TPS Analyzer

Total Performance Score (TPS)

Medicare Value Based Purchasing goes into effect for short term, acute care hospitals on October 1, 2011.  Under the VBP program, reimbursement for all IPPS discharges will be adjusted according to a hospital's performance against a set of quality measurements.  During the first year these adjustments will range from a reduction of -1.0% for hospitals with poorer performance to an increase of 1.5% for hospitals with better performance. For FY13 there are 12 measures of clinical performance and 9 measures of patient satisfaction as published on the Hospital Compare website.  A hospital's performance is measured both on performance during a measurement period and improvement above a baseline period.  Scores are combined into a single Total Performance Score (TPS) that determines the adjustment to reimbursement during one fiscal year.

Clinical Process of Care (CPOC) Domain

Clinical Process of Care measures indicate how often hospitals provide some of the care that is recommended for patients with a heart attack, heart failure, pneumonia, surgery, or children's asthma. Hospitals voluntarily submit data from their medical records about the treatments their patients receive for these conditions, including patients with Medicare and those who do not have Medicare.

Hospital performance rates tell you the proportion of cases where a hospital provided the recommended process of care. Only patients meeting the inclusion criteria for a measure are included in the calculation of the rate for a measure. A rate of 88% means that the hospital provided the recommended process of care 88% of the time. For example, the rates for initial antibiotic timing tell you the percentage of patients who received their first dose of antibiotics within four hours of arrival to the hospital. Higher scores are better.

HCAPHS Patient Experience of Care (PEOC) Domain

The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is used to collect information about patient satisfaction. This survey asks patients about their experiences with care during a recent overnight stay in the hospital and allows consumers to make fair and objective comparisons between hospitals. All hospitals use the same survey questionnaire and standardized data collection procedures. Patients complete the HCAHPS survey after they leave the hospital. Data analysis is done by CMS, not by the hospitals. CMS uses an independent contractor to analyze the HCAHPS survey data and prepare it for reporting.

Measure ID

Each Clinical Process of Care measure and each Patient Experience of Care measure is given an abbreviated Measure ID to facilitate reporting. (By hovering your cursor over a Measure ID you can view the full description.)

Published by CMS – Threshold / Benchmark

For FY13, achievement thresholds are set by CMS at the 50th percentile of overall hospital performance during the baseline period and the benchmarks are the mean of the top decile of overall hospital scores.

Actual Hospital Performance – Baseline / This Period

Actual hospital scores on individual measures are published on Hospital Compare. This app is based on a baseline period of federal FY10. For FY13 the baseline period used for setting thresholds and benchmarks is July 1, 2010, through March 31, 2011.

Calculations – Achievement Score / Improvement Score / Points Earned

A hospital receives an achievement score for each measure that applies to them. The score is 0-10 depending on its performance (HOSP) relative to the published achievement threshold (THRESH) and benchmark (BENCH). :

Score = 0 if HOSP < THRESH or

Score = 10 if HOSP > BENCH else

Score = 1-10 as determined by the following formula (rounded to nearest whole number):

SCORE = ( 9 * (( HOSP – THRESH ) / ( BENCH – THRESH ))) + .5

The hospital receives an improvement score for each measure that applies to them based on how much their performance on the measure improved from the baseline period (HOSPBASE).

Score = 0 if HOSP ≤ HOSPBASE else

Score = 1-9 as determined by the following formula (rounded to nearest whole number):

SCORE = ( 10 * (( HOSP – HOSPBASE ) / ( BENCH – HOSPBASE ))) - .5

A hospital’s performance score (i.e. Points Earned) on a measure is the greater of its achievement score and its improvement score. (Note that on the Comparison View you can hover your cursor next to a score in order to see the individual Achievement and Improvement scores.)

HCAPHS Patient Experience of Care – Floor / Dimension Score

Hospitals may earn consistency points based on the lowest of its 8 HCAHPS dimension scores. Consistency points are awarded proportionately based on the hospital’s lowest HCAHPS dimension score compared to the corresponding achievement threshold (50th percentile of the baseline performance score). The lowest score must, however, be higher than a FLOOR which is the baseline score of the poorest performing hospital (0th percentile of baseline). CMS defines dimension scores according to the following formula:

Dimension Score = (( HOSP – FLOOR) / (THRESH – FLOOR))

Score for the Clinical Process of Care Domain

The CPOC Score is calculated as follows:

Calculate the Total Points Earned for all measures in the Clinical Process of Care Domain.

Determine the Highest Possible Points by multiplying 10 (the highest possible score for each measure) times the number of measures that were applicable for the hospital.

The domain score can then be calculated:

Domain Score = Total Points Earned / Highest Possible Points * 100

Score for the Patient Experience of Care Domain

The HCAHPS base score is calculated by adding points earned for all 8 dimensions of the Patient Experience of Care Domain. The base score will be a total of 0-80 points.

Consistency points are calculated according to the following:

Consistency Points = 0 if hospital’s performance on ALL HCAHPS measures are as poor as the worst performing hospital during the baseline period (FLOOR) or

Consistency Points = 20 if the hospital’s performance on ALL HCAPHS measures are ≥ the achievement threshold (THRESH) else

Consistency Points = (20 * (lowest dimension score) – 0.5)
rounded to the nearest whole number with minimum of 0 and maximum of 20
Domain Score = HCAHPS base score + Consistency points

Total Performance Score (TPS)

For FY13, the Clinical Process of Care Domain is weighted at 70% and the Patient Experience of Care Domain is weighted at 30% of the hospitals Total Performance Score.

TPS = (.70 * Clinical Process Domain score) + (.30 * Patient Experience Domain score))

Financial Impact

A linear exchange function is used to calculate the percentage of value-based incentive payment earned by each hospital. This incentive payment rate will be multiplied by the base operating drg payment on PPS discharges to calculate additional incentive payment (net of a 1% reduction that is withheld on all claims). Those hospitals that receive higher Total Performance Scores will receive higher incentive payments than those that receive lower Total Performance Scores.