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Hospital Rewards Program: Data Reporting and Scoring

Hospital Rewards Program: Data Reporting and Scoring. J. Dennis Bush February 7, 2006. Leapfrog Hospital Rewards Program Data & Reporting Requirements. Objectives Minimize additional reporting burden for hospitals

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Hospital Rewards Program: Data Reporting and Scoring

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  1. Hospital Rewards Program:Data Reporting and Scoring J. Dennis Bush February 7, 2006

  2. 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 Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  3. Leapfrog Hospital Rewards Program Data Requirements Leapfrog Hospital Quality and Safety Survey JCAHO Core Measures Leapfrog Resource-Based Efficiency Measures 1 2 3 Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  4. Data Reporting: Process Flow 1 Leapfrog PatientSafety Survey ProgramLicensees Leapfrog Survey Results • Clinical Area-specificScores: • Quality • Resource-Based Efficiency AggregationandScoring JCAHO CoreMeasures Data 2 Hospital Leapfrog JCAHO Quality-only Vendor* 3 Full-ServiceData Vendor New 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 Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  5. 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 1 Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  6. 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 (<1%) • extraneous data ignored on submission, e.g., heart failure, unused measures • Timing • quarterly • 15-30 day lag after JCAHO deadlines 2 Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  7. 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 3 * Total length of stay for Deliveries ** See details about risk adjustment models at http://leapfrog.medstat.com/hpr Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  8. 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 Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  9. 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. Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  10. Scoring Example: Pneumonia Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  11. 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 Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  12. Scoring Example: Overall – Deliveries Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  13. Leapfrog Hospital Rewards ProgramRanking Overall Quality and Efficiency Scores • Four tiers along each axis • 1: Best quartile • 2: Not significantly below best quartile (p > .10) • 3: Significantly below best quartile (p < .10) • 4: Significantly below best quartile (p < .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 Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  14. Hospitals Arrayed in Four GroupsExample: Pneumonia Cohort 1 Cohort 2 Average Cohort 3 Cohort 4 Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  15. Addenda Scoring Details

  16. 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%) Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  17. Leapfrog Hospital Rewards Program Scoring Component Measures – Quality (cont’d) • 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 = 23.0%No (or no NICU) = 0.0% Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  18. Weighting & Scoring – AMI Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  19. Weighting & Scoring – AMI (cont’d) Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  20. Weighting & Scoring – CABG Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  21. Weighting & Scoring – CABG (cont’d) Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  22. Weighting & Scoring – PCI Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  23. Weighting & Scoring – PCI (cont’d) Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  24. Weighting & Scoring – Pneumonia Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  25. Weighting & Scoring – Pneumonia (cont’d) Leapfrog Hospital Rewards Program: Data Reporting and Scoring

  26. Weighting & Scoring – Deliveries * 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. Leapfrog Hospital Rewards Program: Data Reporting and Scoring

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