Page 19 - Hoag Orthopedic Institute 2017 Outcomes Report

“HOI IS AMONG THE TOP TWO PERCENT OF U.S. HOSPITALS EARNING “HOI IS AMONG 2.2 PERCENT OF U.S. HOSPITALS EARNING MEDICARE’S MEDICARE’S FIRST-TIME, 5-STAR QUALITY RATING. WE DID THIS BY 5-STAR RATING BY EXCELLING AT 64 MEASURES IMPACTING OUTCOMES.” EXCELLING AT PERFORMANCE MEASURES IMPACTING OUTCOMES.”
CARLOS A. PRIETTO, MD; INTERIM CHIEF EXECUTIVE OFFICER CARLOS A. PRIETTO, MD; INTERIM CHIEF EXECUTIVE OFFICER
Under the Affordable Care Act (ACA), CMS has set up several voluntary and mandatory payment incentive programs to link the Medicare payment system to a value-based system that improves health care quality.
HOSPITAL VALUE BASED PURCHASING (VBP) PROGRAM – SECTION 3001(A), AFFORDABLE CARE ACT
Mandatory – Started FY 2013
• Pay for performance program to incentivize hospitals based on improvement or success of patient safety, outcomes, patient satisfaction and Medicare spending per bene ciary.
• Hold providers accountable for quality of care based on a withhold/payback structure.
• Payment withholding began at 1% in FY 2013, increased to 2% in FY 2017. Reimbursement to hospitals is based on performance.
• HOI received VBP incentive payment in all years the organization participated.
HOSPITAL-ACQUIRED CONDITIONS REDUCTION PROGRAM – SECTION 3008, AFFORDABLE CARE ACT
Mandatory – Started FY 2015
• Reduce payment to hospitals that rank among the lowest-performing 25%.
• Penalty based on performance in two domains: patient safety and hospital-acquired infections.
• HOI has not incurred payment reduction due to hospital-acquired conditions.
COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL – SECTION 3021, AFFORDABLE CARE ACT
Mandatory – Started April 2016
• Mandatory bundled payment with up to 3% episode discount for lower extremity joint replacement procedures in 67 selected areas.
• Episode-based payment initiatives to encourage providers to work together to improve the quality and coordination of care from the inpatient hospitalization through 90-days post discharge.
• Hospital may enter into nancial agreements to share downside risk and/or upside rewards.
HOSPITAL READMISSION REDUCTION PROGRAM – SECTION 3025, AFFORDABLE CARE ACT
Mandatory – Started FY 2013
• Reduce up to 3% hospital inpatient Medicare payment to hospitals with excess readmission.
• Based on 30-day all cause unplanned risk standardized readmission measures: Acute Myocardial Infarction (AMI), Chronic Obstructive Pulmonary Disease (COPD), Heart Failure (HF), Pneumonia, Coronary Artery Bypass Graft (CABG) Surgery, Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA).
• HOI has one of the lowest readmission rates in the nation.
HOI’s outcomes are superior as validated by agencies designated by CMS. In those validation audits, the HOI team scored 100%.**
**In 2015, two validation audits showed that HOI was accurately submitting quality indicators to CMS. HOI’s Infection Prevention data went through California Department of Public Health (CDPH) data validation for hip Surgical Site Infection (SSI). HOI quality data went through a validation audit for same day surgery quality indicators. HOI’s overall reliability rate was at 100%.
2017 OUTCOMES REPORT | 14