Corporate Compliance Metrics

Corporate Compliance MetricsCCH Board of Directors

December 20, 2019

Meeting Objectives

Volume Indicators

• Year-Over-Year Comparison

• Annual Metrics

o Cook County Health as a Provider of Health Care Services

o CountyCare Medicaid Health Plan

2

Review Metrics

Volume IndicatorsMetrics

Year-Over-Year Contacts

4

Separating out CCH as a Provider of Care and as the CountyCare Health Plan

609 620

740

834

149 176125

307

0

100

200

300

400

500

600

700

800

900

FY 2016 FY 2017 FY 2018 FY 2019

CCH (Provider) CountyCare

Source: CCH Compliance Tracker

FY 2019 Contacts by Category

5

Categories

Privacy/Security (HIPAA) 302

Documentation 136

Regulatory/Policy 118

Human Resources 109

Contracts 54

Conflict of Interest 40

Fraud Waste & Abuse 15

Other 60

834

CCH as a Provider of Care – Dec 1, 2018 through Nov 30, 2019


834

FY 2019 Contacts by Category

6

Categories

Privacy/Security (HIPAA) 103

Regulatory/Policy 83

Contracts 53

Fraud Waste & Abuse 28

Other 40

307

CountyCare Health Plan – Dec 1, 2018 through Nov 30, 2019


307

CountyCare Special Investigation Unit (SIU) Activity

Number of Tips1 Number of New SIU Investigations2

Number of Audits3 Amount of Overpayments Collected4

48 34 2,585 $1,629,520.96

7

State Fiscal Year 2020 Q1 (July 1, 2019 – September 30, 2019)

1 Tips Incidents of suspected FWA by a provider or member; not vetted

2 Investigations Any tip that has monetary exposure; provider or member specific

3 Audits Claim lines implicated by data mining or algorithms; Data mining/algorithms are trend specific, not provider specific

4 OverpaymentsCollected

Money actually recouped and in the bank; small amount may be paid back to the provider on a corrected claim

Number of Tips

Number of Investigations

Number of Audits

Amount of Overpayments Collected

237 170 26,424 $ 1,986,699.41

For comparison:SFY2019 numbers

Source: CountyCare Compliance Reporting to HFS

Questions?

CCH Board Meeting December 2019

Ekerete Akpan, Chief Financial OfficerDecember 20, 2019

Systems-wide Financials, Observations, and Revenue Cycle Metrics

Observations on Financials

Net Patient Service Revenues - $625M, 5% unfavorable to target due to increasing and unsustainable growth in

charity care, some lower clinical activity and lower revenue cycle activity

• System-wide uninsured numbers

• Captured by Visits, held at 45%

• Captured by Charges, held at 40%

CountyCare Capitation Revenues - $1.6B, 5% unfavorable to target due to lower than budgeted enrollment as a

result of lower State/County MCO enrollment

Other Revenues - $14M , trending to exceed FY2019 target

Cost of Pharma - $76M, unfavorable by 3% compared to budget and closely monitored/managed to get to target

3Source: Finance Department, Business Intelligence & CountyCare

4

* Uncompensated Care is Charity Care + Bad Debt at cost** FY2018 Actual from Audited Financials***FY2019 projected

NOTE: Some numbers are rounded to nearest million for display purposes and could result in small arithmetical differences.

252

174

266 281 273

348377

284

140

139157 200

154

167

FY2013 FY2014 FY2015 FY2016 FY2017 FY2018 ** FY2019 ***

Charity Care Cost Bad Debt Cost

Source: Finance Department & Audited Financials

Income Statement for the Eleven Months ending October 2019 (in thousands)

5

*Year to Date (11 months) Pension Liability per GASB Pension includes Other Post Employment Benefits (OPEB) Expense

Internal Claims based on paid claims and estimated IBNR provided by third-party actuaries priced at 100% of Medicaid rates Unaudited Financial Statement

Balance Sheet for the Eleven Months ending October 2019 (in thousands)

6Unaudited Financial Statement

Year to Date (11 months) Pension Liability per GASB Pension includes Other Post Employment Benefits (OPEB) Expense

Internal Claims based on paid claims and estimated IBNR provided by third-party actuaries priced at 100% of Medicaid ratesCook County Health reflects a refundable deposit asset of $50 million. The actual balance of this deposit may vary due to claims payment timing, however, replenishment of the deposit is reflected in Claims Payable on the balance sheet.

Balance Sheet for the Eleven Months ending October 2019 (in thousands)

7Unaudited Financial Statement

Year to Date (11 months) Pension Liability per GASB Pension includes Other Post Employment Benefits (OPEB) Expense

Internal Claims based on paid claims and estimated IBNR provided by third-party actuaries priced at 100% of Medicaid ratesCook County Health reflects a refundable deposit asset of $50 million. The actual balance of this deposit may vary due to claims payment timing, however, replenishment of the deposit is reflected in Claims Payable on the balance sheet.

Financial Metrics

8

*Days Cash in Hand – Point in time i.e. as of end of each month. Note State owed CCH in payments as of end October 2019. This represents an of Cash in Hand

**Excludes Pension Expense-Target based on compare group consisting of ‘like’ health systems : Alameda Health System, Nebraska Medical Center, Parkland Health & Hospital System, and UI Health. ( )-Moody’s report, August 2017 2.7%***Overtime as percentage of Gross Salary – CCH target 5% , Moody's 2% Report, August 2017 **** Average age of plant (years) ( )-Moody’s report, August 2017 11.2 years

Metric As of end Oct.-

18/YTD

As of end Oct.-

19/YTD

CCH Target

RatingAgency

Target

Days Cash On Hand* 30 1 60 204.7

Operating Margin** -4.8% -11.4% -5.4% 2.7%

Overtime as Percentage of Gross Salary*** 7.4% 7.7% 5.0% 2.0%

Average Age of Plant (Years)**** 24.4 23.2 20 11.2

Revenue Cycle Metrics

9

: Total accounts receivable over average daily revenue: Total charges of discharge not finally billed over average daily revenue

: Percentage of claims denied initially compared to total claims submitted.* Source HFMA Key Hospital Statistics and Ratio Margins – Posted 2014

** ( )-Moody’s report, August 2017 47.8 days***( )-American Academy of Family Physicians, 5-10% industry average

Metric Average FYTD2019

Sept.-19 Oct.-19 Nov.-19

CCH

Benchmark

/Target

Target

Average Days in Accounts Receivable (lower is better)

97 96 91 87 45.85 –

54.9*

47.8**

Discharged Not Finally Billed Days (lower is better)

11 12 13 10 7 5*

Claims Initial Denials Percentage (lower is better)

20% 21% 22% 21% 20%5-10%***

Strategic Plan - 2020 - 2022 Select Financial and Revenue Objectives

Revenue Cycle - Journey to Excellence Building on the gains of Impact 2020

11

• Systems wide assessment conducted in summer 2017

• Clinical documentation Improvements ongoing

• New coding software in place

• Denials management software, ongoing training

• Third party billing supplemental staffing and technologies

• Cerner Patient Accounting – Ongoing end-to-end process improvements

• Outcomes

• Consistent year-over-year growth in gross charges capture

• Consistent year-over-year growth in cash collections

• Sustained growth in Case Mix Index

Strategic Imperative – Impact 2020 - 2022

Increase Domestic Spend2.1 Establish CCH as a provider of choice.

2.1 I Generate sufficient revenues to ensure continuation of CCH’s historical mission.

Increased service line revenues, including CountyCare domestic spend.

Advocate for Care for the Uninsured

2.1 Establish CCH as a provider of choice.

2.1 I Generate sufficient revenues to ensure continuation of CCH’s historical mission. Advocate for strategies to care for the uninsured.

Protect Current Revenue Streams

2.1 Establish CCH as a provider of choice.

2.1 I Generate sufficient revenues to ensure continuation of CCH’s historical mission.

Protection of existing revenue streams. Advocate for strategies to care for the uninsured.

MCO Revenue 3.1 Optimize CCH revenue.

3.1 A Maximize reimbursements from payors by continuing to improve operations, including revenue cycle improvements.

Increase MCO revenue by 10% each year from FY2019 baseline. Achieve 60% Pay for Performance (P4P) targets and benchmarks; Increase provider empanelment for MCOs to 80% of Medical Group Management Association (MGMA) or the FQHC benchmark. Reduce claims denials for managed care organizations by 80% from current levels and reduce accounts receivable. Improve authorization process for inpatient/observation care by Inpatient Care Coordination team for CountyCare members.

12

Strategic Imperative – Impact 2020 - 2022

Patient Accounting System 3.1 Optimize CCH revenue.

3.1 H Optimize information technology infrastructure to improve revenue capture and financial reporting.

Successful implementation of patient accounting system, online bill payment, online financial counseling and routine financial reporting.

Documentation 3.1 Optimize CCH revenue.

3.1 C Continually improve documentation through ongoing provider feedback and provider education to support timely, complete and accurate billing.

Write and implement a three-year plan to improve documentation.

Unfunded Mandates 3.1 Optimize CCH revenue.

3.1 G Advocate for local government financial support of unfunded mandates such as correctional health and public health services.

Public and Correctional Health expenses continue to be covered by local taxpayer support.

Pharmacy 3.3 Manage Pharmaceutical Expenses and Optimize Revenue 3.3 A Optimize pharmacy economics.

Revenue optimize: Identify contractual opportunities to increase pharmacy reimbursement for current formulary products. Insource specialty pharmaceuticals creating opportunity to generate revenue. Minimize Expenses: Maximize use of programs available that will reduce medication expense (such as 340B program) or that will allow eligible patients to obtain required medications through external programs (such as insurance Medication Assistance Programs). Reduce practice variation, especially around chronic disease management, to ensure prescriptions are evidence-based, decreasing variation of drug uses among expense classes.

13

Self Pay – Current Situation

Financial Counseling Process (Flow Chart)

15Source: CCH Finance - Revenue Cycle

21

Non Emergent “Self Pay” Gross Charges vs. Payments (in $millions) • 17% year-over-year increase in charges• Declining year-over-year payments


Source: CCH Finance / Revenue Cycle as of 11/23/2019

22


Source: CCH Finance / Revenue Cycle as of 11/23/2019

Where are non-emergent Self-Pay Charges incurred?• 17% year-over-year increase in gross charges• Declining year-over-year payments

AMBULATORY SURGERY $ 23.37 $ 0.13 0.6% $ 25.48 $ 0.04 0.2% 9.0%

MEDICINE $ 15.85 $ 0.18 1.1% $ 17.39 $ 0.09 0.5% 9.7%

GEN MEDICINE $ 34.34 $ 0.20 0.6% $ 41.75 $ 0.10 0.2% 21.6%

FAMILY PRACTICE $ 7.13 $ 0.13 1.8% $ 10.76 $ 0.05 0.5% 50.9%

SURGERY $ 5.90 $ 0.02 0.4% $ 7.63 $ 0.01 0.1% 29.3%

GYNECOLOGY $ 4.21 $ 0.03 0.7% $ 5.59 $ 0.01 0.2% 32.7%

RADIATION THERAPY $ 2.93 $ 0.30 10.1% $ 5.13 $ 0.03 0.5% 75.1%

All Other Services $ 64.80 $ 0.98 1.5% $ 71.63 $ 0.43 0.6% 10.5%

23

Strategic Considerations - What do others do?


• Continuous improvement in upstream revenue cycle process

• Refine and update self-pay policies to include co-pays for insured or payments

for others

• Refine and update policies on taking self-pay transfers from other healthcare

facilities as appropriate

• Build-out of point of service collections /payment capacity including;

• Online payments as part of patient portal improvements

• Kiosks with payment options

• Industry standard job functions and training of staff to collect /swipe Cash

or credit/debit cards

Questions?

Human Resources MetricsCCH Board of Directors

Barbara Pryor

Chief Human Resources Officer

December 20, 2019

Metrics

CCH HR Activity Report

3Does not include Consultants, Registry and House Staff

Thru 11/30/2019

142

173185

206

242231 227

133

0

50

100

150

200

250

300

FILLED POSITIONS 2018 Filled (706) | Externals (461)

2019 Filled (833) | Externals (581)

15398 89 74

155121

149110

0

100

200

SEPARATIONS2018 Separations (414) 2019 Separations (535)

160 Externals

120Externals

100Externals

159 Externals

161 Externals

104Externals

137Externals

101Externals

Deceased Discharged Resignation Retirement

FY18 (414) 8 39 192 175

FY19 (535) 5 90 243 197

8

39

192 175

5

90

243

197

0

50

100

150

200

250

300

52%48%

NET

External Hire-581

Separations-535

46

CCH HR Activity Report

4Does not include Consultants, Registry and House Staff

Thru 11/30/2019

Finance (32) HIS (3) Nurse (108) Other (311)Pharmacy

(26)Physician

(55)

Deceased (5) 0 1 3 1 0

Discharged (90) 6 17 60 4 3

Resignation (243) 13 2 43 144 13 28

Retirement (197) 13 1 47 104 8 24

0

20

40

60

80

100

120

140

160

SEPARATIONS BY CLASSIFICATION - 472

Cook County Health HR Activity Report – Open Vacancies

5

0

139

11095 90 90

203

140

10895.9 96.4 100

0

50

100

150

200

250

FY14 FY15 FY16 FY17 FY18 FY19

Average Time to Fill(Without Credentialed1)

Goal Actual

Improve/Reduce Average Time to Hire*

1Credentialed Positions: Physicians, Psychologist, Physician Assistant I and Advanced Practice Nurses.

Cook County Health HR Activity Report – Hiring Snapshot

6

5 10 3247

17 5122

8421 833

0

200

400

600

800

1,000

1,200

Co

un

t o

f p

osit

ion

s

421 Positions in Recruitment

Thru 11/30/2019

178 ( 42%) of the positions in process are in the post-validation phase

106

Classification & Compensation (2)40%

HR - PCA (2)40%

Hiring Manager (1)

20%

Shared Responsibility Human Resources Management Human Resources Shared Responsibility

Clinical Positions – 325 / 77%Non-Clinical Positions – 96 / 23%

581 / 70% Externals

CCH HR Activity Report – Turnover

7

Quarter 1 Quarter 2 Quarter 3 Quarter 4

FY19 CCH Turnover 2.4% 4.3% 6.6% 8.4%

FY18 CCH Turnover 2.4% 4.0% 5.4% 6.5%

FY17 U.S. IL Health & Hospital Assoc.Turnover Data

3.7% 4.0% 4.5%

FY19 U.S. Dept. of Labor Turnover Data 3.7% 3.7% 3.8% 3.8%

2.4%

4.3%

6.6%

8.4%

2.4%

4.0%

5.4%

6.5%

3.7%4.0%

4.5%

3.7% 3.7% 3.8% 3.8%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%CCH TURNOVER

Turnover Year-to-DateHead Count: 6,404

YTD Cumulative Totals:

No Report

FY19 data is through 11/30/2019

Include Consultants, Registry and House Staff

Thank you.

Appendix

Cook County Health HR Activity Report – Nursing Hiring

10

1 3 313

5 184 21

9 236

0

50

100

150

200

250

300

350

Co

un

t o

f p

osit

ion

s Classification & Compensation

76 Positions in process

Thru 11/30/2019

52 ( 68%) of the positions in process are in the post-validation phase

25


154 / 65% Externals

Nursing Activity Report – Turnover

11

Quarter 1 Quarter 2 Quarter 3 Quarter 4

FY19 CCH Turnover YTD 1.7% 3.6% 5.9% 7.4%

FY18 CCH Turnover YTD 2.2% 3.6% 4.5% 5.2%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%CCH TURNOVERTurnover Year-to-DateHead Count: 1,469

YTD Cumulative Totals:

FY19 data is through 11/30/2019

Include Registry

FY19: 1,469 - Nurses / 108 - SeparationsFY18: 1,403– Nurses / 73 - Separations

1

43 47

17

2

3038

3

0

20

40

60

Deceased Resignation Retirement Discharged

FY19 (108) FY18 (73)

Cook County Health HR Activity Report – Revenue Cycle

12

1

0 0 0

1

0

22

2

28

0

5

10

15

20

25

30

35

40

Co

un

t o

f p

osit

ion

s7 Positions in process

Thru 11/30/2019


Classification & Compensation

CountyCare UpdatePrepared for: CCH Board of Directors

James Kiamos

CEO, Health Plan Services

December 20, 2019

Current Membership

Category Total Members ACHN Members % ACHN

FHP 211,159 16,083 7.6%

ACA 72,636 12,379 17.0%

ICP 29,635 5,791 19.5%

MLTSS 5,985 0 N/A

Total 319,415 34,253 10.7%

2

Monthly membership as of December 3, 2019

ACA: Affordable Care Act

FHP: Family Health Plan

ICP: Integrated Care Program

MLTSS: Managed Long-Term Service and Support (Dual Eligible)

Source: CCH Health Plan Services Analytics

Managed Medicaid Market

3

Illinois Department of Healthcare and Family Services October 2019 Data

Managed Care OrganizationCook CountyEnrollment

Cook County Market Share

*CountyCare 319,471 31.5%

Blue Cross Blue Shield 241,143 23.8%

Meridian (a WellCare Co.) 225,637 22.3%

IlliniCare (a Centene Co.) 107,769 10.6%

Molina 65,143 6.4%

*Next Level 54,554 5.4%

Total 1,013,717 100.0%

* Only Operating in Cook County

Meridian and WellCare (dba Harmony) merged as of 1/1/2019. Pending Merger with Centene (dba IlliniCare)

CVS/Aeta purchasing IlliniCare legacy Medicaid

Source: https://www.illinois.gov/hfs/MedicalProviders/cc/Pages/TotalCCEnrollmentforAllPrograms.aspx

IL Medicaid Managed Care Trend in Cook County(charts not to scale)

• CountyCare’s monthly enrollment trend closely follows the overall Managed Care enrollment

trend in Cook County

CountyCareCook County Medicaid Managed Care


970,000

980,000

990,000

1,000,000

1,010,000

1,020,000

1,030,000

1,040,000

1,050,000

1,060,000

Nov'18

Dec'18

Jan'19

Feb'19

Mar'19

Apr'19

May'19

Jun'19

Jul'19

Aug'19

Sep'19

Oct'19

Cook County Medicaid Managed Care

305,000

310,000

315,000

320,000

325,000

330,000

335,000

Nov'18

Dec'18

Jan'19

Feb'19

Mar'19

Apr'19

May'19

Jun'19

Jul'19

Aug'19

Sep'19

Oct'19

CountyCare

4

IL Medicaid Managed Care Trend in Cook County

• CountyCare’s monthly enrollment trend closely follows the overall Managed Care enrollment

trend in Cook County

CountyCareCook County Medicaid Managed Care


0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

Nov'18

Dec'18

Jan'19

Feb'19

Mar'19

Apr'19

May'19

Jun'19

Jul'19

Aug'19

Sep'19

Oct'19

Cook County Medicaid Managed Care

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

Nov'18

Dec'18

Jan'19

Feb'19

Mar'19

Apr'19

May'19

Jun'19

Jul'19

Aug'19

Sep'19

Oct'19

CountyCare

5

Overall Care Management Performance

6

Performance

Key Metrics Market % Aug Sep Oct

Completed HRS/HRA (all populations)

Overall Performance 40% 66.3% 67.0% 67.4%

Completed Care Plans on High Risk Members

Overall Performance 65% 62.2% 62.0% 63.2%

CountyCare’s high-risk percentage exceeds the State’s requirement of 2% for Family Health Plan and 5% for

Integrated Care Program


Claims Payment

7

Performance

Key Metrics State Goal Aug Sep Oct

Claims Payment

% of Clean Claims Adjudicated < 30 days

90% 95.8% 94.0% 95.9%

% of Claims Paid < 30 days 90% 32.2% 24.5% 34.2%


Paid Claims Timing, September to October

• Process to catch up on provider payments began with Cook County in October

• Expect trend to continue to improve in November

Month Number of Claims Paid

Dollars Paid % Paid < 30 Days

% Paid < 90 Days

September 318,090 $83,923,345 24.5% 43.0%

October 608,768 $155,453,736 34.2% 53.4%


8

QPS Quality Dashboard

December 13, 2019

3

48.5%

HEDIS 75th %tile: 55%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19

HEDIS – Diabetes Management: HbA1c < 8%

Source: Business Intelligence

4

87.9%

100%Goal: 100%

0%

20%

40%

60%

80%

100%

120%


Core Measure – Venous Thromboembolism (VTE) Prevention

Stroger Provident

Source: Quality Dept.

5

11.0%

9.6% 9.70%10.4%

16%

15%

8.56%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

CY18 Q4 CY19 Q1 CY19 Q2 CY19 Q3

30 Day Readmission Rate

IL AVG National AVG HRO Goal


Hospital Acquired Conditions

6

1 1 2 30 0 0 0 1

30 1

20

32

17

2623 24

26 2730

24

14

20

0

5

10

15

20

25

30

35Pressure Injury (Stage III & IV) Total HAPI


17

8

16

7

11

15

7

1211

5

9

5

0

2

4

6

8

10

12

14

16

18


Falls with Injury


1.8

1.1

2.1

0.57

Goal: 00

0.5

1

1.5

2

2.5

CY18 Q4 CY19 Q1 CY19 Q2 CY19 Q3

Hospital Acquired InfectionsCAUTI CDI CLABSI MRSA

7

Nov-18

Dec-18

Jan-19

Feb-19

Mar-19

Apr-19

May-19

Jun-19

Jul-19

Aug-19

Sep-19

Oct-19

CAUTI 1 3 1 1 2* 1 2* 5 6 2 3 0

CDI 4 4 6 2 6 5 4 4 9 5 7 7

CLABSI 0 2 1 0 2* 2 2 3 2 4 1 1

MRSA 1 0 1 0 1 0 0 2 0 0 1 1

SIR (Standardized Infection Ratio) is a summary measure which compares the actual number of Healthcare Associated Infections (HAI) in a facility with the baseline data for standard population. SIR > 1.0 indicates more HAIs were observed than predicted, conversely SIR of < 1.0 indicates that fewer HAIs were observed than predicted.

Source: Infection Control Dept.*Amended

8

58.8%

69.3%

90th %tile: 82%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Dec17 -Nov18

Jan18 -Dec18

Feb18 -Jan19

Mar18 -Feb19

Apr18 -Mar19

May18 -Apr19

Jun18 -May19

Jul18 -Jun19

Aug18 -Jul19

Sep18 -Aug19

Oct18 -Sep19

Nov18 -Oct19

To

p B

ox

Sco

re

ACHN – Overall Clinic Assessment

ACHN Top Box Score Press Ganey Top Box Mean

Source: Press Ganey

9

69.6%

72.0%

90th %tile: 84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Dec17 -Nov18

Jan18 -Dec18

Feb18 -Jan19

Mar18 -Feb19

Apr18 -Mar19

May18 -Apr19

Jun18 -May19

Jul18 -Jun19

Aug18 -Jul19

Sep18 -Aug19

Oct18 -Sep19

Nov18 -Oct19

To

p B

ox

Sco

re

Provident – Willingness to Recommend the Hospital

Provident Top Box Score Press Ganey Top Box Mean

Source: Press Ganey

10

71.0%

72.0%

90th %tile: 84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Dec17 -Nov18

Jan18 -Dec18

Feb18 -Jan19

Mar18 -Feb19

Apr18 -Mar19

May18 -Apr19

Jun18 -May19

Jul18 -Jun19

Aug18 -Jul19

Sep18 -Aug19

Oct18 -Sep19

Nov18 -Oct19

To

p B

ox

Sco

re

Stroger – Willingness to Recommend the Hospital

Stroger Top Box Score Press Ganey Top Box MeanSource: Press Ganey

Measure Name Measure Definition Source

Diabetes Management HbA1c <8%

Adults ages 18-75 with diabetes (type 1 or type 2) where HbA1c is in control (<8.0%).

Qualifying patients:

- Age 18-75 years as of December 31 of current year AND two diabetic Outpatient/ED visits in the current year or previous year

OR

-One diabetic Inpatient visit in the current year or previous year

OR

-Prescribed insulin or hypoglycemic or antihyperglycemics in the current year or previous year

NCQA,

HEDIS

Core Measure-Venous

Thromboembolism (VTE) Prevention

Percentage of surgical patients aged 18 years and older undergoing procedures for which venous thromboembolism (VTE) prophylaxis is

indicated, who had an order for Low Molecular Weight Heparin (LMWH), Low- Dose Unfractionated Heparin , adjusted-dose warfarin,

fondaparinux or mechanical prophylaxis to be given within 24 hours prior to incision time or within 24 hours after surgery end time

CMS

Readmission RateThe readmission measures are estimates of unplanned readmission to an acute care hospital in the 30 days after discharge from a

hospitalization. Patients may have had an unplanned readmission for any reason.CMS

Hospital Acquired Pressure Injuries

A pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or

other device. Full thickness pressure injuries involve the epidermis and dermis, but also extend into deeper tissues (fat, fascia, muscle,

bone, tendon, etc.)

CMS, AHRQ

Falls with Injury A patient fall is an unplanned descent to the floor (or extension of the floor, e.g., trash can or other equipment) with injury to the patient. TJC, NDNQI

Hospital Acquired Infections - CAUTI Catheter-associated urinary tract infections NHSN

Hospital Acquired Infections - CDI Clostridium difficile intestinal infections NHSN

Hospital Acquired Infections - CLABSI Central line-associated bloodstream infections NHSN

Hospital Acquired Infections - MRSA Methicillin-resistant Staphylococcus Aureus blood infections NHSN

Press Ganey Patient Satisfaction Top

Box Score

The percentage of responses in the highest possible category for a question, section, or survey (e.g. percentage of ‘Very Good,’ or ‘Always’

responses). Press Ganey

Press Ganey Patient Satisfaction

Percentile Rank

A percentile rank tells you where your score falls in relationship to other scores. Percentile rank for any given metric in any peer group is

determined by ordering all facilities’ scores from highest to lowest, then each score receives a percentile rank by determining the

proportion of the database that falls below that score. For example, if your percentile rank is 30, you are scoring the same as or better

than 30% of the organizations you are compared to.

Press Ganey

ACHN Patient Satisfaction-Overall

Assessment

Includes two questions:

1. How well the staff worked together to care for you.

2. Likelihood of your recommending our practice to others.

Press Ganey

Hospital Patient Satisfaction-

Willingness to Recommend HospitalThe likelihood that a patient will recommend a hospital to family members and friends. Press Ganey

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Corporate Compliance Metrics

Documents

Transcript of Corporate Compliance Metrics