Hospital Rewards Program: Data Reporting and Scoring

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Hospital Rewards ProgramData Reporting and
Scoring

• J. Dennis Bush
• February 7, 2006

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Leapfrog Hospital Rewards Program Data
Reporting Requirements

• Objectives
• Minimize additional reporting burden for
  hospitals
• Rely on existing reporting systems, i.e., LFG
  hospital survey, JCAHO Core Measures
• Parallel formats and processes already in place
  for any new data, e.g., data formats, severity
  adjustment processes

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Leapfrog Hospital Rewards Program Data
Requirements

• Leapfrog Hospital Quality and Safety Survey
• JCAHO Core Measures
• Leapfrog Resource-Based Efficiency Measures

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Data Reporting Process Flow
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Leapfrog PatientSafety Survey
ProgramLicensees
Leapfrog
Survey Results

• Clinical Area-specificScores
• Quality
• Resource-Based Efficiency

JCAHO CoreMeasures Data
AggregationandScoring
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Hospital
Leapfrog
JCAHO Quality-only Vendor
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New
Full-ServiceData Vendor
DataLicensees
LFG Efficiency Measures
Hospital Feedbackvia Vendors
Hospitals may split data submission -
quality data through existing quality-only
JCAHO CMV - efficiency data through
Leapfrog-approved full-service vendor
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Leapfrog Hospital Rewards Program Data
Requirements

• Leapfrog Hospital Quality and Safety Survey
• Required for LHRP participation in ANY clinical
  area
• Current survey, including affirmations
• Latest (new cycle) survey as of May 31 for Jul 1
  results
• Latest survey as of Nov 30 for Jan 1 results
• LHRP participating hospitals also complete
  authorization release at on-line survey
• Partial completion no points earned for that
  componentExample process compliance not measured

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Leapfrog Hospital Rewards Program Data
Requirements

• JCAHO Core Measures
• Objective no additional reporting burden
• Core Measures must be reported for clinical
  area(s)
• Copy of JCAHO data submission to LFG
• add LFG hospital identifier
• split HCO into component hospitals (lt1)
• extraneous data ignored on submission, e.g.,
  heart failure, unused measures
• Timing
• quarterly
• 15-30 day lag after JCAHO deadlines

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Leapfrog Hospital Rewards Program Data
Requirements

• Leapfrog Resource-Based Efficiency Measures
• By clinical area for which hospital participates
  in LHRP
• Actual length of stay (LOS), routine and special
• Severity-adjusted expected LOS, routine and
  special
• cases with readmit following discharge, within
  14 days, same hospital, any condition at readmit

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Total length of stay for Deliveries
See details about risk adjustment models at
http//leapfrog.medstat.com/hpr
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Leapfrog Hospital Rewards Program Scoring

• Weights
• Scoring component measures
• Composite score
• Rankings on each axis
• Quality
• Resource-Based Efficiency rankings
• Performance groups (4)

. . . by clinical area. . . for participating
hospitals
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Leapfrog Hospital Rewards Program Quality
Weighting

• Weight is assigned to each measure
• Represents maximum points available for a measure
• Add to 100 possible composite score 0 100
• Basis1
• 46 for mortality-related measures
• 29 for morbidity-related measures
• 25 for complication-related measures
• Allocated evenly for measures within
  category,unless evidence of odds-ratio
  differences

See Weighting details in addenda and at
http//leapfrog.medstat.com/hpr
1 Pauly, M.V., Brailer, D.J., Kroch, E., and O.
Even-Shoshan. "Measuring Hospital Outcomes from a
Buyer's Perspective." American Journal of
Medical Quality. Vol. 11(8)112-122, Fall
1996.
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Scoring Example Pneumonia
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Leapfrog Hospital Rewards Program Scoring
Component Measures Efficiency

• Derive relative severity index from expected LOS
• Standardize actual LOS for severity differences
• Adjust total standardized LOS for readmissions
  std LOS (1 readmit rate)
• Score standard deviations better/ (worse)
  than all-group average adjusted LOS

. . . by clinical area
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Scoring Example Overall Deliveries
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Leapfrog Hospital Rewards ProgramRanking Overall
Quality and Efficiency Scores

• Four tiers along each axis
• 1 Best quartile
• 2 Not significantly below best quartile (p gt
  .10)
• 3 Significantly below best quartile (p lt .10)
• 4 Significantly below best quartile (p lt .05)
• Cohorts performance on both axes
• Top cohort 1st tier (best quartile) on both
  axes
• Bottom cohort 4th tier on either axis

. . . by clinical area
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Hospitals Arrayed in Four GroupsExample
Pneumonia
Cohort 1
Cohort 2
Average
Cohort 3
Cohort 4
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Addenda

• Scoring Details

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Leapfrog Hospital Rewards Program Scoring
Component Measures Quality

• Continuous measures, e.g., complianceExample
  AMI - aspirin at arrival (weight 16.06)
• 72.3 compliance x 16.06 11.61 contribution
  to total score
• multiple compliance measures within category are
  further weighted by denominators of each measure
• Graded/categorical measures, e.g., LFG partial
  credit resultsExample Pneumonia - Leapfrog
  Quality Index (weight 12.5)
• Fully implemented full weight (12.50)
• Good progress 2/3 of weight (8.33)
• Good early stage effort 1/3 of weight (4.17)

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Leapfrog Hospital Rewards Program Scoring
Component Measures Quality (contd)

• Risk-adjusted rates, e.g., mortality
  rateExample Deliveries 3rd/4th degree
  lacerations (weight 8.33)Percent rank (0
  100), where 0 worst, 100 best,times weight
• All or none, e.g., LFG NICU average
  censusExample NICU average daily census 15
  for hospitals electively admitting high-risk
  deliveries (weight 23.0)Yes 23.0No (or no
  NICU) 0.0

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Weighting Scoring AMI
Measure Source Weight Scoring
Inpatient mortality JCAHO (AMI9) 15.33 Percent rank (0 worst, 100 best) times 15.33 weight
Aspirin at arrival JCAHO (AMI-1) 16.06 compliance times weight
Beta blocker at arrival JCAHO (AMI-5) 14.61 compliance times weight
Aspirin prescribed at discharge JCAHO (AMI-2) 4.83 compliance times weight
Beta blocker prescribed at discharge JCAHO (AMI-6) 4.83 compliance times weight
ACEI for LVSD JCAHO (AMI-3) 4.83 compliance times weight
Thrombolytic agent received within 30 minutes of arrival JCAHO (AMI-7a) 4.83 compliance times weight
PCI with door-to-balloon time within 90 minutes of arrival LFG 4.83 compliance times weight
Adult smoking cessation advice/ counseling JCAHO (AMI-4) 4.83 compliance times weight
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Weighting Scoring AMI (contd)
Measure Source Weight Scoring
Computerized physician order entry (CPOE) LFG 8.33 Fully implemented Full credit (8.33) Good progress 2/3 credit (5.55) Good early stage effort 1/3 credit (2.78) else no credit
Intensivist ICU staffing (IPS) LFG 8.33 Fully implemented Full credit (8.33) Good progress 2/3 credit (5.55) Good early stage effort 1/3 credit (2.78) else no credit
Leapfrog Quality Index (NQF Safe Practices) LFG 8.33 Fully implemented Full credit (8.33) Good progress 2/3 credit (5.55) Good early stage effort 1/3 credit (2.78) else no credit
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Weighting Scoring CABG
Measure Source Weight Scoring
Mortality LFG 34.00 Full credit if Public risk-adjusted mortality rate better than state median OR STS risk-adjusted mortality rate better than national average else no credit
Volume LFG 12.00 Full credit if Volume 450 else no credit
Prophylactic antibiotic received within one hour prior to surgical incision JCAHO (SIP-1b) 3.50 compliance times weight
Prophylactic antibiotic selection for surgical patients JCAHO (SIP-2b) 3.50 compliance times weight
Prophylactic antibiotics discontinued within 24 hours after surgery end time JCAHO (SIP-3b) 3.50 compliance times weight
Process measures CABG using internal mammary artery Aspirin at discharge Beta blocker within 24 hours after surgery Beta blockers prescribed at discharge Lipid-lowering therapy prescribed at discharge Extubation within 24 hours after surgery LFG 9.25 9.25 compliance times weight for two highest compliance rates of up to six measures reported else no credit if not measured
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Weighting Scoring CABG (contd)
Measure Source Weight Scoring
Computerized physician order entry (CPOE) LFG 8.33 Fully implemented Full credit (8.33) Good progress 2/3 credit (5.55) Good early stage effort 1/3 credit (2.78) else no credit
Intensivist ICU staffing (IPS) LFG 8.33 Fully implemented Full credit (8.33) Good progress 2/3 credit (5.55) Good early stage effort 1/3 credit (2.78) else no credit
Leapfrog Quality Index (NQF Safe Practices) LFG 8.33 Fully implemented Full credit (8.33) Good progress 2/3 credit (5.55) Good early stage effort 1/3 credit (2.78) else no credit
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Weighting Scoring PCI
Measure Source Weight Scoring
Mortality LFG 34.00 Full credit if Public risk-adjusted mortality rate better than state median OR ACC risk-adjusted mortality rate better than national average else no credit
Volume LFG 12.00 Full credit if Volume 400 else no credit
Process measures Aspirin at arrival 1st balloon inflation within 90 minutes LFG 14.5014.50 compliance times weight for each measure else no credit if not measured
Computerized physician order entry (CPOE) LFG 8.33 Fully implemented Full credit (8.33) Good progress 2/3 credit (5.55) Good early stage effort 1/3 credit (2.78) else no credit
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Weighting Scoring PCI (contd)
Measure Source Weight Scoring
Intensivist ICU staffing (IPS) LFG 8.33 Fully implemented Full credit (8.33) Good progress 2/3 credit (5.55) Good early stage effort 1/3 credit (2.78) else no credit
Leapfrog Quality Index (NQF Safe Practices) LFG 8.33 Fully implemented Full credit (8.33) Good progress 2/3 credit (5.55) Good early stage effort 1/3 credit (2.78) else no credit
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Weighting Scoring Pneumonia
Measure Source Weight Scoring
Initial antibiotic received within 4 hours of hospital arrival JCAHO (PN-5b) 5.50 Percent rank (0 worst, 100 best) times 5.50 weight
Influenza vaccination JCAHO (PN-7) 7.50 compliance times weight
Pneumococcal vaccination JCAHO (PN-2) 12.00 compliance times weight
Adult smoking cessation advice/ counseling JCAHO (PN-4) 7.50 compliance times weight
Intensivist ICU staffing (IPS) LFG 13.50 Fully implemented Full credit (13.50) Good progress 2/3 credit (9.00) Good early stage effort 1/3 credit (4.50) else no credit
Oxygenation assessment JCAHO (PN-1) 14.50 compliance times weight
Blood cultures (collected prior to antibiotic administration) JCAHO (PN-5b) 14.50 compliance times weight
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Weighting Scoring Pneumonia (contd)
Measure Source Weight Scoring
Computerized physician order entry (CPOE) LFG 12.50 Fully implemented Full credit (12.50) Good progress 2/3 credit (8.33) Good early stage effort 1/3 credit (4.17) else no credit
Leapfrog Quality Index (NQF Safe Practices) LFG 12.50 Fully implemented Full credit (12.50) Good progress 2/3 credit (8.33) Good early stage effort 1/3 credit (4.17) else no credit
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Weighting Scoring Deliveries
Measure Source Weight Scoring
Inpatient neonatal mortality JCAHO (PR-2) 23.00or60.50 Percent rank (0 worst, 100 best) times 23.00 or 60.50 weight
NICU census LFG 23.00or0.00 Full credit if NICU census 15 else no credit
Antenatal steroids for certain high-risk deliveries LFG 29.00or0.00 compliance times weight (if measure is applicable)
Third- or fourth-degree lacerations JCAHO (PR-3) 8.33or13.17 Percent rank (0 worst, 100 best) times 8.33 or 13.17 weight
Computerized physician order entry (CPOE) LFG 8.33or13.17 Fully implemented Full credit (8.33 or 13.17 ) Good progress 2/3 credit (5.55 or 13.17 ) Good early stage effort 1/3 credit (2.78 or 13.17 ) else no credit
Leapfrog Quality Index (NQF Safe Practices) LFG 8.33or13.17 Fully implemented Full credit (8.33) Good progress 2/3 credit (5.55) Good early stage effort 1/3 credit (2.78) else no credit
For a hospital indicating in its Leapfrog
survey responses that it electively admits
high-risk deliveries (mothers expected to deliver
complicated newborns), NICU census and Antenatal
steroids measures do not apply. The weights
associated with these measures are allocated to
the remaining measures and the second set of
weights applies.