95th percentile)
nationally
Threshold: 50th
percentile performance
nationally
Floor (HCAHPS only!):
Minimum performance
nationally
10
WHAT DOES VBP MEAN FOR
ME?
The Questions
• Do you know your VBP score?
• Do you know how much is projected to be
withheld?
• Can you get to the data to understand your
score?
• Can you pinpoint which measure is costing you
most?
• Can you build a plan to improve your score?
• How can you maximize your earnback?
The People
• Financial Management
– Wants to earn back the money
CMS withheld
• Quality & Clinical
Management
– Needs to understand VBP
scores
– Take action to improve
processes that target nurses,
doctors, housekeeping staff,
nursing units, etc.
The Challenges
• Hospitals and their technology solutions have
evolved as siloed point solutions
The Challenges
• Data, systems and technologies are virtually
everywhere with limited commonality in
format and accessibility
The Challenges
• So you can’t get the information you need when
you need it!
The Opportunity
• Get as much money back as
possible
• Improve hospital performance
across measured areas
HOW DO I MANAGE THIS?
Common Approaches
Hospitals vary in their approach:
• Implement stand-alone solution
• Retain consulting firms
• Manage compliance manually
• Figure it out later
There’s a Better Way
• Unified VBP Application
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Automate the collection of all data required
View the organization across all 20 measures
Evaluate root cause of positive or negative results
Calculate how score improvements increase reimbursements
Typical Health System
Thousands of hours of manual labor
Nursing ICU
ED
CBO
Surgery
VBP
Dashboard Dashboard DashboardDashboardDashboard Dashboard
Manual &
Semi-Manual
Departmental Analytics
Initiatives
DM
Lawson
Essbase
Diver
Hyperion
TSI
Premier
Kronos
Reports
Access
Dashboards
Cerner
Insight
Lab
Cerner
Cerner
Cognos Invision SignatureExploring Surgery
Crimson Compass
Ad hoc Ad hoc
eClinical
Morrissey
Invision
Signature
Vision
ERP
VisionW
Surgery
Prism
Analytics at Many Hospitals
and Health Systems
Transactional Systems
Islands of Data
End User Reporting
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External Systems
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Unified Analytics via an EDW
Internal
Systems
Transformation and Mapping
EDW
SOA/We
b
Services
GL
PA
HR
Cntrct
EMR
Time
SIS
PM
Cost
Clinical Trial
Screening
Multi-Dimensional
Analysis & Data Mining
Revenue
Cleanse
Validate
Standardize
Transform
Aggregate
Geo Code
Data Profile
Data Model
Meta Data
Load
Ad-hoc Query
Rejection
Encounter
Pt Sat
Text Mining, NLP
Meds
Lab
Orders
SIS
Census
Error
s
End User Reporting
Unified data
Model
Web Scorecards
& Dashboards
De-identified Data
Readmits
W
Benchmarking
Registries
External Systems
Predictive Modeling
Research
META DATA
DATA GOVERNANCE
Additional Value
Effective VBP management will lead to positive
change:
• Improve the quality of patient care as a
result of operational enhancements
– Increase management visibility
– Increase accountability across the organization
– Decrease workforce burden
• Estimate and manage financial
implications
Takeaways/Summary
• The CMS VBP program is here and will
continue to evolve
• A portion of your CMS reimbursements will be
withheld starting Oct. 1 and will increase
through 2017
• In the absence of a unified solution, managing
VBP will require heavy lifting
Questions?
Herb Smaltz, Ph.D., FHIMSS, FACHE
877 979 4239
herb.smaltz@hcdataworks.com