Embed Size (px)
Citation preview
EOHHS Statewide Acute Hospital Webcast
August 10, 2018
11:00am – 12:00 noon (ET)
RY2019 MassHealth Hospital P4P Requirements
Technical Briefing Session
RY2019 Webcast Agenda Welcome/Session Goal 11:00 am I. RY19 Acute Hospital RFA Requirements Quality Inpatient Measures Performance Assessment Methods Incentive Payment Methods Reporting Requirements
II. RY19 EOHHS Technical Specifications Process Measure Specs/tools Outcome Measures Collection MassHealth NHSN Group MassQEX Portal Updates
III. Q & A Period
Wrap-up 12:00 noon
Webcast Logistics
Registration is required to view webcast slides
All Hospital Phone lines are muted during the session to prevent background noise entering webcast.
Avoid putting your phone line on hold during the Q & A period to prevent your organizations automated advertising system spilling into webcast environ.
Slides posted on Mass.Gov website within 3 business days: https://www.mass.gov/service-details/masshealth-quality-exchange-massqex
8.10.18 1
EOHHS Medicaid Acute Hospital RFA Contract (Section 7: Quality Reporting Requirements & Payment Methods)
Iris Garcia-Caban, PhD
Hospital Performance Program Lead
MassHealth Delivery Systems Operation
8.10.18 2
EOHHS Medicaid Acute Hospital RFA Quality Requirements
Acute P4P Core Principles (Sect.7.1)
Program Aim Reward hospitals for
high quality care and better outcomes for MassHealth patients.
Performance Assessment Each hospitals performance is assessed using methods outlined in the RFA.
Payment Eligibility Hospital payments are contingent on meeting standards set forth in the RFA.
No Hospitals Exempt All Hospitals
are required to participate in P4P Program
Designate Key Contacts (7.2)
Submit Quality Measures Data (7.3)
Meet Data Completeness Requirements (7.3)
Pass Data Validation (7.4)
Achieve Performance Thresholds (7.4)
Incentive Payment Methods (7.5)
Meet Reporting Deadlines (7.6)
8.10.18 3
Summary of Key Changes Affecting RY2019
Acute Hospital Quality Program
EOHHS Acute RFA2019 Contract
Requirements
Performance Measures Transition
New Reduce process measures reporting
New Safety Outcome Measure Category
New Patient Experience/ Outcome Category
Reporting Requirements
New - One Reporting cycle in RY19
New - Revised P4P Program Forms
Payment Calculations
New Eligible Medicaid Discharges
Incentive Payment Approaches
All measures are on P4P status
New – Safety category threshold provision
EOHHS Technical Specifications
RY19 EOHHS Manuals (v12.0 series)
New - ACO Medicaid Payer Codes
New - CCM2 provisional scoring
New - Reduce chart record request
Updated PSI-90 specs
New Appendix and Data Tools
MassHealth NHSN Group Enrollment
New - Identify Hospital NHSN contact
New - Confer rights template
8.10.18
Simplify measures data collection
and reduce burden
4
Align with CMS Meaningful Measures Initiative
8.10.18
Make Care Safer by Reducing Harm
• Healthcare Associated Infections
• Preventable Complications
Promote Effective Communication & Care
Coordination
• Medication Management
• Transfer of HIT & Interoperability
• Hospital Admissions and Readmissions
Strengthen Person & Family Engagement
• Care Aligned to Patient Goals
• End of Life Care Preferences
• Patient Experience of Care
• Patient Reported Functional Outcomes
Promote Effective Prevention & Treatment
• Preventative Care
• Chronic Conditions Mgt.
• Mental Health Prevention, Treatment and Mgt.
• Prevention and Treatment of Opioid & SUD
• Risk Adjusted Mortality
Promote Best Practices of Healthy Living
• Equity of Care
• Community Engagement
Make Care Affordable
• Appropriate Use of Healthcare
• Patient Focused Episode of Care
• Risk Adjusted Total Cost of Care
CMS identifies priority measurement areas, under each of six NQS domains, that are critical to ensuring
high quality care and better patient outcomes for its Medicare, Medicaid and CHIP programs
5
RY19 Acute Inpatient Quality Measurement Transition (7.3)
8.10.18
No. Acute Measures
Acute Quality
Domain Category (New)
MassHealth
ACO/DSRIP Alignment
Reconciled medication list at D/C
Transition record (TR) w/specific data elements
Transmit TR w/in 48hrs to PCP
Care Integration
Cesarean Birth, NTSV
Exclusive Breast milk feeding
Prevention & Wellness*
Health Disparities Composite Health Equity*
Patient Safety & Adverse Events Composite
Healthcare-Associated Infections
(CAUTI, CLABSI , MRSA, CDI, SSI’s)
Safer Care*
Patient Experience/Engagement
(seven HCAHPS survey dimensions)
Person-Centered
Integrated Care
Alignment with ACO/DSRIP Initiatives
Retain metrics which support care integration/data sharing (#1,2,3, 9) for better population mgt. by ACO and Community Partners.
Adapt metrics which supplement or fill key gaps in the ACO quality strategy (*) Safety Events (#7, #8); Potentially avoidable utilization (#4 ,#8);
Maternal/infant well-being (#4, #5); Health disparities monitoring (#6)
Promote joint accountability
between hospitals and PCP’s
6
RY19 Transition of Clinical Process Quality Domain (7.3)
Retain Care Coordination Category
Goal Ensure safe & effective hand-off at time of discharge
CCM-1: Medications Reconciled at discharge
CCM-2: Transition Record (TR) with specified data elements
CCM-3: Timely transmittal of TR w/in 48 hours
Consolidate OB/Newborn Category
Cesarean Birth, NVST
Exclusive Breastmilk feeding
Retain Health Disparity Category
Continue monitoring progress to reduce disparities (MGL legislative mandate)
8.10.18
CCM-2 Measure
Provisional algorithm
scoring change to
address alignment
EHR_MU concerns
7
RY19 Transition of Measures Data Collection Procedures (7.3)
Claims based data reflect a snapshot of MMIS claims after 6 month of measurement
period.
Registry-based data reflect a snapshot following CMS submission deadline for HAI data.
Survey-based data reflect a snapshot following CMS correction period submission
deadlines.
8.10.18
Data Source Collection Format Payer Source Data Data Completeness Chart-based (CCM, MAT, NEWB)
Hospital reported data Use All Medicaid Payer (new Medicaid ACO
payer codes)
Upload electronic files
ICD popn data entry
Submit charts for validation
Meet EOHHS submission deadlines
Claims-based (PSI-90)
EOHHS collects from MMIS claims
Use All Medicaid Payer Clinical and administrative codes
required by AHRQ software (POA,
ICD, age, etc.)
Registry-based (HAI’s)
EOHHS collects via MassHealth NHSN Group
Accept all payer data file Meet NHSN clinical reporting
protocols
Meet CMS reporting deadlines
Survey-based (HCAHPS)
EOHHS collects from Hospital Compare archived datasets
Accept all payer data file Meet HCAHPS measure guidelines
Meet CMS reporting deadlines
8
RY19 Transition of Data Validation Requirements (7.4)
Data Reliability Standard
• Data validation requirement applies to Clinical Process Metrics Only
• Hospitals must meet data validation standard (.80) on submitted chart data.
• Chart data validation uses a random selection of cases, extracted from hospital uploaded files, to evaluate specific data elements.
• In RY19, chart validation will apply to Q3 & Q4 data only.
Quality Scoring Impact
• Passing Validation is required prior to computing the hospital’s performance scores.
• If FAIL validation in comparison year (RY19) for reported measures then all process measures data is considered unreliable for quality scoring.
• If FAILED validation in previous year (RY18) then data is considered invalid for computing comparative year performance. (In this case – Improvement Points do not apply but may get Attainment points if PASS validation in RY18 and have already established a valid baseline rate)
.
8.10.18 9
RY19 Transition of Performance Assessment Methods (7.4)
• Performance assessment methods will vary by measures
• Scoring eligibility criteria applies for each measure
• Patient safety measures will adapt CMS-HACRP scoring methods
8.10.18
Quality Measure Category Raw
Measure Result
Improvement
Noted As
Performance
Assessment Method
Clinical Process Measures Measure Rate Higher is better
Attainment & Improvement
Health Disparities Composite BGV value Lower is better Decile Rank
PSI-90 Composite Composite Index value Lower is better
Interquartile Range
(overall winsor z-score) Healthcare-Associated
Infections
Standard Infection Ratio
Value
Lower is better
Patient Experience &
Engagement
Survey Dimension
Measure Rates
Higher is Better Attainment & Improvement
10
Attainment & Improvement Model (1 of 2)
Attainment Threshold
• Represents minimum level of performance required to earn points
• Set at Median (50th) of all hospital prior year data.
Benchmark Threshold
• Represents highest performance achieved to earn maximum points
• Set at Mean of top decile (90th) of all hospital prior year data
8.10.18
Improvement
• Represents progress achieved from prior year to earn points
• Individual hospital results is better than prior year
Evaluates each Hospitals result compared to all Hospitals
Evaluates each Hospitals Previous & Comparison Year Rates
plus
Prior & Comparison Year
11
Attainment & Improvement Model (2 of 2)
8.10.18
Quality Point System to Weight Raw Measure Rates
Award Attainment Points Award Improvement Points
0 points: If rate attainment 1 to 9 points: If rate > attainment but < benchmark 10 points: If rate ≥ benchmark
0 points: If rate previous year 0 – 9 points: If rate between previous year & benchmark
(Hospital Measure Rate – Attainment) x 9+0.5 = Attainment Pts.
(Benchmark – Attainment)
(Current Measure Rate – Prior Yr. Rate) x10 – 0.5 = Improvement Pts
(Benchmark Threshold – Prior Yr. Rate)
Total Awarded Points x 100 = Total Performance Score
Total Possible Points
Quality Scoring Criteria
Award the higher of the Attainment or Improvement Points
Award points only after have established initial baseline measure result
Attainment Pts if NO cases in baseline period may be eligible for attainment pts if pass data validation in comparison period
Improvement Pts Awarded if have cases in both baseline & comparison period
12
Health Disparity Composite (HD-2) Performance Rank Model
8.10.18
RY2019 Quality Scoring Methods
Measures included
Clinical process measures, as applicable (MAT, NEWB, CCM)
Measure Results
Racial Comparison Group Rate Hospital Reference Group Rate HD2 Composite Value = BGV
(reflects variation in care)
Setting Thresholds
BGV Target Attainment set above 2nd decile All Hospital BGV’s are ranked highest to
lowest
Conversion Factor
A weight is assigned to each decile group
Scoring
Eligibility
Hospitals data must have more than one racial group to be scored
Must pass data validation for process measures
Performance
Threshold
Decile
Group
Conversion
Factor
10th decile 1.0
9th decile .90
8th decile .80
7th decile .70
6th decile .60
5th decile .50
4th decile .40
Target Attainment 3rd decile .30
Lower Deciles
2nd decile
1st decile
0 (zero)
HD2 Performance Score = Conversion Factor x
100%
13
New MassHealth Safety Outcome Measure Category (7.4)
Component 1
Patient Safety & Adverse Events Composite
• PSI 03 Pressure Ulcers Rate • PSI 06 Iatrogenic Pneumothorax Rate • PSI 08 In-Hospital Fall with Hip Fracture Rate • PSI 09 Perioperative Hemorrhage /Hematoma Rate • PSI 10 Postoperative Acute Kidney Injury Rate • PSI 11 Postoperative Respiratory Failure • PSI 12 Perioperative PE or DVT Rate • PSI 13 Postoperative Sepsis Rate • PSI 14 Postoperative Wound Dehiscence Rate • PSI 15 Unrecognized Abdominopelvic Accidental
Puncture/Laceration Rate
Modified PSI-90 component weights will factor for volume and harm.
Component 2
Healthcare-Associated Infections
Catheter Assoc. Urinary Tract Infection (CAUTI)
Central Line Assoc. Blood Stream Infection (CLABSI)
Methicillin Resistant Staph Aureus (MRSA) bacteremia
Clostridium Difficile Infection (CDI)
• Surgical Site Infections (SSI’s)
(includes colon & abdominal hysterectomy)
EOHHS has arranged with CDC to establish the “MassHealth NSHN Group” for hospitals to exchange nationally reported HAI data.
EOHHS contractor is the designated “Group Administrator”
8.10.18
No data reporting to EOHHS is required for above metrics
14
Safety Outcome Measure Performance Assessment (1 of 3)
Step 1: Winsorized Method
The Winsorized Measure Result that is
obtained by creating a continuous rank
distribution of all eligible hospital raw values,
truncated at the 5th and 95th percentiles.
The relative position of where each measures
value falls in the distribution is determined as
follows:
If falls between minimum value and 5th
percentile then it is equal to 5th percentile
If falls between 95th percentile and
maximum then it is equal to 95th percentile
If falls between 5th and 95th percentile then
it is equal to the Hospital’s raw result.
Step 2: Winsor Z-score
A Winsor Z-score (Zi) is calculated for each hospital safety measure as the difference between the Hospitals Winsorized measure result (Xi) and the mean of Winsor measure results across all eligible hospitals (X ) divided by the standard deviation of the Winsorized measure result from all eligible hospitals data using the following formula
• The Hospitals winsor z-score for each
safety metric reflects how many standard
deviations each value is away from the
mean measure result.
8.10.18
Measure Zi score = (Xi) – (𝐗 )
SD (xi)
15
Safety Outcome Measure Performance Assessment (2 of 3)
Component 1
PSI-90 Composite
PSI-90 winsorized z-score
Contributes to 60% of overall z-score
Component 2
Healthcare-Associated Infections (HAI)
Ave. of all 5 HAI’s winsorized z-score
Contributes to 40% of overall z-score.
Step 3: Overall Safety Z-Score
The Hospital’s safety category
performance is evaluated using two
measure components that each
contribute to overall safety z-score.
If Hospital has winsor z-scores for
only one component then the 100%
weight is applied as overall safety
winsor z-score.
If Hospital has no winsor z-scores for
any component it will not get an
overall safety score.
The Hospital’s overall safety z-score
is calculated as the weighted
average of both Components based
on the following formula
8.10.18
(Component 1 z-score*.60) +
(Component 2 z-score*.40)
= Overall
Safety Z-score
16
Safety Outcome Measure Performance Assessment (3 of 3)
Step 4: Interquartile Range
Interquartile Rank Method. All hospital
overall safety z-score results data are
ranked from worse (highest) to better
(lowest) performance and divided into
four equal groups.
Minimum Attainment Threshold.
Defined as the boundary for the overall
safety z-score values that falls above the
1st quartile group.
The minimum attainment threshold
represents the minimum level of
performance that must be attained to
earn incentive payments.
Important Note
• In RY19 only, the newly introduced safety outcome measure minimum threshold will not apply
• In RY19 only, an overall z-score in the 1st quartile gets a conversion factor of .25.
8.10.18
Interquartile
Range
Quartile
Group
Conversion
Factor
Top Quartile 4th Quartile 1.0
3rd Quartile .75
2nd Quartile .50
Lower Quartile
(Higher z-score)
1th Quartile zero
17
New Patient Experience Measure Category Performance Assessment (7.4)
HCAHPS Survey Dimensions
1. Nurse Communication (3 items) 2. Dr. Communication (3 items) 3. Communication about Meds (2 items) 4. Responsiveness of Hospital Staff (2 items) 5. Discharge Information (2 items) 6. Overall Rating (1 item) 7. Care transition (3 items)
No data reporting to EOHHS is required for this measure.
Quality Scoring Attainment & Improvement Model: Each
survey dimension is assessed using the
quality points system described in prior
slides.
Setting Thresholds: Performance
benchmarks are computed form state all
hospital prior year reported HCAHPS data
obtained from Hospital Compare website.
Awarding Quality Points: Attainment and
improvement points are awarded when the
hospital has already established a baseline
rate on each survey dimension.
8.10.18
Total Awarded Points x 100 = Total Performance
Total Possible Points Score
18
RY19 Performance Evaluation Data Periods (7.4)
8.10.18
Metric # Acute Inpatient Metrics RY19
Baseline Period
RY19
Performance Period CCM-1x
CCM-2x
CCM-3x
MAT-4x
NEWB1x
HD2x
Medications reconciled at discharge
Transition Record w/specified data elements
Timely transmit TR w/in 48 hours
Cesarean Birth, NVST
Exclusive breast milk feeding
Health Disparities Composite
CY2017
CY2017
CY2017
CY2017
CY2017
N/A
July 1 – Dec 31, 2018*
July 1 – Dec 31, 2018
July 1 – Dec 31, 2018
July 1 – Dec 31, 2018
July 1 – Dec 31, 2018
July 1 – Dec 31, 2018
PSI-90 Patient Safety & Adverse Events Composite N/A Oct. 1, 2013 - Sept. 30, 2015
(24 mos.)
HAI Healthcare-Associated Infections
N/A
Jan 1, 2015 - Dec 31, 2016
(24 mos.)
HCPS-X Patient Experience/Engagement
Jan 1 – Dec 31, 2016
Jan 1 – Dec 31, 2017
Clinical Process Measures (*) RY19 Performance period uses partial CY18 that was determined based on:
Post ACO go-live 3/1/18 transition adjustments; and CHIA new Medicaid ACO Payer Codes posted May 2018
19
RY2019 Incentive Payment Methods (7.5)
Payment Eligibility Criteria
Meet Data Completeness Requirement
Meet Data Validation Standard
Achieve Performance Thresholds
Incentive Payment Components
Maximum Allocated Amt.: overall dollars tied
to achieving performance
Statewide Eligible Medicaid Discharges: all
hospital discharges for measure population
QMC per Discharge Amt.: estimated amount
by quality category
Incentive Payment Formula
Final Performance Score Computed for each QMC
QMC per-discharge Amount Final computed from FY18 eligible discharges
Eligible Discharges for each QMC Final computed from FY18 discharges
RY19 Incentive Payment Approach
• All measures are on P4P status
Maximum Allocated Amount = Quality Measure
Category per
Discharge Amount Statewide Eligible Medicaid
Discharges
(Final Performance Score) x
(Eligible Medicaid Discharges) x
(QMC per Discharge Amount)
= Hospital
Incentive
Payment
8.10.18 20
RFA2019 Eligible Medicaid Discharge Data Volume (7.5)
Definition of Terms
Identifying Discharges
Meet measure ICD /DRG code requirement
MassHealth is primary and only payer source
Discharges covered by acute FFS payments
(Traditional FFS + PCCP, + ACO-B Plans)
MMIS Paid Claims Extract Included : Adjudicated Payment Amount per
Discharge (APAD) is an all-inclusive facility payment for an acute inpatient hospitalization from admission to discharge,
Excluded: Per Diem payments (Transfer, Psych, Rehab); Admin days, Interim bills, and outlier payments
Data Period: Use FY18 10/1/17 – 9/30/18
discharges to compute RY19 P4P payments.
Identifying MDD Records
Included Claim
8.10.18
QMC Measure Patient Population
OB/Newborn • Meet ICD population in TJC code tables
• Mothers age ≥ 8 and 65 years
• Newborn must be 0 and 2 days
Care
Coordination
Meet ICD population in EHS Manual.
Age > 2years and 65 years
HD-2
Composite
Unique Discharges that meet ICD
requirement for at least one or more
clinical process measures the hospital
reported on (counted only once).
Safety
Outcomes
Meet APR-DRG medical and surgical
population codes
Patients ≥ 18 years of age
Patient
Engagement
Meet APR-DRG medical, surgical, &
cesarean population codes
Patients age ≥ 18 and 65 years
21
RFA2019 Hospital RFA Reporting and Submission Timelines (7.6)
8.10.18
Key Changes in RFA19 Transition One RY19 submission cycle (Q3+Q4 only) Hospitals have 8 months to submit data Revert to quarterly reporting with Aug 2019 cycle New Hospital Quality Contact & Hospital DACA Forms New MassHealth NHSN Group Enrollment
Nationally Reported Data EOHHS expects compliance with CMS submission deadlines for NHSN reporting of HAI data EOHHS expects compliance with CMS submission deadlines for HCAHPS survey data
Submission Due Date
Submission Requirement Submission Format Reporting Instructions
Oct. 2, 2018
Hospital Quality Contacts Form
Hospital DACA Form
HospContact_2019 Form
HospDACA_2019 Form
RFA Section 7.2.D
RFA Section 7.6.C
Nov. 1, 2018 MassHealth NHSN Group Enrollment Complete Confer Rights
Template
Technical Specs Manual
(Version 12.0)
April 26, 2019 Q3-2018 (July – Sept 2018)
Q3-2018 ICD population data
Q4-2018 (Oct – Dec 2018)
Q4-2018 ICD population data
Electronic Data Files; and
ICD online data entry form
(via MassQEX Portal)
Technical Specs Manual
(Version 12.0)
Aug 16, 2019 Q1-2019 (Jan – Mar 2019)
Q1-2019 ICD population data
Electronic Data Files; and
ICD online data entry form
(via MassQEX Portal)
Technical Specs Manual
(Version TBD)
22
RY19 MassHealth P4P Program Participation Forms (7.2 & 7.6)
Required Program Forms
Hospital Quality Contact Form Key Representatives (Quality & Finance)
Identify MassQEX Portal Users
Identify MassHealth NHSN Group contact
Hospital Data Attestation Form Attest to data accuracy & completeness
Enter measures exemption provision
Mailing Hard Copy Forms Iris Garcia-Caban, PhD EOHHS MassHealth Attention: Acute Hospital P4P Program 100 Hancock St. 6th floor Quincy MA. 02171
8.10.18
EOHHS Business Contacts
Key Reps are staff liaisons for EHS business communication on Acute RFA requirements Only Key Reps are entered in EHS email distribution list & mailing dbases.
New – Must identify the Hospitals NHSN Administrator authorized to interface with MassHealth NHSN Group Administrator.
Getting Program Forms Posted on Mass.Gov Webpage on:
http://www.mass.gov/eohhs/provider/insurance/masshealth/massqex/
23
RY2019 EOHHS Technical Specifications
for Acute Hospital Quality Measures
Cynthia Sacco, MD
EOHHS Contractor: Telligen, Inc.
8.10.18 24
RY2019 Clinical Process Measure Data Collection Transition
Measure Description & Flowchart
MassHealth Data Dictionary
Hospital & Vendor Data Tools/XML
All Charts
REMOVE: • Ethnicity • Hospital Bill Number • Postal Code • Sample
REMOVE: • Ethnicity • Hospital Bill Number • Postal Code • Sample UPDATES • New Medicaid ACO Payer Codes • Discharge Disposition • Episode of Care
REMOVE: • Ethnicity • Hospital Bill Number • Postal Code • Sample UPDATES: • New Medicaid ACO Payer Codes
MAT-4 • See above all charts • Gestational Age • ICD Code Tables consistent with applicable version TJC specifications
NEWB-1 • See above all charts • No change • ICD Code Tables consistent with applicable version TJC specifications
CCM-1 • See above all charts • No change • No change
CCM-2 • Provisional scoring counter logic
• No change • No Change
CCM-3 • See above all charts • Transmission Date via CEHRT accepted
• No change
New – RY19 Transition simplifies chart abstraction to reduce burden. EOHHS Technical Specs Manual (v12.0) provides more detail.
8.10.18 25
RY19 Care Coordination (CCM-2) Data Element Considerations
Key Observation CCM-2 data elements #7-11 not stated as required for MU measure MU data elements #8-13 not identified by AMA-PCPI specs for transition record EOHHS will not eliminate CCM-2 data elements but instead adapt provisional algorithm scoring method
MassHealth CCM 2 Required Data Fields
(AMA-PCPI Specs)
CMS- IPFQR Reporting Data Fields
(AMA-PCPI Specs)
CMS-EHR MU data elements
(Stage 2 Objective 3; Stage 3/Objective 5) 1. Discharge Diagnosis Principal Diagnosis at discharge 1. Encounter diagnosis
2. Medical Procedures/Tests & Summary of Results Major Procedures/Tests and Summary of Results 2. Procedures
3. Laboratory test results
3. Plan of Follow Up Care Contact Information for Studies Pending 4. Care Plan Field (minimum goals and instructions)
4. Primary Physician or Other HCP for Follow Up Care Primary Physician or Other HCP for Follow Up Care 5. Care team including primary care provider of record
5. Patient Instructions Patient instructions 6. Discharge Instructions
6. Current Medication List Current Medication List 7. Current Medication List
7. Reason for Inpatient Admission Reason for Inpatient Admission
Data elements not listed
8. Studies Pending at Discharge Studies Pending at discharge
9. Contact Information for Studies Pending Contact Information for Studies Pending
10. Contact Information 24/7 Contact Information 24/7
11. Advance Care Plan Advance Directives
Data elements
not listed by AMA-PCPI
8. Vital signs (height, wt., blood pressure, BMI)
9. Smoking status
10. Immunizations
11. Functional status (ADL, cognitive /disability status)
12. Active/Current Problem List
13. Active/Current medication allergy list
8.10.18 26
RY2019 Provisional Algorithm Scoring of CCM-2 Measure
Hospitals Required: All Transition Record required data elements will be abstracted and evaluated.
New Provision: In RY19, EOHHS will remove the all n=11 data elements be required to meet the measure.
Portal Scoring: The
measure met threshold will be modified to require > = 6 of 11 data elements present on the Transition Record given the patient.
Excerpt from CCM 2 Measure Algorithm
X
B
D
Review Ended
Not in Measure Population
Excluded from Numerator
and Denominator
Review Ended
In Measure Population
Excluded from Numerator
Included in Denominator
EMeasure Met
In Measure Population
Included in Numerator and
Denominator
Review Ended
Not in Measure Population
Missing or Invalid Data
Case will be Rejected
Transition
Record Counter
Plan for
Follow-Up
Care?
Primary Physician/
Health Care
Professional Designated
for Follow Up Care?
Yes
Yes
Missing
Missing
X
X
Add 1 to Transition Record Counter
Add 1 to Transition Record Counter
No
No
D
E
Stop
> = 6
< 6
8.10.18 27
RY2019 Transition of Process Metric Data Validation Procedures
Reduced Chart Request
Chart Sampling for Q3-2018 & Q4-2018 will request N=5 charts for each quarter
Must pass validation (.80) based on two quarters of chart data
Validation Scoring Changes (with removed elements)
RY2018 RY2019 RY2020
Total # Charts/Year N=24 N=10 N=12
Charts per Quarter N=8 charts each Submit Q1,Q2, Q3
N=5 charts Submit Q3 & Q4 only
N=4 charts Submit Q1,Q2,Q3
Time to submit records 21 calendar days 21 calendar days 21 calendar days
Scored Data Elements Non-Scored Data Elements
Administrative Elements:
Race
Hispanic Indicator
Clinical Data Elements:
NEWB-1 measure
MAT-4 measure
CCM-1,2,3 measures
Admission Date
Birth date
Discharge Date (scored for CCM-3 only)
Discharge Disposition (scored for NEWB-
1, CCM only)
Episode of Care
First Name
ICD-CM Diagnosis Codes
ICD-PCS Procedure Codes
Hospital Patient ID #
Last Name
Member ID Number
Payer Source
Provider ID
Provider Name
Sex
28 8.10.18
RY19 New MassHealth Insurance Plan Payer Codes
Chart abstracted data files with INVALID payer codes will be rejected by the Portal* Invalid Payer Codes will apply to PSI-90 retro measurement period* The EOHHS Manual and Appendix tools (v12.0) contains more detail
Data File
Requirement
Payer Source Description Payer Code
(as of 3/1/18)
Medicaid Managed Care- Fallon Community Health Plan 108
INVALID Medicaid PAYER
POPULATION
Medicaid Managed Care- Health New England 110
Medicaid Managed Care - Neighborhood Health Plan 113
Medicaid Managed Care - Mass Behavioral Health Partnership Plan 118
Boston Medical Center - MassHealth Care Plus 282
Fallon - MassHealth CarePlus 283
Neighborhood Health Plan - MassHealth Care Plus 284
Tufts Health Together - MassHealth CarePlus 285
Celticare - MassHealth CarePlus 286
MassHealth CarePlus 287
Data File
Requirement
Payer Source Description Payer Code
(as of 3/1/18)
Healthy Start (free care pool) 98
Out of State Medicaid (Other Government) 120
EXCLUDED Other Government 144
MEDICAID Children’s Medical Security Plan (CMSP) 178
PAYER MassHealth Senior Care Options 273
POPULATION One Care – Tufts Health Unify 280
One Care – Commonwealth Care Alliance 281
Health Safety Net 995
Other: Commercial ACO Plan 310
All Commonwealth Care Plans *
All Health Connector Care Plans *
Excluded Medicaid Payer Codes* Included Medicaid Payer Codes
Payer Source Description Payer Code
(as of 3/1/18)
Medicaid: Includes MassHealth FFS and MassHealth Limited 103
Medicaid: Primary Care Clinician (PCC) Plan 104
Medicaid Managed Care – Boston Medical Center HealthNet
Plan 208
Medicaid Managed Care – Tufts Health Together Plan 270, 274
Medicaid Managed Care - Other (not listed elsewhere) 119
Medicaid: Fallon 365 Care (ACO) 312
Medicaid: Be Healthy Partnership Health New England (ACO) 313
Medicaid: Berkshire Fallon Health Collaborative (ACO) 314
Medicaid: BMC HealthNet Plan Community Alliance (ACO) 315
Medicaid: BMC HealthNet Plan Mercy Alliance (ACO) 316
Medicaid: BMC HealthNet Plan Signature Alliance (ACO) 317
Medicaid: BMC HealthNet Plan Southcoast Alliance (ACO) 318
Medicaid: My Care Family with Neighborhood Health Plan (ACO) 321
Medicaid: Tufts Health Together with Atrius Health (ACO) 324
Medicaid: Tufts Health Together with BIDCO (ACO) 325
Medicaid: Tufts Health Together with Boston Children’s (ACO) 326
Medicaid: Tufts Health Together with CHA (ACO) 327
Medicaid: Wellforce Care Plan (ACO) 328
Medicaid: Community Care Cooperative (ACO) 320
Medicaid: Partners Healthcare Choice (ACO) 322
Medicaid: Steward Health Choice (ACO) 323
Medicaid: Other ACO 311
29 8.10.18
Component 1: PSI-90 Patient Safety & Adverse Events Composite
PSI-90 Calculation Rules
Components: Includes n=10 PSI components
Data Source: All Medicaid payer data from MMIS and Encounter claims
Data Completeness: exclude discharges with incomplete, partial or missing/invalid data in clinical and administrative data fields.
Scoring Eligibility: Hospital data must have 3 cases for any one indicator in data period
Composite Index: the weighted average of all PSI Indicators will be utilized to calculate the winsorized Z-score
AHRQ Software
• SAS Software (v6.02): use 25 ICD-9 Diagnosis and 25 Procedure Codes. ICD-10 software version schedule is yet to be determined (speculated for Dec 2018).
• Reference Population: 2013 HCUP data from 36 states that only includes states that provide POA info
Indicator Weights: weighting of the individual component indicators is based on two concepts: the volume of the adverse event (numerator weights) and the harm associated with the adverse event
• Additional detail provided in EHS Manual (V12.0)
30 8.10.18
Component 2: Healthcare-Associated Infection Measures (HAI)
MassQEX Data Collection
Hospital Reporting Requirements
Must adhere to NHSN clinical
specifications for reporting of all HAIs
required by MassHealth.
Must Review and resolve NHSN
submission warnings for complete
and accurate data.
Must adhere to NHSN reporting
deadlines.
MassQEX Calculation Rules
MassQEX will generate results reports containing the HAI measure’s SIR, observed, and expected rates utilizing NHSN’s analysis tools
SIRs are not generated in NHSN if the expected infection rate is less than 1.0
If no SIR is reported in NHSN, that HAI will not be included as part of the HAI scoring
31 8.10.18
Component 2: MassHealth NHSN Group Enrollment Instruction
Step 1:
Hospital Key Quality Contact will receive email invitation from the
designated EHS Group Administrator (MassQEX)
with joining information
*********
MassQEX Key Information:
• 5 digit group ID • Group Joining PASSWORD
Step 2:
The Key Quality Contact must coordinate enrollment by providing
the hospital’s NHSN Facility Administrator the joining information
from the invitation email
********* Only the Hospital’s NHSN facility
administrator has authority to join the MassHealth NHSN Group
Step 3:
Hospital Facility Administrator selects “Group” and then “Join” on the
NHSN navigation bar
*********
Step 4:
Hospital Facility Administrator REVIEWS and ACCEPTS the
Data Rights Template for data sharing.
*********
The data rights template lists the
measure data that MH is requesting
access to for the specified HAIs.
Successful Enrollment: When the data rights template is accepted, data sharing is complete
and the facility is added to the MassHealth NHSN Group.
*********
Hospital Enrollment Deadline:
November 1, 2018
EOHHS MassHealth and CDC Arrangement MassQEX is designated as MassHealth NHSN “Group Administrator “ on EOHHS behalf Hospitals joining the group will not have access to data from other facilities Contact MassQEX Helpdesk for questions on Group enrollment
32 8.10.18
RY2019 New Patient Experience and Engagement Measure
MassQEX Data Collection
The Hospital’s “Top Box result” on HCAHPS survey dimension will be obtained from Hospital Compare.
Hospitals must meet the minimum threshold for survey responses to be eligible for this measure
MassQEX Calculation Rules
Top Box” results are percentages with highest response on survey scale for each HCAHPS survey dimension
The Top Box result is displayed as an “Answer Percent” for each dimension
Measure Identifier HCAHPS Dimension /
Technical Measure Title
HCAHPS Answer Description “Top Box Response”
H-COMP-1-A-P Nurse Communication Patients who reported that their nurses "Always" communicated well
H-COMP-2-A-P Doctor Communication Patients who reported that their doctors "Always" communicated well
H-COMP-3-A-P Responsiveness of Hospital Staff Patients who reported that they "Always" received help as soon as they wanted
H-COMP-5-U-P Communication about Medications
Patients who reported that staff "Always" explained about medicines before giving it to them
H-COMP-6-Y-P Discharge Information Patients who reported that YES, they were given information about what to do during their recovery at home
H-COMP-7-SA Care Transition/CTM-3 Patients who "Strongly Agree" they understood their care when they left the hospital
H-HSP-RATING-9-10 Overall Rating Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)
33 8.10.18
RY2019 MassHealth Measure Report Results Mailed
Measure Results Report Report Description
Data Validation Rate Overall results, quarterly results, case detail for clinical process measure
Process Measure Rates Overall results, quarterly results, and HD-2 report
PSI 90 Composite (New) Each PSI component results and composite index result
Healthcare-Associated Infection Results (New)
SIR results for each reported HAI measure
Patient Experience and Engagement (New)
Baseline and Performance Period Top Box results
All Year-end reports will be mailed to the hospital designated Key Quality Contact and Acute RFA Manager Contact.
34 8.10.18
New RY2019 MassQEX Portal Self-Serve Report
Portal Report Report Description User Access
New PSI 90 Drill Down Report
Will allow hospitals to drill down to claims level data utilized for calculation of the numerator events for each PSI component measure.
Hospitals Registered Users Only
***Reports contain PHI***
Sample Template
35 8.10.18
RY2019 MassQEX User Account Maintenance
MassQEX Portal Authorized Users :
Existing MassQEX Hospital Staff User Accounts are considered active in the RY19 transition period
Existing Data Vendor Accounts must identify essential users and establish any new accounts to ensure timely portal access for submission and input file reports.
Each Hospital is allowed to have 3 Hospital staff and 3 vendor user accounts
MassQEX Listserv Communication: All User Accounts must be updated to ensure receipt of listserv notifications.
Registered Users are auto-enrolled for MassQEX list serv communication.
Other individuals can be added to listserv by contacting MassQEX Helpdesk.:
Phone: 844-546-1343 (toll free #)
Email: [email protected]
36 8.10.18
Wrap Up
EOHHS Contact
Medicaid Acute Hospital RFA Requirements Iris Garcia-Caban, PhD Phone: (617) 847–6528 EOHHS Business Mailbox: [email protected] Mass.Gov P4P Resources https://www.mass.gov/service-details/masshealth-quality-exchange-massqex
MassQEX Help Desk
Technical Support Phone: 844-546-1343 (toll free #) Email: [email protected]
MassHealth NHSN Group Enrollment
8.10.18 37
