Pay for Performance and Best Demonstrated Practice
Centers for Medicare and Medicaid Services (CMS) are establishing pay for performance programs to reward healthcare organizations around the nation for performing well on industry standard quality measures. Healthcare organizations need to know where they stand with regard to quality performance since it will have a significant impact on reimbursement now and in the future.
TBS’ Response
Total Benchmark Solution, LLC’s (TBS’) goal is “To Have the most robust solution for analyzing Quality Measures to enable Healthcare Organizations to improve performance and healthcare purchasers to make the best decisions when selecting providers.” TBS’s solution – Pay for Performance Monitoring and Best Demonstrated Practices Assessments which include:
- Pay for Performance Monitor Summary Report
- Pay for Performance Monitor Detail Report
- Best Demonstrated Practices Assessment
- Practice Performance Report
TBS analyzes your healthcare organizations data for CMS care areas using sophisticated calculation tools and provides you with a full line of Pay for Performance Monitoring and Best Demonstrated Practice Assessment reports. These reports can be generated and regenerated at any time to give your organization a window to see where each facility stands on pay for performance reimbursements and best demonstrated practices.
Below is a synopsis of the solutions we provide for you to monitor your pay for performance and assess your best demonstrated practices.
Facility Pay for Performance Detail
The Facility Pay for Performance Detail gives a breakdown of each facility’s care area pay for performance. Bonus and penalty estimates are shown by period and year to date. Trend Graphs allow for viewing progress over time and percentiles show nationwide CMS Quality Area rankings.
|
ST. JOSEPH’S Acute Care STEAMBOAT SPRINGS, CO – Bed Size: 321 – ID: 158612
|
Care
Area
|
Monthly
Nationwide
Percentile
|
Monthly
Graphic
|
Trend Graphic
|
Estimated
Bonus /
Penalty
|
Estimated
Missed
Opportunity
|
YTD
Nationwide
Percentile
|
YTD
Graphic
|
YTD
Estimated
Bonus / Penalty
|
YTD Missed
Opportunity
|
Heart Attack
(98.5%) |
90.64% |
2% |
 |
$13,333.33 |
$0.00 |
92.82% |
2% |
$106,666.67 |
$0.00 |
Best Demonstrated Practice Assessment
The Best Demonstrated Practice Assessment allows an organization to analyze the results for Best Demonstrated Practice Surveys that are taken by each facility and compare them to their health system rankings. The Best Demonstrated Practices Assessment table columns show:
- Area - Related practices are combined into best demonstrated practice areas for use in evaluation
- Number of Practices – The total number of best demonstrated practices for an area
- Number Implemented – The number of best demonstrated practices implemented by a facility for an area
- Percent Implemented – The percent of best demonstrated practices implemented for an area
- Health System Percentile – The percentile where the facility stands in the health system
- Health System Rank – The facility standing within the health system
ST. JOSEPH’S Acute Care STEAMBOAT SPRINGS, CO – Bed Size: 321 – ID: 158612
Best Demonstrated Practice Assessment |
| Area |
Number of Practices |
Number Implemented |
Percent Implemented |
Health System Percentile |
Health System Rank |
| Quality Management |
4
| 2
| 50%
| 55.32%
| 22 out of 48
|
| Abstracting |
6
| 2
| 33.33%
| 55.32%
| 22 out of 48
|
| Heart Failure Care |
6
| 3
| 50%
| 59.57%
| 20 out of 48
|
| Pneumonia Care |
4
| 2
| 50%
| 61.70%
| 19 out of 48
|
|
| Totals: |
20 |
9 |
45% |
57.98% |
21 out of 48 |
Measure History
Measure history gives prior period CMS quality measure history for any time period that data was submitted. Peer comparisons allow for evaluation against other peer groups.
| ST. JOSEPH’S
|
AMI
1 |
AMI
2 |
AMI 3 |
AMI 4 |
AMI
5 |
AMI
6 |
AMI 7a |
AMI 8a |
CHF 1 |
CHF 2 |
CHF 3 |
CHF 4 |
CAP 1 |
CAP 2 |
CAP 3b |
CAP 4 |
CAP 5b |
CAP 6 |
SIP 1 |
SIP 3 |
| 2004 |
100% |
N/A |
N/A |
N/A |
100% |
53% |
99% |
64% |
93% |
93% | 86% |
N/A |
99% |
64% |
67% |
79% |
25% |
83% |
85% |
63% |
| March 2005 |
100% |
100% |
93% | N/A |
N/A |
100% |
100% |
93% |
94% |
90% |
99% |
64% |
89% |
62% |
80% |
76% |
N/A |
100% |
90% |
88% |
| Peer Group 1
| 90% |
87% |
77% |
80% |
93% | 85% |
82% |
99% |
64% |
98% |
51% |
84% |
71% |
71% |
45% |
65% |
81% |
90% |
71% |
45% |
| Peer Group 2
| 94% |
93% |
79% |
87% |
93% | 90% |
89% |
98% |
43% |
82% |
68% |
72% |
58% |
75% |
99% |
64% |
82% |
68% |
78% |
65% |
Best Demonstrated Practice Detail
The best demonstrated practice detail shows the results for each practice overall, by category and individually. Pie Graphs allow for easy viewing of facility and peer group results.
| Questions |
Headings |
Peer Group Responses |
Graphs |
|
1 - Have you implemented standard orders/protocols for admission for each measure under the condition of AMI?
|
1)No
2)Yes
|
42%
58%
|
|
|
2 - Have you implemented standard orders/protocols for discharge to include each measure under the condition of AMI?
|
1)No
2)Yes
|
50%
50%
|
|
Care Area Performance
The Care Area Performance gives a brief overview of where each facility within a healthcare organization stands on pay for performance in a given period. Each care area is shown by its own Care Area Performance table. Easy to read tables show facilities that have potential to receive 1% or 2% bonuses, missed opportunities, and 1% or 2% penalties by care area.
| Facility |
Percentile |
2% Bonus |
Score |
| ST ANTHONY'S HOSPITAL |
98.74% |
$11,166.67 |
98.75% |
| COMMUNITY GENERAL HOSPITAL |
94.31% |
$21,666.67 |
93.25% |
| ST JOSEPH'S ACUTE CARE |
90.31% |
$13,333.33 |
91% |
| Facility |
Percentile |
1% Bonus |
Score |
| No Facilities |
| Facility |
Percentile |
Missed
Opportunity |
Score |
| AMERICAN GENERAL HOSPITAL |
59.06% |
$7,833.33 |
77.75% |
| Facility |
Percentile |
1% Penalty |
Score |
| No Facilities |
| Facility |
Percentile |
2% Penalty |
Score |
| No Facilities |
Practice Performance Care Area Matrix
The Practice Performance Care Area Matrix allows your healthcare organization to graphically view which facilities have better care area performance against how many best demonstrated practices they have implemented.
- The vertical lines indicate where the 10th, 20th, 80th and 90th percentiles exist
- Colors of the Matrix indicate:
- Green - High Number of Practices Implemented and High Quality Score
- Yellow - Low Number of Practices Implemented and High Quality Score
- Orange - High Number of Practices Implemented and Low Quality Score
- Red - Low Number of Practices Implemented and Low Quality Score
- Numbers show the hospital position on the matrix
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