Understanding Your Hospital Relative Quality Index

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Understanding YourHospital Relative Quality Index

• June 2009

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Things to Be Covered

• Brief Recap of Index
• Why Change the Index?
• What does the new Index look like?
• How do you calculate this new Index?
• Who gets this information?
• Where to find this information on the PHA
  website?

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Why Change the Index?
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Here is the why!
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Brief Recap Of Index

• An index is not an assigned rank-order, which
  means no hospital has to be the best or
  worst. Think of it like a math test, where
  everyone wants to get 100.
• Many people will get 95 as opposed to ranking
  hospitals from 1 to 156.

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Brief Recap Of Index

• 2004 Threshold was developed and decision to
  make it static and initially below the TJC
  National Average
• 2005 Hospitals start receiving Index Scores May
• 2006 Index Score goes public on Insights and
  core measure threshold changed to TJC National
  Average. Also Medication Safety Rates were
  removed from Index

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Brief Recap Of Index

• 2008 PHA starts discussing possible changes to
  the Index in June 2008
• 2008 Index Task Force created in September 2008
  and met 11/04, 12/02
• 2009 GHA agreement to re-evaluate the Index for
  publication on DCH site
• 2009 Task Force expanded in January

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Brief Recap Of Index

• 2009  GHA further expands the Index Task Force
  membership
• 2009  GHA Board consensus to change to a model
  that is defensible, reliable, and valid (2/3
  re-affirmed 4/17)
• 2009  Task Force meetings were held 1/14, 1/21,
  2/25, 3/18, 3/25, 4/8, 5/27, 6/3, 6/9

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Brief Recap Of Index

• Department of Community Health wanted ONE number
  to post to their website that was reflective of
  quality in Georgia
• Their suggestions were infection rates or raw
  mortality
• GHA suggested the Hospital Relative Quality
  Indicator Score

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Why Change the Index?

• The Hospital Relative Quality Index had not had
  any changes to it since 2006
• As the Nation has improved in Core Measures we
  were still measuring against average
• Best-Practice Committee decided that average was
  no longer good enough
• And so the snowball rolled..

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What does the new Index look like?

• Old Index
• 3 Sections Process Measures, Outcomes, and
  Patient Safety
• The index was weighted as follows
• Process at 40
• Outcomes at 40
• Patient Safety at 20
• The target for the process measures was the
  National Average

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What does the new Index look like?

• Old Index
• Full points were received for Outcomes Measures
  if observed/expected (O/E ratio) was less than 1
• ARHQ indicators without the POA flag were used as
  a bundled measure

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What does the new Index look like?

• New Hospital Relative Quality Index has 2
  sections
• Process and Outcomes
• Patient Safety was removed but is to be revisited
  next year
• Patient Satisfaction will also be evaluated next
  year
• The Index will be reviewed annually from now on

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Process Section
Outcomes Section
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What does the new Index look like?

• Process Section
• Consists of AMI, HF, PN, and SCIP measures
• HCO Rate is compared against a score of 100
• Weighted at 60 instead of 40
• Core Measures play an important part in the
  national ranking of Healthcare in Georgia
• The consensus that these measures are what they
  are with no issues related to risk or severity
  adjustments

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What does the new Index look like?

• Process Section
• Each of the Core Measure sets is given a weight
  of 25 for a total of 100
• The 25 points is spread across the number of
  measures in the measure set
• Hospitals will be scored on the total number of
  points submitted and therefore their total may be
  less than 100
• This is done so that hospitals are not penalized
  for not submitting all indicators and/or measure
  sets.

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How do you calculate this new Index?

• Calculating Your Process Section Example

Please note that while calculating the total
points, all the decimals have been taken into
account to give the correct mathematical total.
Hence, the total would be listed as 23.2975
instead of 23.31. This is why when you add up
your listed points it may not give you your total
points.
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How do you calculate this new Index?

• Calculating Your Process Section
• When calculating the points for the individual
  process measures, the possible points for each of
  the process measures in a measure set are
  multiplied with the corresponding hospital rate
  to give the total points for that particular
  measure. These points are added up to get the
  Total Points for Process

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What does the new Index look like?

• Outcomes Section
• Consists of Length of Stay (LOS) and Mortality
• Weighted at 20 instead of 40
• HCO Observed/Expected ratio compared to a
  reference table and scored accordingly

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What does the new Index look like?

• Outcomes Section
• Solely based on the Risk-adjusted Mortality and
  Severity-adjusted Length of Stay
• The current risk-adjusted model used is based on
  APS Severity Adjustment Model designed by
  Ingenix.
• A reference table is used to assign a score to
  the index value (observed/expected ratio) for
  both Length of Stay and Mortality

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What does the new Index look like?

• Outcomes Section
• The reference table is based on the assumption
  that for all Georgia hospitals the median index
  for each hospital category (Critical Access
  Hospitals, Acute Care Hospitals, and Teaching
  Hospitals) is given a score of 80 for Mortality
  and 80 for Length of Stay
• Scores are then determined based on how a
  hospital performs relative to the median
  performance each quarter
• Fifty percent of the score is for Length of Stay
  and 50 is for Mortality
• Both Length of Stay and Mortality excludes
  neonates

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Conversion Table
Index Type of Hospital
Mortality Score
Length of Stay Score
Mortality Benchmark for Acute Care Hospitals
LOS Benchmark for Acute Care Hospitals
Median Mortality for Acute Care Hospitals
Median LOS for Acute Care Hospitals
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How do you calculate this new Index?

• Calculating Your Outcomes Section Example

Please note that while calculating the total
points, all the decimals had been taken into
account to give the correct mathematical total.
Hence, the total would be listed as 90.67538126
instead of 90.67. This is why when you add up
your listed points it may not give you your total
points.
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How do you calculate this new Index?

• Calculating Your Outcomes Section
• The points given in each outcomes measures are
  derived by referring the corresponding Index for
  the HCO to the respective measure on the Index
  Conversion Reference Table (see listed points
  below)
• The points for Inpatient Mortality and Length of
  Stay are then added to derive the Total Points
  for Outcomes

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How do you calculate this new Index?
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How do you calculate this new Index?
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How do you calculate this new Index?

• Calculating the Total Score Example

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Who gets this information?

• The Hospital Relative Quality Index Score and
  details will go to the CEO and the Peer Review
  Contacts
• The Hospital Relative Quality Index Score (only
  the number) will go to
• Submit to DCH Website by June 30, 2009 with
  consumer disclaimer
• Price Check
• Quality Check

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Who gets this information?

• DCH Consumer Disclaimer
• The quality index is a way of joining all kinds
  of information into one number. You can use this
  number as one tool to help you look at any
  hospital in Georgia.  You need to know that this
  is not the whole picture.  Some hospitals see
  more patients some hospitals see sicker
  patients.  We try to show this by adjusting the
  scores to make it more equal between hospitals
  this method is called risk-adjustment.  This
  index works best if you look at a lot of
  hospitals instead of just one or two.  Talking
  with your doctor to see what hospital might be
  best for you is another way to decide about
  hospitals.  You are the most important person on
  your healthcare team.

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Where to find the Index reports on the PHA
website?

• To the PHA Website http//www.gha.org/pha/
• Click on the Provider Tab

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Where to find the Index reports on the PHA
website?
3. Click on HOSPITAL DATA located at the top of
the page 4. Login screen will appear. Enter your
login and password. 5. Choose the PHA DATA
REPORTS Tab (this is where your all of your core
measure reports are located)
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Reference Websites

• Reference Websites
• Toolkit http//www.gha.org/pha/Provider/toolkits/
  index.asp
• Quality Check http//www.gahospitalqualitycheck.o
  rg/
• Price Check http//www.gahospitalpricecheck.org/
  
• DCH
• http//georgiahealthinfo.gov/cms/

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Questions?

• The only way to discover the limits of the
  possible is to go beyond them into the impossible"