Medicaid Quality Incentive
Web Conference
June 3, 2013
Washington State Hospital Association
1
Presenters
Carol Wagner, RN
Senior Vice President, Patient Safety
Washington State Hospital Association
Washington State Hospital Association
Daniel Lessler, MD
Chief Medical Officer
Washington State Health Care Authority
Thank You
• Vision and drive for quality incentive
Rep. Eileen Cody
Washington State Hospital Association
Today’s Presentation
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History of the Medicaid Quality Incentive
July 1, 2013 program and timeline
Purpose and goals
Measures
Factors to consider
Additional resources
Questions
Washington State Hospital Association
History
• First Medicaid Quality Incentive was passed by
the Washington State Legislature in 2010
• Among the first in the country
• Tied to the Hospital Safety Net Assessment
• Significant quality improvements occurred
• 90 percent of eligible hospitals earned
an incentive payment
Washington State Hospital Association
5
Medicaid Quality Incentive
July 1, 2013
• The program is included in the Hospital Safety
Net Assessment legislation
Expected to Pass as Part of the Budget
Washington State Hospital Association
Timeline
July 1, 2013 - December 31, 2013
Hospitals collect performance data
(Work force flu immunization October 1, 2013 to March 31, 2014)
April 2014
Chief Financial Officer attestation
May 2014
HCA determines which hospitals qualify for payment
July 2014
Qualifying hospitals receive incentive payment
Washington State Hospital Association
Guiding Principles
• Measures must be:
Evidence based
Consistent with national measures where possible
• Methodology for earning incentives:
 Recognize some measures may not be appropriate to
specialty, pediatric, psychiatric, or rehabilitation hospitals
 Represent real improvement in quality
 Designed so hospitals can earn incentive payments if
performance is at or above the benchmark
 Consistent with areas Washington hospitals are working on
Washington State Hospital Association
Process for Selecting Measures
Clinical experts from hospitals provided
guidance for measure development
Improvement and sustaining measures
Moving safety and quality forward while sustaining gains of
first incentive program while also
Final selection by HCA in collaboration with
WSHA, clinical experts, and payors
Washington State Hospital Association
Payment Increases
• One percent inpatient Medicaid increase for
non-critical access hospitals
• Acute general and pediatric hospitals
Receive increase across services based on overall
hospital performance
• Behavioral health hospitals and units
Increase based on behavioral health measures
Washington State Hospital Association
Funding for Incentives
• The money comes from savings to the
program as match rates improve with federal
ACA enrollment.
• Will only be paid if there are sufficient funds
to pay for it — we expect there will be.
Washington State Hospital Association
Funding for Incentives
• Quality incentive provided to all qualifying
Washington hospitals
• No partial increases
Hospitals receive either zero or one percent
increase
Washington State Hospital Association
Selected Measures
Acute, Rehabilitation, and Pediatric Services
Infection Prevention
Improvement Measure: Catheter AssociatedUrinary Tract Infection Per Patient Day
(Hospital-wide)
Sustaining Measure: Health Care Personnel
(HCP) Influenza Vaccination Rate
Washington State Hospital Association
Selected Measures
Acute, Rehabilitation, and Pediatric Services
ER is for Emergencies
(Adult and pediatric hospitals with emergency rooms only)
Improvement Measure: Percent of Patients (all
payors) with Five or More Visits to Emergency
Room with Care Plans
Washington State Hospital Association
Selected Measures
Acute, Rehabilitation, and Pediatric Services
Safety
Improvement Measure: Falls with Injury Per
Patient Day
Washington State Hospital Association
Selected Measures
Acute, Rehabilitation, and Pediatric Services
Readmissions
Improvement Measure: Reducing Readmissions
Rates
Washington State Hospital Association
Selected Measures
Acute, Rehabilitation, and Pediatric Services
Safe Deliveries: Induction Appropriateness and Elective
Deliveries Prior to 39 Weeks
(Applies to hospitals with obstetrical programs only)
Improvement Measure: Percent of Patients Undergoing
Labor Induction with Documentation of Consent,
Bishop Score, and Indication
Sustaining Measure: Percent of Patients with Elective
Deliveries 37 to Less than 39 Weeks Gestational Age
Washington State Hospital Association
Selected Measures:
Behavioral Health Services
Improvement Measure: Percent Patients Post-Discharge
Continuing Care Plan Transmitted
Sustaining Measures:
• Health Care Personnel (HCP) Influenza Vaccination
Rate
• Percent of Patients Discharged on Multiple
Antipsychotic Medications with Appropriate
Justification
Washington State Hospital Association
Incentive Payments
• All non-Critical Access Hospitals have the
opportunity to earn the one percent incentive based
on their results
• Critical Access Hospitals are welcomed and
encouraged to participate in improvement efforts,
but cannot receive incentive payments
Hospitals with ten points in all eligible measures will be recognized.
Includes critical and non-critical access hospitals.
Washington State Hospital Association
Incentive Methodology
• Current results used to set improvement goals
 For sustaining measures, hospital data were arrayed in
quartiles based on prior performance
• Points awarded for each quartile
 For each measure, hospitals can earn 10, 5, 3, or 0 points
 Points averaged across all applicable measures
• Hospitals receiving an average score of 5 or above
receive the increase
Washington State Hospital Association
Methodology Example
The quartiles were then reviewed for:
• Patient Safety
• Appropriateness
Washington State Hospital Association
Medicaid Quality Incentive Thresholds
Measure
CA-UTI ICU
CA-UTI Non-ICU
Healthcare Personnel
Influenza Vaccination
Threshold
Points
>11.8
0
11.8-6.2
3
6.1-1.5
5
<1.5
10
>3.5
0
3.5-1.1
3
1.0-0.1
5
<0.1
10
<85%
0
85-89.4%
3
89.5-93%
5
>93%
10
Washington State Hospital Association
Medicaid Quality Incentive Thresholds
Measure
ER is for Emergencies
Falls with Injury
Induction Appropriateness
Threshold
Points
<1%
0
1-4.9%
3
5-9.9%
5
>9.9%
10
>1.5
0
1.5-0.85
3
0.84-0.70
5
<0.70
10
<60%
0
60-71%
3
72-84%
5
>84%
10
Washington State Hospital Association
Medicaid Quality Incentive Thresholds
Measure
Elective Delivery 37 to 39
Weeks
Behavioral Health: Post
Discharge Continuing Care
Plan Transmitted
Behavioral Health:
Justification on
Antipsychotic Medications
Threshold
Points
>2%
0
2-1.1%
3
1-0.1%
5
<0.1%
10
<60%
0
60-69.9%
3
70-79.9%
5
>80%
10
<85%
0
85-89%
3
90-94%
5
>94%
10
Washington State Hospital Association
Earning the Incentive
• Patient days should match those submitted in
financials
• Reporting begins July 1, 2013, regardless of
when Legislature passes budget
WSHA is here to help!
Washington State Hospital Association
Additional Resources
• WSHA webpage with definitions,
methodology, and tools to help make
successful
• Safe Tables to share best practices
http://www.wsha.org/qualityincentive.cfm
For official documents:
See website. Items on this web conference may change.
Washington State Hospital Association
Additional Training in June
Upcoming Events:
• June 4 Safe Deliveries Safe Table
• June 19 Reducing Infections
Measurement Details Web Conferences:
• Web conference in June (date to be determined)
Washington State Hospital Association
Safe Tables
Safe Table Participation:
• Sharing best practices
• Learn together
Washington State Hospital Association
Public/Private Collaboration
Thanks to the Medicaid Quality Incentive Advisory Group
David Fisher, MD
Seattle Children’s
Karen Geheb, MD
Pullman Regional (Critical Access Hospital)
Thuy Hua-Ly
Health Care Authority
Daniel Lessler, MD
Health Care Authority
MaryAnne Lindeblad, RN
Health Care Authority
Michael Owens, MD
Molina Healthcare of Washington
Gene Peterson, MD
University of Washington Health System
Claudia Sanders
Washington State Hospital Association
Larry Schecter, MD
Providence Health & Services
Carol Wagner, RN
Washington State Hospital Association
And the many expert advisors
Washington State Hospital Association
Questions?
Dr. Daniel Lessler - Daniel.Lessler@hca.wa.gov
Carol Wagner, RN - CarolW@wsha.org
Washington State Hospital Association