Maternity Multi‐Stakeholder Action Collaborative Session 7 ... · PERINATAL Q1 + Q2 2016 DISCLAIMER: The information contained in these reports is intended solely for use in the

Maternity Multi‐Stakeholder Action Collaborative Session 7:

Data Sharing and Infrastructure

Table of Contents

U.S. Women’s Health Alliance Presentation ......................................................................................... 3

Sample Provider Reports ................................................................................................................... 46

Ohio Department of Medicaid, Payment Innovation ............................................................................. 47

Tennessee Health Care Innovation Initiative .......................................................................................... 51

New York Delivery System Reform Incentive Payment Program ........................................................... 57

Guide for Interpreting Arkansas’ Episode of Care Report .................................................................... 58

Community Health Choice Provider Submitted Quality Data Spreadsheets ........................................ 63

Quality Data Collection Template ........................................................................................................... 64

Example Maternity Scorecards ............................................................................................................... 65

U.S. Women’s Health Alliance Presentation

INTRODUCTION: USWHA MATERNITY EOC

Jack Feltz, MD

March 10, 1876

Alexander Graham Bell

Better, More Affordable Care for Women

Lower Cost for Health Plans & Employers

Fulfilled and Thriving Providers

USWHA National Maternity Episode of Care

USWHA Maternity Episode of Care Smart

Not so Smart

Easy to Use Hard to Use

Success through

Simplicity

Achieving the Quadruple Aim

Triple Aim + All Stakeholders Thriving in a New Healthcare Environment

WHY?

Medical Errors are 3RD most common

cause of death

Medical Error 251K

Although considered mainly as problems of the developing world, maternal mortality and morbidity remain a challenge in the United States of America (USA).1 Between 1990 and 2013, the maternal mortality ratio for the USA more than doubled from an estimated 12 to 28 maternal deaths per 100,000 births1 and the country has now a higher ratio than those reported for most high-income countries. About half of all maternal deaths in the USA are preventable. Each year an estimated 1,200 women in the USA suffer complications during pregnancy or childbirth that prove fatal and 60,000 suffer complications that are near-fatal – even though costs of maternity care in the USA in 2012 exceeded 60 billion United States dollars.

Three factors are probably contributing to the upward trend in maternal mortality and morbidity in the USA. First, there is inconsistent obstetric practice. Hospitals across the USA lack a standard approach to managing obstetric emergencies and the complications of pregnancy and childbirth are often identified too late. Nationally endorsed plans to manage obstetric emergencies and updated training and guidance on implementing these plans is a serious and ongoing need. A second factor is the increasing number of women who present at antenatal clinics with chronic conditions, such as hypertension, diabetes and obesity, which contribute to pregnancy-related complications. Many of these women could benefit from the closer coordination of antenatal and primary care – including case management and other community-based services that help them access care and overcome cost and other obstacles. In the USA, women who lack health insurance are three to four times more likely to die of pregnancy-related complications than their insured counterparts

Another factor is the general lack of good data – and related analysis – on maternal health outcomes. Only half the USA’s states have maternal mortality review boards and the data that are collected are not systematically used to guide changes that could reduce maternal mortality and morbidity. There is no national forum for the states to share either their best practices for reviewing maternal deaths or the relevant lessons that they may have learned. There is a growing effort by physicians, nurses and community organizations to address these three factors. Hospitals are beginning to implement standard approaches to managing obstetric emergencies so that, wherever a woman gives birth, she receives appropriate evidence-based care. Community initiatives are coordinating care for high-risk women to ensure good health and management of chronic conditions during and beyond pregnancy. More states are establishing or strengthening maternal mortality review boards.

Although maternal mortality is relatively rare in the USA, one preventable maternal death is one too many. All states need to mobilize health providers, policy-makers and communities to make maternal health a priority. With increased awareness of maternal mortality and life-threatening events – and concrete actions to ensure that pregnant women get the quality care they need – many fatal and near-fatal complications could be prevented.

PROJECT DESIGN

Jack Feltz, MD

An Episode of Care is a value-based model designed to engage specialists

PROJECT COMPONENTS

Project Components

Episode Design

Episode Contracting

Member Readiness

Data Analytics

Medical Policy &

Guidelines

Project Leadership & Design

Project Coordination

EPISODE DESIGN

Lili Brillstein, MPH

Mark Cone, MD Jack Feltz, MD

Mission To create a Maternity

Episode of Care model design that can used by USWHA partners in their

respective markets, in collaboration with payers

and other stakeholders, that will reward excellent outcomes, patient

experience, and most efficient cost of care.

Episodes of Care

23

Value-based model designed to engage specialists.

Full SPECTRUM of services related to and delivered for a specific medical condition, illness, procedure or health care event during a defined time period. Coordination, communication, collaboration across the continuum.

Pre-Trigger Services e.g., labs, radiology

Trigger Event/Diagnosis e.g., delivery/pregnancy

Post-trigger services

e.g., postpartum visits, hospital

Readmission, extended use of opioids

Day 1 Last Day

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwirj5fq2ufSAhUk04MKHTtlBT4QjRwIBw&url=https://clipartfest.com/categories/view/0e4a56fcc6ff52fffe481c5f4ab096b0df0cef7c/arms-clipart.html&bvm=bv.150120842,d.amc&psig=AFQjCNGmyz7gYsU940WhMGOk3FFFo6Lixw&ust=1490189535986437

Keys to Success

• Partnership & Collaboration at Every Level – Defining episode construct, intent, launch – Establishing metrics – Creating workable model – Fluidity, Willingness to change

• Simplicity • Respect

– Physicians are the clinical experts in charge of the care – Providers make clinical care decisions – Payers track and share data – Payers help identify opportunities

• Patient is center stage

How to Make It Work

• Be open to the possibilities • Work to Build Trust/Share Information • Communicate and collaborate regularly • Be flexible, willing to make changes • Know that it won't be perfect • Follow USWHA established guidelines

Guidelines Make the Model Work

Success occurs when data is shared and studied between payer and providers, and clinical partners use the information to develop guidelines for optimizing care, which they then communicate and enforce in their practice.

MEDICAL POLICY AND GUIDELINES

Genevieve Fairbrother, MD Rhona Magaril, MD

Medical Guidelines & EOC: What’s the Advantage

Value = quality/cost

• Consistent high quality care • Predictable and affordable costs • Data analytics • Guidelines insure we can reach the quality metric goal

and success in EOC

Guideline Development Process • Task force: diverse group of volunteer alliance members • Topics:

– Standard testing – High risk conditions

• Sources: – ACOG practice bulletins – ACOG committee opinions – Journal review articles

• Review process: – Committee members assigned to topic – Reviewed sample guideline documents – Edited documents – Presented to committee for approval

Medical Guidelines Committee Report

• Five Primary Categories Addressed by Task Force: 1. Laboratory: agreeing on a basic set of intake labs 2. Hospital Stays: based on uncomplicated PP course, learning from

Members what the usual SOC is. 3. Pharmacy: provide recommendation of OTC and prescription PNV based

on committee’s experience 4. Guidelines: creating guidelines for high risk conditions 5. Induction & Labor Management: share and review protocols from

hospitals to produce a consensus • Categories 1 – 3 are completed

– Recommendation for Standard Laboratory Testing • Category 4 completed in draft (8 high-risk conditions) • Return on Investment

– Consensus among a diverse group of providers – Maternity Episode of Care ready to launch

High Risk Guideline Topics

1. Hypertensive Diseases in Pregnancy 2. Diabetes in Pregnancy 3. Pre-Term Labor, Pre-Term, Premature Rupture of

Membranes 4. Multiple Gestation 5. Advanced Maternal Age 6. History of Thromboembolic Phenomenon or

Hypercoaguable States 7. Obesity 8. Abnormal Placentation

UTILIZATION OF GUIDELINES

Utilization of Guidelines

• Distribute document to providers • Embed document in EHR for ease of use • Guideline specific order sets (ensure consistent high

quality care that produces reproducible results) • Consider online course on management of high risk

conditions (e.g. Gnosis)

Guidelines to Improve Data Collection

• Guidelines recommend documentation in EHR • Order sets allow collection of recommended laboratory

and imaging testing • Data collection by the provider important for adjudication

with data collected by insurance companies

EPISODE CONTRACTING

Mark Cone, MD

Jack Feltz, MD

Elements of the Contract

• Purpose / Mission • Definitions • Analytics • Quality Metrics • Shared Savings • Contract Term • Budget • Episode Type

MEMBER READINESS

Jack Feltz, MD Heather Schueppert

Member Readiness • Define eligible groups • Meet with participating groups • Establish team roles within group

– Project leader – Project coordinator – Medical leader – IT leader

• Track data – Claims data – Quality data – Physician performance data

• Define shared savings distributions in group • Group retreat to educate and prepare for launch

Member Readiness

• Host and promote regular webinars on changes and progress

• Continued USWHA support • Continued health plan support • Continued communication between Alliance

groups to share progress and experiences

CLOSING COMMENTS

Jack Feltz, MD

“It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most

adaptable to change.”

Charles Darwin 1809 - 1882

Sample Provider Reports

Quality metrics

HIV screening

GBS screening

C-section

Follow-up visit within 60 days

30%

60%

30%

70%

You achieved 3 of 4 quality metrics linked to gain sharing

Q4 ‘15 Q2 ‘16Q1 ‘16Q3 ‘15

Performance period 2016Reporting period 2015

Key performance

1315 13 15 28

51%55% 36% 5% 16%

Weightedaverage

$3,400$3,110

$2,696 $2,888$3,307

Avg adjusted episode spend

# of includedepisodes

Your spendpercentile

Rolling four quarters

Acceptable ($4,405)

Commendable ($3,169)

Gain Sharing Limit ($1,235)

Not acceptableAcceptableCommendable

You are here$2,888

Risk adjusted average spend per episodeDistribution of provider average episode spend (risk adj.)

Avg.

adj

. epi

sode

spe

nd ($

,000

) 7

6

5

4

3

2

1

0

Episodes included, excluded & adjusted

Total episodes: 40

Episodes 30% Excluded12

Episodes 70% Included28

of your episodes have been risk adjusted 71%

IncludedExcluded

You are currently not eligible for gain or risk-sharing because you have less than 5 episodes during this period. If you realize at least five episodes by the end of the performance period, you will be eligible. Eligibility requirements for gain or risk-sharing payments

This report is informational only. Eligibility for gain or risk-sharing will be determined at the end of the performance period and any applicable payments will be calculated at that time.i

Quality: You are not currently eligible for gain-sharing because you have not passed all quality metrics linked to gain-sharing.!

Spend: Your average risk-adjusted spend per episode is below the commendable threshold.

Episode volume: You have at least 5 episodes in the current performance period.

EPISODE of CARE PROVIDER REPORT PERINATAL Q1 + Q2 2016

DISCLAIMER: The information contained in these reports is intended solely for use in the administration of the Medicaid program. The data in the reports are neither intended nor suitable for other uses, including the selection of a health care provider. The figures in these reports are preliminary and are subject to revision. For more information, please visit http://medicaid.ohio.gov/Providers/PaymentInnovation.aspx.

PAYER: Ohio - Medicaid FFS PROVIDER: ABC Womens Health CenterPROVIDER ID: 0000000000

Reporting period covering episodes that ended between January 1, 2016 to June 30, 2016

Gain/risk sharing calculationGain / risk sharing component You Description

1. Total spend across included episodes

2. Total # of included episodes

3. Avg. episode spend (non adj.)

4. Risk adjustment ratio (avg.)

5. Average risk-adjusted spend per episode

Total of all associated claims submitted paid during this cycle, excluding medical education and capital portions of the hospital base rates

Net of episodes excluded for clinical or operational considerations

Average spend before risk adjustment; Equals line (1) divided by line (2)

Average adjustment to raw claims to account for clinical variability(set by payers)

Adjusted spend per episode; Equals line (3) multiplied by line (4)

$129,979

28

$4,642

0.6222

$2,888

1N/A6. Commendable spend threshold per episode Commendable threshold

9. Total spend eligible for gain sharing

10. Gain sharing proportion

Equals line (1) times line (8)

Proportion of spending eligible for gain you share in

7. Risk-adjusted spend per episode below threshold

8. Percentage of spend subject to gain sharing

The smaller of the difference between adjusted spend and commendable spend or adjusted spend and the gain sharing limit; equals line (6) minus line (5) or line (6) minus the gain sharing limit ($1,235)

Difference between adjusted spend and commendable spend aspercentage of adjusted spend; equals line (7) divided by line (5)

11. Total gain share Total gain-sharing payment; equals line (9) times line (10)

1N/A

1N/A

1N/A

1N/A

1N/A

Episodes

Your episode spend distribution (risk adjusted)

Episodes included: 28Each bar represents one episode

Your average$2,888

Not acceptableAcceptableCommendable

6

5

4

3

2

1

0

Ris

k-ad

just

ed e

piso

de s

pend

($,

000

)

PERINATAL Q1 + Q2 2015

EPISODE of CARE PROVIDER REPORT



2 / 4

1 Eligibility for gain or risk-sharing will be determined at the end of the performance period and any applicable payments will be calculated at that time.


Metrics for information only

Median 0%

You 0%Smoking cessation

% of episodes where smoking cessation counseling is provided during the episode

Median 58%

You 72%

You 18%

You 0%

Chest X-ray % of episodes where a chest x-ray is performed during the trigger window

Median 13%

You 4%Follow-up visit within 7 days

% of episodes where the patient receives an office or home consultation or preventative counseling within 7 days after the trigger acute exacerbation

Follow-up visit% of episodes where the patient receives an office or home consultation or preventative counseling with a physician during the post-trigger window

Asthma controller medication

% of episodes where the patient receives an appropriate medication determined by a filled prescription for an asthma controller medication during the episode window or within 30 days before the episode

Repeat acute exacerbations

% of episodes with a repeat acute exacerbation

Inpatient treatment

% of episodes where the trigger acute exacerbation is treated in an inpatient setting

Metrics linked to gain sharing

Quality and utilization metrics comparison to threshold and other providers

Median 17%

You 10%

Median 12%

Median 6%

Median 29%

You 30%

Threshold 26%

Threshold 28%

Metrics for information only

Median 47%

You 45%

Gestational diabetes screening

% of valid episodes where the patient receives a screening for gestational diabetes during the pre-trigger window

Median 50%

You 40%Chlamydia screening

% of valid episodes where the patient receives a screening for chlamydia during the pre-trigger window

Median 44%

You 40%Hepatitis B screening

% of valid episodes where the patient receives a screening for hepatitis B specific antigen during the pre-trigger window

Median 1.83

Ultrasound rate Average # of ultrasounds given by a PAP in the pre-trigger window of valid episodes

HIV screening % of valid episodes where the patient receives a screening for HIV during the pre-trigger window

GBS screening% of valid vaginal delivery episodes where the patient receives a screening for Group B streptococcus (GBS) during the pre-trigger window

C-section % of valid episodes where the patient receives a C-section during the episode window

Follow-up visit within 60 days

% of valid episodes where the patient receives a follow-up visit during the post-trigger window 1 or post-trigger window 2

You 1.80

Metrics linked to gain sharing

Quality and utilization metrics comparison to threshold and other providers

Median 63%

Median 65%

You 60%

You 70%

Median 29%

Median 40%

You 30%

Threshold 50%

Threshold 50%

Threshold 45%

Threshold 50%

You 30%






3 / 4

Episode spend breakdown by claim type (non risk adj.)

# of episodeswith spend in claim type % of episodes with spend in claim typeClaim type

Avg. spend per episode when claim type utilized

Episodes included: 28

Average $3,427

$2,262

Average 100%

100%Inpatient 28

$0

Average 0% Average $0

0%Long term care 0

Average $1,119

$650

Average 80%

82%Outpatient 23

Average $104

$100

Average 56%

71%Pharmacy 20

Average $1,536Average 100%

Professional 28 100% $1,775






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<episode algorithm version #>

State of Tennessee Health Care Innovation

Initiative

Illustrative Provider Report

Payer Name (TennCare/Commercial)Provider NameProvider Code

Preliminary draft of the provider report template for State of TN (for discussion only)All content/ numbers included in this report are purely illustrative

[Report Date][Report Period: Start/end dates of period]

$2,000

$4,000

$6,000

$8,000

$10,000

9. Total gain / risk share$81,783 Net proceeds to you above claims already paid

Not acceptable cost zone

[1. Perinatal] Overall Performance Summary

Episode of careQualitymetrics

ShareValue ($)

Gain/risk share eligibility

Perinatal[Start/end dates of period]

$81,7831.

Payer Name (TennCare/Commercial) | Provider Name | Provider Code

Period<current>

Period <current – 1>

Period <current – 2>

Period<current – 3>

Met 4,298 Gain SharingCommendable

Avg

. ris

k ad

j.

ep

iso

de

co

st (

$)

1

Average risk adj. episode cost ($)

5,334

6,5146,611

4,2985,000

7,443

Your cost performance over prior reporting periods

Commendable cost zone

Acceptable cost zone

Your cost performance

Preliminary draft of the provider report template for State of TN (for discussion only) | All content/ numbers included in this report are purely illustrative

Description of gain / risk sharing You Description

5. Avg. episode cost (risk adj.) $4,298Commendable

Adjusted cost per episode; Equals line (3) divided by line (4)

2. Total # of included episodes 233 Net of episodes excluded for clinical or operational considerations

3. Avg. episode cost (non adj.) $5,244 Raw claims average ; Equals line (1) divided by line (2)

4. Risk adjustment factor* (avg.) 1.22 Average adjustment to raw claims to account for clinical variability

1. Total cost across episodes $1,221,749 Total of all associated claims submitted and paid during this cycle

6. Versus: commendable cost $5,000 Commendable threshold

7. Total upside generated** $163,566

Total difference in adjusted cost vs. commendable cost; Equals difference between line (5) and line (6), then multiplied by total included episodes i.e. line (2)

8. Risk sharing factor 50% Portion of total upside to be shared with you

Payer Name (TennCare/ Commercial) Provider Name Provider Code Report Date: July 2013

*Risk adjustment factor calculated for select provider's patient base and rounded to the nearest hundredth** If the average episode cost (risk-adjusted) is below the gain sharing limit, then the gain sharing limit is substituted for the amount from line (5).

5. Avg. episode cost (risk adj.)

You are eligible for gain sharing

Episode cost summary

Overview

Cost of care (avg. adj. episode cost) comparison

1

2

3

[1. Perinatal] A. Episode Summary

182122

4337

64

28

$5500-$5999

$5000-$5499

$4500-$4999

$4000-$4499

Below$4000

80

60

40

20

Above $6500

$6000-$6499

Distribution of provider average episode cost (risk adj.)

Your episode cost distribution (risk adj.)

Total episodes: 262 Total episodes included: 233 Total episodes excluded: 29

Your average episode cost is commendable

YOUR GAIN/ RISK SHARE

# o

f e

pis

od

es

Avg

. ad

j. e

pis

od

e

cost

($

‘00

0)

Commendable Not acceptableAcceptable

> $4000

Tennessee providers

10

8

6

4

Not acceptableAcceptableCommendableYou

Less than $5,000 More than $7,443$5,000 to $7,443

Parameters YouProvider

base average

Episode quality and utilization summary4

You achieved selected quality metrics

1. HIV screening

2. Group B Strep screening

3. C-section rate

Quality metrics linked to gain sharing

YouGain share

standard

97%

90%

20%

+ $81,783Number of episodes

Sharefactor

Your avg. cost: $4,298 Providers’ base avg. cost: $5,444233 50%

Commendable cost ($)

Your avg. cost ($)

5,000 4,298

– x x

$4,298Commendable

$5,444Acceptable


2

1. Gestational DM screening

2. Bacteriuria screening

3. Hepatitis B screening

YouProvider

base averageQuality metrics not linked to gain sharing

56% 50%

90% 62%

58% 55%

1. Total cost across episodes

2. Total # of included episodes

3. Avg. episode cost (non adj.)

233 235

$5,244 $6,152

4. Risk adjustment factor* (avg.) 1.22 1.13

$1,221,749 $1,445,654

* Risk adjustment factor calculated for select provider’s patient base

Metstandard


4. Tdap vaccination rate 90% 62%

85%

85%

41%

Top 5 Prescribed Drugs, by spend

1. Prenatal Plus Tablet

2. Ibuprofen Tablet

3. Hydrocodone-Acetaminophen Tablet

4. Ferrous Sulfate Tablet

5. Zofran Tablet

$2,485

$1,259

$1,099

$1,039

$997

[1. Perinatal] B. Episode quality and utilization details

5025

Percentile (Quartile) of Providers

Quality metrics linked to gain sharing

HIV screening rate

0 10075

Your performance Minimum standard for gain sharing

Quality and utilization (metrics) comparison with provider base5

3

Percent of patients for whom HIV screening was conducted

Provider-base screening rate

Group B strep screening rate

C-section rate

Percent of patients for whom Group B strep screening was conducted

Percent of patients for whom C-Section was conducted

50% 99%

Quality metrics not linked to gain sharing

Asymptomatic bacteriuriascreening rate

Hepatitis Bscreening rate

Percent of patients for whom Asymptomatic bacteriuria screening was conducted

Percent of patients for whom Hepatitis B screening was conducted

Gestational diabetesscreening rate

Percent of patients for whom Gestational diabetes screening was conducted

62%43% 73%

55%41% 69%

50%42% 65%

You achieved selected quality metrics linked to gain sharing


(first) (second) (third) (fourth)

5025


0 10075(first) (second) (third) (fourth)

66%

97%

56%

–

–

+

+

+90%–

58%– +


Tdap vaccination rate

Percent of patients for whom Tdapvaccination was given

83%60% 93%

33%41% 21%

90%

–

–

–

+

+

+

+

+20%

–

–

85%

90%

85%

41%

55%41% 85%

– +90%

Your performance Provider base average


Pharmacy

Emergency department or observation


[1. Perinatal] C. Episode cost details

4

Outpatient lab

Outpatientradiology/ procedures

Inpatient professional

Inpatient facility

Outpatientfacility

Other

Total episodes included: 233

Outpatient Professional

5025


0 10075(first) (second) (third) (fourth)

% of episodes with claims in care category

Avg. adj. cost per episode when care category utilized# of episodes with claims in care category

195

11

90

220

215

220

233

0

210

< $125< $100 < $150

$120

$120

84%

82%

< $45< $25 < $65

5%

< $230< $200 < $260

$235

$230

39%

30%

< $195< $145 < $245

$190

$200

96%

84%

< $325< $275 < $375

$320

$330

94%

88%

< $1,000< $950 < $1,200

$960

$1,000

96%

91%

< $1,300< $1,200 < $1,650

$1,255

$1,315

100%

99%

$0$0 $0

0%

0%

< $190< $165 < $210

$170

$180

90%

88%

5%

0%

0%

$50

$50

Care category

Episode cost breakdown by care category (risk adj.)6

The Excel document contains detailed information for each patient

included in your episode results, such as:

- Provider

- Episode ID

- Patient Identifier

- Episode risk factor

- Cost information

- Quality metrics

5


[1. Perinatal] D. List of included episodes with cost and quality information

LINK TO LIST OF INCLUDED EPISODES

[1. Perinatal] E. List of excluded episodes

The Excel document contains detailed information for each

patient excluded from your episode results, such as:

- Episode ID

- Provider

- Patient Identifier

- Non-risk adjusted cost

- Reason for exclusion

LINK TO LIST OF EXCLUDED EPISODES

New York’s Delivery System Reform Incentive Payment (DSRIP) Program

New York’s DSRIP Public Facing Dashboards Webpage: https://dsripdashboards.health.ny.gov/ Tutorial: https://dsripdashboards.health.ny.gov/hopscotch.html

Guide for Interpreting Arkansas’ Episode of Care Report

Visit us online to login to the portal and access resources

Our website www.paymentinitiative.org has details on:

� Initiative background and leadership.

� Episode details, methodology, and links to resources.

� Where to direct your questions and how to share feedback.

� Upcoming events/additional resources, such as Town Halls and WebEx informational sessions.

The website also has a link to the online portal. Use a secure username and password to:

� View your full report.

� Submit additional data as required for your episodes.

The Arkansas Health Care Payment Improvement Initiative is a multi-payer collaboration between Arkansas Medicaid, Arkansas Blue Cross Blue Shield, and QualChoice of Arkansas. The initiative rewards providers for high-quality care to drive system-wide quality and efficien-cy. Periodically, each payer will provide a performance report with details on quality, cost, and utilization for episodes where you are designated as Principal Accountable Provider (PAP).

This brief guide explains how to read your report using an illustrative example and may help you

� Understand the cost and quality of care given to patients where you are the PAP. � Identify where there is potential for practice changes, care coordination, and documenting

best practices.

The guide assumes knowledge of the design of payment episodes. To find out more, please go to: www.paymentinitiative.org.

Look inside to learn more about:

Arkansas Health Care Payment Improvement InitiativeProvider Report

MedicaidReport date: July 2012

Historical performance: January 1, 2011 – December 31, 2011

Medicaid Little Rock Clinic 123456789 July 2012

Guide to Reading Your Report

Summary Quality detail Cost detailPerformance

summary Episode detail

Building a healthier future for all Arkansans

Summary – Perinatal

Quality summary

71268825

41

20

>$4500$3906-$4500

$3735-$3906

$3565-$3735

$3394-$3565

$3000$3394

$3000

6040

347,889

You (non- adjusted)

473,934

You(adjusted)

All providers

3,600

You

3,196

Cost summary

Your total cost overview, $

Distribution of provider average episode cost

Your episode cost distribution

Average cost overview, $

Chlamydia screening rate 90%

Group B strepscreening rate 87%

HIV screening rate 97%

Quality metrics – linked to gain sharing

Minimum quality requirement

All providers

11%17% 21

Key utilization metricsC-section rate Avg number of ED visits per episode

OverviewTotal episodes: 262 Total episodes included: 233 Total episodes excluded: 29

Does not meet minimum quality requirements

You met the minimum quality requirements Your average cost is commendable

Allproviders

You

Gain/Risk share

You are not eligible for gain sharing Quality requirements: Met Average episode cost: Acceptable

# ep

isod

esC

ost,

$

You All providers


> $4000$0

Hepatitis Bscreening rate 58%

Asymptomatic bacter-iuria screening rage 90%

Gestational diabetesscreening rate 56%

Quality metrics – not linked to gain sharing


84%

83%

66%

50%

62%

55%

Average cost of care compared to other providers


< $3000 > $4000$3000 to $4000

01000200030004000500060007000

Percentiles


$$

$$

$$

$$

Phar

mac

yC

ost

# cl

aim

s

Patie

nt

nam

eEp

isod

e ID

Mar

k S

mith

4578

61

Ali

Cru

ss65

722

Fran

kC

ole

4902

12

Mar

k S

mith

8219

20

Jude

Pau

l84

4563

Cra

ig

Han

sen

1244

45

Bill

W

ilson

1002

35

Mol

ly

Sm

ith83

2011

Jerr

y Fr

ank

3245

77

Tim

W

esto

n11

5320

Rah

ulP

awar

1124

47

Eile

en

Sim

ms

4500

21

Bill

W

ilson

7879

99

Will

Bra

dley

9002

91

Mat

t Ja

ckso

n66

6587

Non

-ad

just

ed

cost

Cos

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189

175

84

97

744

828

1,200

1,120

1,995

2,457

14,904

14,904

16,796

16,796

552,000

555,450

116,500

128,150

Cost detail – Perinatal

Carecategory

All providersYou

4%

3%

<1%

<1%

3%

5%

75%

78%

80%

75%

77%

79%

97%

95%

99%

99%

100%

100%

27

25

84

97

62

69

75

70

95

117

81

81

76

76

2,400

2,415

500

550


Total episodes included = 233

Inpatientprofessional

Inpatientfacility

Outpatientprofessional

Pharmacy

Outpatientlab

Outpatientradiology / procedures

Emergencydepartment

Outpatientsurgery

Other

233

230

221

184

21

16

12

1

7

# and % of episodes with claims in care category

Total cost in care category, $

Average cost per episode when care category utilized, $

Quality and utilization detail – Perinatal

5025Percentile

Metric

HIV screening rate


Chlamydia screening rate

You met the minimum quality requirements

Metric

C-section rate

% episodes with an ultrasound

5025

Percentile

Gestational diabetes screening rate

Asymptomatic bacteriuria screening rate

Hepatitis B screening rate

You

97%

87%

90%

56%

90%

58%

25th

50%

60%

63%

42%

43%

41%

50th

66%

83%

84%

50%

62%

55%

75th

99%

93%

87%

65%

73%

69%

Percentile

Percentile

Avg number of ED visits per episode

25th

23%

71%

1.7

50th

30%

75%

2.1

You

17%

78%

1.3

75th

40%

81%

5.1


0

0

100

100

75

75

Metric with a minimum quality requirementYou Minimum quality requirement

Quality metrics: Performance compared to provider distribution

Utilization metrics: Performance compared to provider distribution

-

-

-

-

--

Upper Respiratory Infection – PharyngitisQuality of service requirements: Not met

Upper Respiratory Infection – Sinusitis

Average episode cost: Commendable

Quality of service requirements: N/A

You are not eligible for gain sharing

Your gain/risk shareYou will receive gain sharing

Your gain/risk share

Upper Respiratory Infection – Non-specific URI

Average episode cost: Not acceptable


You are subject to risk sharing


Perinatal

Average episode cost: Acceptable

Quality of service requirements: Met

You will not receivegain or risk sharing



Attention Deficit/ Hyperactivity Disorder (ADHD)



You will not receive gain or risk sharing


$0

$x $0

$0

$x


Performance summary (Informational)


Quality summary

71268825

41

20

>$4500$3906-$4500

$3735-$3906

$3565-$3735

$3394-$3565

$3000$3394

$3000

6040

347,889

You (non- adjusted)

473,934

You(adjusted)

All providers

3,600

You

3,196

Cost summary










All providers

11%17% 21





Allproviders

You

Gain/Risk share


# ep

isod

esC

ost,

$

You All providers


> $4000$0






84%

83%

66%

50%

62%

55%



< $3000 > $4000$3000 to $4000

01000200030004000500060007000

Percentiles

Summary and Results: Example, Perinatal

Summary

1

2

3 4

1Overview

The overview indicates the total number of episodes you treated, and how many were included and excluded in your results.

� These are episodes completed during the period for which you are considered the PAP.

� Throughout the report, unless otherwise indicated, all results are based on the “total episodes included” number.

� An episode could be excluded for a number of reasons (e.g., extreme cost outlier or high risk patient).

Total episodes:262

Total episodes included:233

Total episodes excluded:29

2Average cost of care compared to other providers

The bar above shows the cost ranges for commendable, acceptable, and not acceptable costs.

� If your costs are considered not acceptable, you are subject to risk sharing.

� If you are in the acceptable range there is no gain or risk sharing.

� If your costs are within the commendable range, you are eligible for gain sharing as long as you meet required quality metrics.

How ranges/thresholds are set.

� Each payer sets thresholds independently using claims data for PAPs in that episode .

� The diamond represents your average cost; the triangle represents the overall average.

5


Quality summary

71268825

41

20

>$4500$3906-$4500

$3735-$3906

$3565-$3735

$3394-$3565

$3000$3394

$3000

6040

347,889

You (non- adjusted)

473,934

You(adjusted)

All providers

3,600

You

3,196

Cost summary










All providers

11%17% 21





Allproviders

You

Gain/Risk share


# ep

isod

esC

ost,

$

You All providers


> $4000$0






84%

83%

66%

50%

62%

55%



< $3000 > $4000$3000 to $4000

01000200030004000500060007000

Percentiles

Quality summary

The quality of service section gives you a more detailed picture of the quality metrics that go into your quality outcomes, and how you are performing relative to other PAPs in this episode.

� The metrics on the left side are numerically linked to gain sharing. The metrics on the right are currently informational.

� If the bars are blue, it indicates that you exceeded the minimum quality requirement. If the bars are red it indicates you did not meet the requirement

� The metrics are widely accepted clinical guidelines and are evidence based best practices.


Quality summary

71268825

41

20

>$4500$3906-$4500

$3735-$3906

$3565-$3735

$3394-$3565

$3000$3394

$3000

6040

347,889

You (non- adjusted)

473,934

You(adjusted)

All providers

3,600

You

3,196

Cost summary










All providers

11%17% 21





Allproviders

You

Gain/Risk share


# ep

isod

esC

ost,

$

You All providers


> $4000$0






84%

83%

66%

50%

62%

55%



< $3000 > $4000$3000 to $4000

01000200030004000500060007000

Percentiles


Quality summary

71268825

41

20

>$4500$3906-$4500

$3735-$3906

$3565-$3735

$3394-$3565

$3000$3394

$3000

6040

347,889

You (non- adjusted)

473,934

You(adjusted)

All providers

3,600

You

3,196

Cost summary










All providers

11%17% 21





Allproviders

You

Gain/Risk share


# ep

isod

esC

ost,

$

You All providers


> $4000$0






84%

83%

66%

50%

62%

55%



< $3000 > $4000$3000 to $4000

01000200030004000500060007000

Percentiles

3

Upper Respiratory Infection – PharyngitisQuality of service requirements: Not met

Upper Respiratory Infection – Sinusitis

Average episode cost: Commendable


You are not eligible for gain sharing

Your gain/risk shareYou will receive gain sharing


Upper Respiratory Infection – Non-specific URI

Average episode cost: Not acceptable


You are subject to risk sharing


Perinatal


Quality of service requirements: Met

You will not receivegain or risk sharing



Attention Deficit/ Hyperactivity Disorder (ADHD)



You will not receive gain or risk sharing


$0

$x $0

$0

$x


Performance summary (Informational)

5Key utilization statistics

The utilization statistics show you how many times you have performed certain activities and procedures relative to other PAPs.

� This may help you see where improvements could be made. It may also encourage you to identify other providers to see how they may have achieved better rates.

4Cost summaryThis section shows a breakdown of your cost performance. There will be a summary page for each episode for which you are the PAP.

� The blue bars on the top left show total costs for all included episodes compared to total costs for all included episodes after risk adjustments have been made.

� The blue bars on the top right show your average individual episode costs compared to all PAPs.

� The middle section shows how much the episodes you treated cost, on a range of low to high, and how many episodes were completed at that cost.

– This information may be helpful to you in trying to understand the source of the high costs.

– It may also help you identify the practices that led to lower cost episodes.

Your performance summary page includes data for all epi-sodes for which you are considered the PAP. In this exam-ple, the PAP has results for five different episode types.The results show whether you will receive gain sharing, no change to payment, or are subject to risk sharing.

Performance summary

Gain sharing: (Green) If your quality of service is above the minimum standard, and costs are lower than the commendable threshold (indicated with check marks) you are eligible for gain sharing.

No impact on payment: (Gray) If your costs are between commendable and acceptable, there is no gain or risk sharing.

Risk sharing: (Red) If your costs are higher than the acceptable threshold (regardless of whether the quality standard is met), you are subject to risk sharing.


Quality summary

71268825

41

20

>$4500$3906-$4500

$3735-$3906

$3565-$3735

$3394-$3565

$3000$3394

$3000

6040

347,889

You (non- adjusted)

473,934

You(adjusted)

All providers

3,600

You

3,196

Cost summary










All providers

11%17% 21





Allproviders

You

Gain/Risk share


# ep

isod

esC

ost,

$

You All providers


> $4000$0






84%

83%

66%

50%

62%

55%



< $3000 > $4000$3000 to $4000

01000200030004000500060007000

Percentiles


Quality summary

71268825

41

20

>$4500$3906-$4500

$3735-$3906

$3565-$3735

$3394-$3565

$3000$3394

$3000

6040

347,889

You (non- adjusted)

473,934

You(adjusted)

All providers

3,600

You

3,196

Cost summary










All providers

11%17% 21





Allproviders

You

Gain/Risk share


# ep

isod

esC

ost,

$

You All providers


> $4000$0






84%

83%

66%

50%

62%

55%



< $3000 > $4000$3000 to $4000

01000200030004000500060007000

Percentiles

Medicaid Little R

ock Clinic 123456789 July 2012

$ $ $ $ $ $ $ $

PharmacyCost# claims

Patient name

Episode ID

Mark Smith

457861

Ali Cruss

65722

FrankCole

490212

Mark Smith

821920

JudePaul

844563

Craig Hansen

124445

Bill Wilson

100235

Molly Smith

832011

Jerry Frank

324577

Tim Weston

115320

RahulPawar

112447

Eileen Simms

450021

Bill Wilson

787999

Will Bradley

900291

Matt Jackson

666587

Non-adjusted cost Cost

Episodestart date

Episodeend date

Inpatient facilityCost# claims

Entered clinical input

$ $01/13/13 02/01/13Y

$ $01/15/13 02/04/13Y

$ $02/19/13 03/09/13Y

$ $04/13/13 05/02/13Y

$ $04/21/13 05/11/13Y

$ $51/14/13 06/03/13Y

$ $05/14/13 06/03/13Y

$ $06/02/13 6/22/13N

$ $06/03/13 06/23/13Y

$ $06/07/13 06/27/13Y

$ $06/07/13 06/27/13Y

$ $06/07/13 06/27/13Y

$ $06/09/13 06/29/13Y

$ $06/10/13 06/30/13N

$ $06/10/13 06/30/13Y

Care categories with costs

Detailed episode cost information for Dr. Joe Smith

Inpatient professionalCost# claims

Outpatient professionalCost# claims

Outpatient surgeryCost# claims

Outpatient radiology / proceduresCost# claims

Outpatient labsCost# claims

Emergency departmentCost# claims

OtherCost# claims

#

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189

175

84

97

744

828

1,200

1,120

1,995

2,457

14,904

14,904

16,796

16,796

552,000

555,450

116,500

128,150

Cost detail – Perinatal

Carecategory

All providersYou

4%

3%

<1%

<1%

3%

5%

75%

78%

80%

75%

77%

79%

97%

95%

99%

99%

100%

100%

27

25

84

97

62

69

75

70

95

117

81

81

76

76

2,400

2,415

500

550


Total episodes included = 233

Inpatientprofessional

Inpatientfacility

Outpatientprofessional

Pharmacy

Outpatientlab

Outpatientradiology / procedures

Emergencydepartment

Outpatientsurgery

Other

233

230

221

184

21

16

12

1

7

# and % of episodes with claims in care category

Total cost in care category, $

Average cost per episode when care category utilized, $

Quality and utilization detail – Perinatal

5025Percentile

Metric

HIV screening rate


Chlamydia screening rate


Metric

C-section rate

% episodes with an ultrasound

5025

Percentile

Gestational diabetes screening rate

Asymptomatic bacteriuria screening rate

Hepatitis B screening rate

You

97%

87%

90%

56%

90%

58%

25th

50%

60%

63%

42%

43%

41%

50th

66%

83%

84%

50%

62%

55%

75th

99%

93%

87%

65%

73%

69%

Percentile

Percentile

Avg number of ED visits per episode

25th

23%

71%

1.7

50th

30%

75%

2.1

You

17%

78%

1.3

75th

40%

81%

5.1


0

0

100

100

75

75

Metric with a minimum quality requirementYou Minimum quality requirement

Quality metrics: Performance compared to provider distribution

Utilization metrics: Performance compared to provider distribution

-

-

-

-

--

Guide to Quality, Cost, and Episode Detail pages

Cost detail

Quality detail

Episode detail

Contact our knowledgeable provider support teams with questions and feedback

This page details your performance compared to both other providers and to the threshold required for gain sharing. The spectrum of red-gray-green repre-sents a range of results from lowest to highest quality. The diamond indicates your performance and the black line shows the minimum requirement. This information can help you identify areas for improvement or areas to continue best practices if you achieved high quality results.

� The blue shading indicates metrics required to be eligible for gain sharing; unshaded metrics are informational and may help you evaluate your practice.

Utilization rates do not currently affect eligibility for gain sharing, but may be useful in showing:

� How you are performing compared with other providers. � Where your practice patterns could be changed.

This page provides a detailed look at your costs and average costs of all providers. Care categories list all categories of service that make up an episode.

� The number of episodes refers to how many episodes included costs in this category.

� Average cost per category is shown per PAP and overall. This may indicate that other providers were able to achieve better results, or that your performance was strong and may be valuable to sustain.

� Total category cost shows your cost summary compared to overall costs among all PAPs.

This page has detailed information for each patient included in your results. This may help you understand what occurred for an individual patient’s episode(s) of care.

� The episode ID is a reference number. � The name is the name of the patient from claims data.

� The Y/N column indicates whether appropriate data was entered via the portal. It is n/a if data entry is not required.

� The cost information to the right is a detailed look at how much each component cost for that patient.

� Arkansas Medicaid:1-866-322-4696 (in-state) or 1-501-301-8311 (local and out-of state) or [email protected]. � Arkansas Blue Cross Blue Shield: Provider Line 1-800-827- 4814, direct line to EBI 1-888-800-3283 or

[email protected]. � QualChoice of Arkansas: 1-501-228-7111 or [email protected].


Community Health Choice Provider Submitted Quality Data Spreadsheets

Field Group Item # Category Measure set Data Field Format Member 1 Member 2 Member 31 Member ID Alphanumeric2 Member Last Name Alphanumeric3 Delivery Only Indicator Alphanumeric4 Newborn Gestational Age Numeric5 Newborn Weight Numeric

6 Pre-natal care Term and Pre Term Did the patient receive gestational diabetes pre-screening testing 1=YES; 0=NO; N/A7 Pre-natal care Term and Pre Term Date of Gestational Diabetes Screening MM/DD/YYYY

8 Pre-natal care Term and Pre TermDid patient participate in documented shared decision making discussion(s) 1=YES; 0=NO; N/A

9 Pre-natal care Term and Pre Term Date of shared decision making in patient record/patient refusal MM/DD/YYYY10 Pre-natal care Pre Term only Antenatal steroids 1=YES; 0=NO; N/A11 Delivery care Term only Was the delivery an elective delivery 1=YES; 0=NO; N/A12 Delivery care Term only Was the delivery a c-section 1=YES; 0=NO; N/A13 Delivery care Term only Was patient nulliparous 1=YES; 0=NO;14 Delivery care Term and Pre Term Intrapartum antibiotic prophylaxis For GBS 1=YES; 0=NO; N/A15 Delivery care Term and Pre Term Was an episiotomy performed 1=YES; 0=NO; N/A16 Post-Partum Care Term and Pre Term Post-Partum follow up visit 1=YES; 0=NO; 17 Post-Partum Care Term and PreTerm Date of post-partum visit MM/DD/YYYY18 Post-Partum care Term and Pre Term Blood Pressure Monitoring 1=YES; 0=NO; N/A19 Post-Partum care Term and Pre Term Date of Blood Pressure screening MM/DD/YYYY20 Post-Partum care Term and Pre Term Post partum glucose test for patients at risk 1=YES; 0=NO; N/A21 Post-Partum care Term and Pre Term Date of post partum glucose test MM/DD/YYYY22 Post-Partum care Term and Pre Term Depression Screening 1=YES; 0=NO; N/A23 Post-Partum care Term and Pre Term Date of Depression Screening MM/DD/YYYY24 Baby care Term Only Exclusively breast fed during hospital stay 1=YES; 0=NO; N/A25 Baby care Term and Pre Term Babies recceiving Hep B vac prior to discharge 1=YES; 0=NO; N/A26 Baby care Term and Pre Term Date of Hep B vac MM/DD/YYYY27 Baby care Term and Pre Term Baby discharge date MM/DD/YYYY28 Baby care Pre Term only Blood Stream Infection Prior to discharge 1=YES; 0=NO; N/A29 Baby care Pre Term only Baby - late sepsis or meningitis 1=YES; 0=NO; N/A30 Baby care Pre Term only Retinopathy of prematurity - screened 1=YES; 0=NO; N/A

Qua

lity

Scor

ecar

d M

easu

res

Community Health ChoiceExample Maternity Scorecare

Full Term Scores

Measure (244 patients) Domain Numerator DenominatoRatio ThresholdScorecard Points Score Numerator Description Denominator Description Score Calculation

Prenatal gestational diabetes screening Prenatal 5

Patient had a resulted procedure/test between 16-28 weeks gestation

All patients that were not delivery only (as submitted by provider)

Points awarded according to ratio (ratio x points)

Pre-natal shared decision making Prenatal 5Patient had a completed birth plan prior to delivery



% Elective deliveries Delivery 0.10 15

Patients with elective induction between 1 day prior to admit and delivery date and/or elective csection (not marked as "medical" reason)

Patients with newborn age >= 37 and < 39 weeks

Points awarded according to inverse of ratio (1-ratio) x points, on a scale within the threshold of 0% = 15 points and >10% = 0 points

Primary csection rate Delivery 0.18 13Nulliparous Patients with C-section delivery mode

Nulliparous Patients (those with first time pregnancies)


Patients receiving antibiotic prophylaxis during delivery encounter Delivery 5

Administration of IV antibiotic during the delivery encounter prior to delivery

Vaginal delivery Patients with positive or no result from most recent GBS lab test within 7 weeks prior to delivery


Obstetric trauma with instrument Delivery 0.10 5

Vaginal deliveries with instrument with OB trauma indicated

Vaginal deliveries with instrument


Obstetric trauma without instrument Delivery 0.10 7

Vaginal deliveries without instrument with OB trauma indicated

Vaginal deliveries without instrument


Vaginal deliveries with episiotomy Delivery 5

Patients with episiotomy procedure coded on hospital record

Vaginal deliveries (excluding those with shoulder dystocia coded on record)

Points awarded according to inverse of ratio (1-ratio) x points

Was there a post-partum visit Post-Partum

Patients with a post-partum visit between 1 day after discharge and 8 weeks postpartum All delivery patients


Post-Partum BP Monitoring Post-Partum 10

Outpatient blood pressure was recorded for the patient between 1 day after discharge and 8 weeks postpartum

All delivery patients; Note this may change to a base of patients with a recorded post-partum visit for Year 2


Post-Partum Depression Screening Post-Partum 5

Patients with a recorded score for postpatum screen on an outpatient visit that was recorded between 1 day after discharge and 8 weeks postpartum



Post-Partum fasting glucose testing Post-Partum 5

Patient had a resulted procedure recorded between 1 day after discharge and 8 weeks postpartum

Patients with a diagnosis of gestational diabetes documented between gestational age of 16 weeks and delivery date


Exclusively breastfed Newborn 10

Newborns that had no formula documented and that had breastmilk intake or time recorded

All newborns except with gestional age <37 weeks; stillborns; or multiple liveborn babies; or no flowsheets documented


Babies receiving Hep B Vaccine Newborn 10

Newborns with HEPB vaccine administered between birth date and disharge date

All newborns excluding stillborns


Total Score 100 0.0Total 244 0.0 0.748466258

82 0.251533742326

not collected/scored for Year 1; will add to year 2

Community Health ChoiceExample Maternity Scorecare

Preterm Scores

Measure (82 patients) Domain Numerator DenominatoRatio ThresholdScorecard Points Score Numerator Description Denominator Description Score Calculation

Prenatal gestational diabetes screening Prenatal 15

Patient had a resulted procedure/test between 16-28 weeks gestation

All patients that were not delivery only (as submitted by provider) and not <24 weeks gestional age


Pre-natal shared decision making Prenatal 5Patient had a completed birth plan pror to delivery



Antenatal steroids administered for at risk patients Prenatal

Patients with administration of steroids within 10 weeks prior to delivery date

Patients with newborn gestational age between >=24 weeks and <34 weeks


Patients receiving antibiotic prophylaxis during delivery encounter Delivery 20

Administration of IV antibiotic during the delivery encounter prior to delivery

Vaginal delivery Patients with positive or no result from most recent GBS lab test within 7 weeks prior to delivery


Obstetric trauma with instrument Delivery 0.10 10

Vaginal deliveries with instrument with OB trauma indicated

Vaginal deliveries with instrument


Obstetric trauma without instrument Delivery 0.10 5

Vaginal deliveries without instrument with OB trauma indicated

Vaginal deliveries without instrument


Vaginal deliveries with episiotomy Delivery 5

Patients with episiotomy procedure coded on hospital record

Vaginal deliveries (excluding those with shoulder dystocia coded on record)


Was there a post-partum visit Post-Partum

Patients with a post-partum visit between 1 day after discharge and 8 weeks postpartum All delivery patients


Post-Partum BP Monitoring Post-Partum 10

Outpatient blood pressure was recorded for the patient between 1 day after discharge and 8 weeks postpartum



Post-Partum Depression Screening Post-Partum 5

Patients with a recorded score for postpatum depression screen on an outpatient visit that was recorded between 1 day after discharge and 8 weeks postpartum



Post-Partum fasting glucose testing Post-Partum 5

Patient had a resulted procedure recorded between 1 day after discharge and 8 weeks postpartum

Patients with a diagnosis of gestational diabetes documented between gestational age of 16 weeks and delivery date


Babies receiving Hep B Vaccine Newborn 5

Newborns with HEPB vaccine administered between birth date and disharge date

All newborns excluding stillborns


Blood stream infection prior to discharge Newborn 5

Newborns with a secondary diagnosis of sepsis or bacteremia

All live newborns with birth weight >=500 and <1500g; LOS >7 days; gestional age >=24 weeks or <=30 weeks; Exclude newborns with primary diagnosis of sepsis or bacteriemia


Newborn sepsis or meningitis Newborn 5Newborns with diagnosis of sepsis, regardless of age

All live newborns with birth weight <=1500g or GA <=29 weeks and LOS > 3 days


Newborns screened for retinopathy of pre Newborn 1.0 5Consult for pediatric ophthalmology ordered

All live newborns with LOS >3 days and gestional age <=29 weeks

Receive all points for ratio of 1 and 0 points for ratio less than 1

Total Score 100 0.0

not collected/scored separately in Year 1--will be added for year 2

not collected/scored for Year 1; will add to year 2

Documents

Maternity Multi‐Stakeholder Action Collaborative Session 7 ... · PERINATAL Q1 + Q2 2016 DISCLAIMER: The information contained in these reports is intended solely for use in the