Oregon Hospital Transformation Performance Program (HTPP), Year 2 Performance Report, June 2016

12 Jun 2016

 

The Oregon Health Authority has released the second year performance report for the Oregon Hospital Transformation Performance Program (HTPP). Salem Health (formerly Salem Hospital) will receive an incentive payment, having met or exceeded most of the measures. Salem Health West Valley is not part of this program.

Background

• HTPP was enacted by the Legislature in 2013 to support ongoing efforts by Oregon hospitals to provide services of the highest quality at a time when utilization might go down as a result of health care transformation.
• HTPP creates an incentive program that rewards hospitals that meet specific performance goals on a range of quality measures.
• The metrics and the structure were designed by the state's Hospital Performance Metrics Advisory Committee then approved by the U.S. Centers for Medicare and Medicaid Services.
• Hospitals that show improvement in quality and patient safety receive incentive payments.
• Funding for the HTPP comes from the Hospital Provider Assessment Program authorized by the Oregon Legislature (also known as the provider tax) into which Oregon’s DRG hospitals pay. As such, incentive payments are only made to DRG hospitals.

Results from 2^nd year of HTPP

• This report measures results from October 2014 through September 2015.
• Oregon hospitals are improving patient safety and the quality of care they provide.
• All 28 participating hospitals will receive some payment, ranging from $166,000 to $21.8 million.
• Salem Health met or exceeded seven of the 11 measures and will receive more than $6 million for meeting individual benchmarks or making progress toward them. Overall, hospitals met between five to 10 measures.

Salem Hospital specifics
The full report is available online.

Here are some examples for Salem Health:

• Adverse drug events due to opioids (defined as the percentage of time a patient receiving an opioid agent also received naloxone, an antidote for opiate overdose that reverses opioid intoxication). Salem Health was the most improved in the state for this measure and is better than the benchmark.
• Hospitals share ED visit information with primary care providers and other hospitals to reduce unnecessary ED visits. Salem Health went from a baseline of 42 percent to 63.2 percent, but like the majority of hospitals is below the state benchmark of 77.4 percent.
• Central Line-Associated Bloodstream Infection. Although Salem Health didn’t meet the benchmark during this reporting period, a concentrated team is working on this. Their work recently reduced the rate by more than 50 percent. The team is still at work, with the goal of getting to zero infections and staying at that level.
• HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey: Staff gave patient discharge information. Salem Health’s performance was just under the benchmark during the reporting period. The Care Management team recently developed standards for discharge process communication to patients. Additionally, they have done significant work to improve the discharge paperwork given to patients and their providers.
• ED screening for alcohol misuse, brief intervention, and referral to treatment (SBIRT) in the emergency department. Salem Health’s performance exceeded the benchmark. The ED Nursing and Care Management teams implemented the SBIRT program this year. The program is focused on screening patients for alcohol misuse and proactively intervening to avoid long-term health and safety concerns.
• Follow-up after hospitalization for mental illness. Salem Health’s score declined during the reporting period. However, we have done significant work to address this issue and developed a process that now ensures 89 percent of our patients are consistently scheduled for a follow-up visit. The group is continuing to partner with Marion County mental health providers to address the barriers that prevent patients from making it to their scheduled visit. 

Future strategy work

Several measures included in the HTPP will be included in next year’s strategy work.

• HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey: Staff always explained medicines. No hospital achieved the benchmark. Our work next year will focus on both communicating this information to patients and confirming it is understood. 
• Readmissions:  Hospital-wide all-cause readmissions. Several specific populations have been identified for attention next year. Additionally, we have done significant work this year standardizing the discharge process and implementing disease-specific transition pathways. This has resulted in a six percent drop in readmissions this year compared to last year.

Most of the HTPP results for Salem Health are positive and improvements continue to be made. Keep in mind that Salem Health’s quality work is driven by needs identified by the providers and staff at Salem Health, not the measures in the HTPP.

Salem Health has a culture of continuous improvement, where departments continually review the current condition of their unit and proactively address quality problems as they emerge.  This approach allows staff and providers to implement small changes to their work that improve the quality of care. It’s an approach about which all members of the Salem Health team can be proud.