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FY 2015 New Access Point Clinical and Financial Performance Measures Technical Assistance Presentation Health Resources and Services Administration Department of Health and Human Services NAP TA Website: http://www.hrsa.gov/grants/apply/assistance/nap http://www.hrsa.gov/grants/apply/assistance/nap Slide 2 Agenda Overview of Performance Measures Financial Performance Measures Clinical Performance Measures Resources 2 Slide 3 Overview Performance Measures Serve as ongoing monitoring and performance improvement tools Are required in the NAP application to set baselines and goals for the NAP project Should be integrated into all aspects of the organizations performance improvement and evaluation process Are required as part of annual reporting in the Uniform Data System (UDS) See Appendix B in the funding opportunity announcement and the UDS Manual for information http://bphc.hrsa.gov/healthcenterdatastatistics/index.html http://bphc.hrsa.gov/healthcenterdatastatistics/index.html 3 Slide 4 Overview Performance Measures Forms Focus Area Performance Measure Numerator Description Denominator Description Target Goal Description Baseline Data Projected Data (by End of Project Period) Data Source & Methodology Key Factors and Major Planned Actions 4 Slide 5 Overview of the Financial Performance Measures 5 Slide 6 Focus Area, Measure, and Goal Focus area and measure are shown in the form Goal Description: shown as annual rate of increase and absolute target at the end of the 2-year project period 6 Slide 7 Measure Calculation Description The numerator and denominator are described for each measure Use the numerator and denominator to set the baseline and two-year goal Goals are set in relation to the baseline 7 Slide 8 Baseline Data Baselines are set using data from the calendar year and audit period completed prior to the application submission If baseline data are not available, state when they will be 8 Slide 9 9 Key Factors and Planned Actions Provide at least one contributing and one restricting factor for each measure Contributing factorspositive impact Restricting factorsnegative impact Planned strategies to address Slide 10 Financial Performance Measures Total cost per patient The dollar value of services provided Medical cost per medical visit Medical cost efficiency Change in net assets to expense ratio Financial performance during audit period Working capital to monthly expense ratio Current financial condition Long term debt to equity ratio Long term financial condition 10 Slide 11 Total Cost Per Patient Measurement: The dollar value of services provided Description: Total accrued cost before donations and after allocation of overhead divided by total patients Total cost before donations Defined by UDS table 8a, line 17, column c Facility and administrative costs are included Donated/In-kind costs are excluded Formula: (T8A,L17,CC / T4,L6,CA) 11 Slide 12 Calendar Year Patient Data Unduplicated patients in the calendar year for the NAP scope of project only Patients defined as individuals with one or more reportable visits during the calendar year Unduplicated patients are reported in the UDS on tables 3a, 3b and 4 See UDS Manual for definitions: http://bphc.hrsa.gov/healthcenterdatastatistics/index.html http://bphc.hrsa.gov/healthcenterdatastatistics/index.html 12 Slide 13 Medical Cost per Medical Visit Measurement: Medical cost efficiency Description: Total accrued medical staff and medical other cost after allocation of overhead divided by non-nursing medical visits (excludes nursing and psychiatrist visits) Medical cost is defined by UDS table 8a, line 1 plus line 3, column c and excludes lab, x-ray, pharmacy, and other clinical costs Formula: (T8A,L1,CC + T8A,L3,CC) / (T5,L15,CB - L11,CB) 13 Slide 14 Calendar Year Visit Data Reportable visits include six types of service visits: Medical, dental, mental health, substance abuse, vision, and other professional A reportable visit must meet the following criteria: Face-to-face contact between the patient and clinician The clinician must be licensed or credentialed The clinician must be acting independently The visit must be documented in the patient record 14 Slide 15 Calendar Year Medical Visit Data Reportable medical visits in the calendar year for the NAP scope of project only Medical visits are defined and reported in the UDS on table 5 Medical visits used in the medical cost per medical visit measure exclude nursing visits, table 5, line 15 minus line 11, column b 15 Slide 16 Change in Net Assets to Expense Ratio Measurement: Financial performance during the audit period Description: Change in net assets divided by total expenses Formula: (Ending Net Assets - Beginning Net Assets) / (Total Expense) Also known as: Change in net assets as a percent of expense expressed as a % rather than a number 16 Slide 17 Change in Net Assets to Expense Sample 17 Slide 18 Working Capital to Monthly Expense Ratio Measurement: Current financial condition related to size of operation Description: Working capital, defined as current assets less current liabilities, divided by average monthly expense Formula: (Current Assets - Current Liabilities) / (Total Expense / Number of Months in Audit) Also known as: Months in Working Capital 18 Slide 19 Sample Balance Sheet 19 Slide 20 Working Capital to Monthly Expense Ratio Sample Measure 20 Slide 21 Long Term Debt to Equity Ratio Measurement: Long term financial condition Description: Long term debt divided by net assets Formula: Long Term Liabilities / Net Assets 21 Slide 22 Tribal and Public Entities Audit measures not applicable May use substitute audit measures Comparable to financial measures: cost and viability Limit to scope of proposed NAP 22 Slide 23 Overview of the Clinical Performance Measures 23 Slide 24 Target Population Data Address ONLY the service area and target population of the proposed NAP New starts: measures based on entire proposed scope of project Satellites: measures based on proposed new access point(s) only 24 Slide 25 Clinical Performance Measures Format 25 Slide 26 Baselines 26 Starting point from which to measure trends and progress If not operating at NAP site, use experience to estimate If health center not yet operational, enter zeros and explain when baseline data will be available Slide 27 Projected Data Determine a goal for the two-year project period Goal is to demonstrate improvement over time or maintain high rate Primary purpose is to determine health care trends Benchmarks may be helpful in setting goals: o Health Center Program averages (national, state) o Other national and state data (for similar type patients) o Healthy People 2020 27 Slide 28 Data Source & Methodology Identify data source from choices Describe methodology For chart sampling methodology, see UDS Manual, Appendix C 28 Slide 29 Key Factors and Major Planned Actions 29 Provide at least one contributing and one restricting factor for each measure Contributing factorspositive impact Restricting factorsnegative impact Planned strategies to address Slide 30 16 Required Clinical Performance Measures Percentage of diabetic patients whose HbA1c levels are less than 8 percent, less than or equal to 9 percent, or greater than 9 percent Percentage of adult patients with diagnosed hypertension whose most recent blood pressure was less than 140/90 Percentage of women age 21-64 who received one or more Pap tests to screen for cervical cancer Percentage of pregnant women beginning prenatal care in the first trimester 30 Slide 31 16 Required Clinical Performance Measures Percentage of low birthweight infants (less than 2,500 grams) born to prenatal care patients Percentage of children who have received age appropriate vaccines on or before their 3rd birthday Percentage of patients age 2 to 17 years who had a visit during the measurement year and who had Body Mass Index (BMI) Percentile documentation, counseling for nutrition, and counseling for physical activity during the measurement year Percentage of patients age 18 years or older who had their calculated BMI documented at the last visit or within the last six months and, if they were overweight or underweight, had a follow-up plan documented 31 Slide 32 16 Required Clinical Performance Measures Percentage of patients age 18 years and older who were screened for tobacco use at least once during the measurement year or prior year AND who received cessation counseling intervention and/or pharmacotherapy if identified as a tobacco user Percentage of patients age 5 to 40 years with a diagnosis of persistent asthma (either mild, moderate, or severe) who were prescribed either the preferred long term control medication or an acceptable alternative pharmacological therapy during the measurement year 32 Slide 33 16 Required Clinical Performance Measures Percentage of patients age 18 years and older with a diagnosis of Coronary Artery Disease prescribed a lipid lowering therapy during the measurement year Percentage of patients age 18 years and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty (PTCA) from January 1 to November 1 of the prior year OR who had a diagnosis of Ischemic Vascular Disease (IVD) during the measurement year or prior year, who had documentation of use of aspirin or another antithrombotic 33 Slide 34 16 Required Clinical Performance Measures Percentage of patients age 50 to 75 years who had appropriate screening for colorectal cancer (includes colonoscopy 10 years, flexible sigmoidoscopy 5 years, or annual fecal occult blood test) Percentage of newly diagnosed HIV patients who had a medical visit for HIV care within 90 days of first-ever HIV diagnosis Percentage of patients aged 12 and older screened for clinical depression using an age appropriate standardized tool AND follow-up plan documented Oral Heath 34 Slide 35 Oral Health Measure 35 Create your own oral health measure Slide 36 Oral Health Measures Some examples of oral health measures: Percent of dental patients with a Phase I treatment plan completed within a 12 month period Percent of pregnant women with comprehensive dental exam completed while pregnant Percent of children 12-60 months with dental evaluation completed in last 12 months Percent of patients who visited the dentist in the past year 36 Slide 37 Additional Clinical Measures Additional measures If proposing to serve special populations, at least one measure that specifically addresses unique needs of special populations (migratory and seasonal agricultural workers, homeless individuals, public housing residents) must be included May add other measures relevant to the target population that will be tracked over the course of the project period 37 Slide 38 Resources Instructions: Appendix B of NAP funding opportunity announcement Performance Measures Forms and Examples: http://www.hrsa.gov/grants/apply/assistance/nap http://www.hrsa.gov/grants/apply/assistance/nap Clinical Performance Measures: http://bphc.hrsa.gov/policiesregulations/performancemeasures/ http://bphc.hrsa.gov/policiesregulations/performancemeasures/ UDS manual and reporting: http://bphc.hrsa.gov/healthcenterdatastatistics/reporting/index. html http://bphc.hrsa.gov/healthcenterdatastatistics/reporting/index. html National Cooperative Agreements http://bphc.hrsa.gov/technicalassistance/partnerlinks/natlagr eement.html http://bphc.hrsa.gov/technicalassistance/partnerlinks/natlagr eement.html 38 Slide 39 Resources National Quality Forum http://www.qualityforum.org/ http://www.qualityforum.org/ National Committee for Quality Assurance http://www.ncqa.org/ http://www.ncqa.org/ Institute for Healthcare Improvement http://www.ihi.org/ http://www.ihi.org/ National Quality CenterImproving HIV Care http://nationalqualitycenter.org/ http://nationalqualitycenter.org/ Healthy People 2020 http://www.healthypeople.gov/2020 http://www.healthypeople.gov/2020 39