2019 Participation FAQ


 1)      What is required for an OBI hospital? 

a.      Complete and submit the OBI Participation Agreement to the OBI Coordinating Center.

b.      Obtain institutional approval for OBI data collection and transmission requirements, as specified by the Coordinating Center (e.g., a signed Data Usage Agreement).

c.       Work closely with the OBI Coordinating Center and the other participating Michigan maternity hospitals to develop a quality improvement program to advance collaborative-wide performance using feedback from OBI registry data.

d.      Participate in the OBI 2019 activities outlined in the 2019 OBI Performance Index Scorecard.

e.      Collaborate with other participating sites in overall process improvement essential to the success of the program, including sharing of and learning from best practices.

f.        Implement a process to extract and accurately submit the required OBI data elements into the OBI clinical registry in a timely manner.

2) Many hospitals are already engaged in multiple initiatives. What are the benefits of joining OBI?

The Obstetrics Initiative:
•    Facilitates a statewide community of maternity hospitals and maternity clinicians
•    Promotes consistent and standardized approaches to obstetrical care
•    Supports evidence-based labor and delivery practices
•    Provides educational webinars
•    Promotes evidence-based resources and tools
•    Presents data-driven insights into areas for focused quality improvement
•    Provide the opportunity to share experiences, outcomes (challenges AND successes), and        best practices so that all can learn
•    Supports hospitals to develop their own site-specific goals with regards to obstetric    care, specifically around supporting vaginal births and safely reducing cesarean births

In addition, BCBSM:

1.      Is supporting OBI as a required CQI in 2019 with their hospital incentive-based program called pay-for-performance, or P4P.   

2.      Will provide Clinical Data Abstractors to OBI hospitals to support OBI data validation and collection efforts. The percentage of the FTE at each hospital will be based on BCBSM’s algorithm based in part on delivery volume.

 3) My hospital is not eligible for the BCBSM P4P financial incentive. If my hospital voluntarily participates in the OBI CQI without the need to achieve P4P points, would my hospital need to fulfill the 2019 OBI Performance Index Scorecard in full to participate in the CQI?

OBI encourages all Michigan maternity hospitals to join OBI regardless of whether they are eligible for P4P, because it will benefit your hospital’s labor and delivery practices. Despite not being eligible for P4P, BCBSM is generously willing to support a CDA at your hospital. If your hospitals decides to join OBI in 2019, your hospital must submit the Participation Agreement by February 1st and participate fully in the OBI Performance Index activities or BCBSM reserves the right to retract the funding for the Clinical Data Abstractor.

There are 3 levels of participation in OBI:

I. Fully participate in the 2019 OBI Performance Index Scorecard activities AND receive P4P AND receive salary support for a Clinical Data Abstractor. Participation Agreement required.

II. Fully participate in the 2019 OBI Performance Index Scorecard activities AND receive salary support for a Clinical Data Abstractor. Participation Agreement required.

III. Join OBI webinars, meetings, video workgroup conferences, and events as convenient. Participation Agreement required.

What is criteria is used to determine if a hospital is eligible for P4P?

A hospital’s P4P eligibility is determined by BCBSM. BCBSM has an internal system of designating hospitals as Peer Group 1-4 which is determined by the Hospital Contracting department at an individual level. Here is the list of the 2019 P4P eligible Michigan Maternity Hospitals.

4)  2019 OBI Performance Index Scorecard Questions

a.      Who is the “clinical lead” on the Participation Agreement? Does it have to be a physician?

The Clinical Lead is the clinician at the hospital level that will be most effective in driving change.  In some cases, that will be an CNM or RN in others it will be a physician, depending on the culture at that site. 

b.      Can the clinical lead be the unit administrative lead as well?

The clinical lead should be different than the unit administrative lead. The goal is to make the team robust and multidisciplinary. 

c.       What if a hospital does not have a midwife, is ok to state N/A on the agreement?

Yes, you may put N/A if your hospital does not have midwives.

d.      Can a clinical lead cover more than 1 hospital if they deliver at more than one hospital? Can the someone serve as the communications lead for more than one hospital?

OBI would like each hospital to have their own clinical lead and communications lead, but we recognize this may be a challenge for some of the health systems. If the individual believes they can serve as the communications lead by being the main point of contact with OBI and their hospital teams, then we defer to them to manage the role. And if the individual believes they can serve as the clinical lead by championing change in practice with mulit- hospital teams, then we defer to them to manage the role.

e.      Will you be sending a data use agreement (DUA)?

OBI is currently developing the DUA and will have it available on our website this spring. Hospitals will receive a packet of documents to sign including the DUA and a Business Associate Agreement prior to receiving their BCBSM funding for a Data Abstractor.

f. Is the OBI recorded provider education webinar link available (listed in the Providers Education portion of Performance Index Scorecard)?

The OBI recorded webinar will be available in late-January. It should be distributed to your L&D staff (by email) by March 31st and viewed by your L&D staff by June 1, 2019. It will be sent out to those on our email list, as well as to those that have submitted their Participation Agreements, and will have a designated page in the P4P section of the site.

g. What are the the video workgroup conference dates (listed under the Peer-to-Peer Engagement portion of the Performance Index Scorecard)?

Once OBI has received all of the Participation Agreements from those hospitals that will participate in OBI in 2019, we will be able to establish the workgroups (by Option A/Option B and delivery volume) and will then set the dates for the video workgroup conferences.

h. If a hospital decides that they no longer want to participate in OBI after learning their FTE allotment, can they change their participation agreement? 

Yes, your hospital may decide not to participate in OBI after finding out your hospital’s level of FTE support for a Clinical Data Abstractor.

i. Can the names listed on a hospital’s Participation Agreement change over the course of a year?

Yes, please just notify Jill Brown, the OBI Clinical Site Engagement Coordinator at jillbrow@med.umich.edu of any changes.

5) What are other hospitals doing to support the P4P data validation piece & data reporting?  What role would complete this and what is the expected time commitment for this? Can you tell me more about the abstraction dollars and how the abstraction process will be like for the OBI?

In addition to P4P, BCBSM has confirmed that they will provide Clinical Data Abstractors (CDAs) at the OBI Hospitals (regardless of P4P eligibility) to support our data validation and collection efforts. The percentage of the FTE at each hospital will be based on BCBSM’s algorithm based in part on delivery volume.  OBI Hospitals will receive their payments in June 2019 to have Data Abstractors in place in summer 2019. OBI’s data reporting efforts will begin in third quarter 2019. OBI has a Data Abstraction page on our site. OBI is in the process of finalizing our Clinical Data Abstractor position description. It will be posted on the site soon as will the variables that we will be using for both data sources for the one-time data validation as well as our OBI Data Reporting Variables & Process Measures document.

 6) How large a sample will the hospital-based Clinical Data Abstractors be reporting?

The OBI Data Reporting Variables & Process Measures document (currently under review by the OBI Advisory Committee) reflects the data variables that will be collected on Term Singleton Vertex patients from January 2019 onward via the OBI registry on a consecutive sample of cases each month from OBI participating hospitals per the table below.

cases table.JPG

7) When will hospitals be notified of the level of FTE support for their on-site Clinical Data Abstractor? Based on the delivery volume requirements for the number of cases to be abstracted can you explain how this will lead to the FTE allotment?

OBI will notify our hospital contacts of their FTE allotment by Friday, January 25th. Please note that the level of support is based on a BCBSM algorithm that uses a hospital’s 2016 delivery volume (from MDHHS birth certificate data). 1200 cases (100 NTSV cases/month) a year is considered a full-time employee (FTE). BCBSM support is based on a nurse Clinical Data Abstractor salary of $97,210. They will support up to 80%, which is $77,768. The payment will be sent from BCBSM to the hospitals in June 2019.

8) what will the platform look like for data abstraction and submission? Will there be any use for PC2 data?

OBI is working with our vendor, Arbor Metrix to build onto our existing OBI Registry to where the Clinical Data Abstractors can directly enter the data.

9) Will a data dictionary be available? How many variables will the Clinical Data Abstractors be reporting on?

Yes, a data dictionary will be available. OBI is finalizing the data elements will be collected. Once final, OBI will post the case report forms as well as the data dictionary.

10) When the Clinical Data Abstractors start reporting on the NTSV cases, what month will they start with?

OBI is finalizing our data abstraction reporting plan. The Abstractors will likely report on a few select months to serve as baseline data and then report monthly starting in October 2019. OBI does not expect to have the hospitals report on a full 12-months of 2019.

11) Will you be using the same numerator and denominator for NTSV as is used by the Joint Commission for PC 02 data abstraction?

Not exactly. We would like the Clinical Data Abstractors to report on their NTSV cases. For those hospitals with more than 4000 deliveries a year, OBI asks that they report on the first 100 NTSV cases a month. For those hospitals with less than 4000 deliveries a year, OBI asks that they report on all NTSV cases a year.

12) Will OBI have training sessions for the Clinical Data Abstractors?

Yes, OBI will host training sessions that the CDAs can attend remotely as well as have one-on-one screen sharing sessions with our OBI Data Manager to ensure that they are prepared for their role. In addition, the CDAs will receive a User’s Guide and Operations Manual.

13) Is choosing Option A or Option B mandatory?

If your hospital decides to participate in the Obstetrics Initiative and pursue P4P points, then yes selecting Option A or B is mandatory. The OBI Participation Agreement requires that you select which strategy your hospital will implement. Option A or B is 30% of the overall performance index.

14) How do we show that our hospital is implementing Option A and B? Does it have to be a part of the medical record?

Option A or B is 30% of the overall performance index. The OBI registry will prompt the Clinical Data Abstractor to describe your hospital’s strategy and timeline to implement Option A or B by June 2019. And then they will need to report on their progress of the proposed strategy and timeline by September and then again in December.

No, it does not need to be part of the medical record.

15) Option A

a. Please clarify what is meant by “reassuring fetal testing” – is this reactive NST or BPP > 6? Reassuring fetal testing is to be determined by the standard practice of each institution.  For most institutions that will mean a reassuring NST that is reactive or category 1 if in labor.

b. What is meant by “coping with contractions?” – Is this using a coping score or yes/no?

For coping, OBI recognized that this is a clinical judgement.  OBI suggests using the Robert's Coping with Labor Algorithm© [Fairchild, E. Implementation of Robert's Coping with Labor Algorithm© in a large tertiary care facility. Midwifery. 2017 Jul;50:208-218. doi: 10.1016/j.midw.2017.03.008. Epub 2017 Mar 16].  

c. Is this best implemented on patients using chief complaint or would it be used on all unscheduled patients who arrive in OB Triage?

This is meant to be used for anyone presenting with a complaint of labor / contractions

d. Is the expectation that if any one of the check boxes is checked that an absolute admit or discharge decision is made based on that one checkbox?

These check boxes are meant to be a guideline to be sure that all the relevant clinical information is considered prior to not recommending admission to labor and delivery.  If all are checked, the patient is a candidate for discharge.  If some are un-checked, the provider will need to use her or his judgement.  The goal is safely delay admission in early labor.

16) Option B: When submitting timeline and strategy information for Option B, will it be "how we are addressing readiness", "how we are addressing risk and assessment", etc?

Yes, that is exactly how your hospital will report on your strategy is how you are addressing each piece of the Option B Bundle. OBI asks that the hospitals report on process measures rather than outcome measures in 2019.

17) OBI is a required CQI in 2019. What does that mean?

Hospitals eligible for, but voluntarily electing not to participate in a “required” CQI like the Obstetrics Initiative, will forfeit the ability to earn the portion of their P4P associated with the CQI. Hospitals can earn up to 40% of their P4P through participation in CQIs. If a hospital participates in 1 CQI, that CQI would be worth 40%. If a hospital participates in 2 CQIs, each would be worth 20%, up to 10 CQIs at 4% each. The amount of P4P you will forfeit is tied to the number of CQIs that your hospital participates in.

18) are MVC and OBI part of the same CQI?

OBI was a QI project within the Michigan Value Collaborative (MVC) in 2018. In 2019, OBI is a CQI separate from MVC. OBI will host our own SemiAnnual meetings and our P4P scorecard is also distinct from MVC’s scorecard.

17)  Is the P4P incentive payable to the hospital or to the individuals who participate for example the physicians directly?

The Pay for Performance (P4P) Program pays the hospitals. BCBSM also has an incentive-based program called Value Based Reimbursement (VBR) that provides the incentive to the physicians. OBI may participate in VBR in 2020. OBI has a couple of P4P pages that might provide some additional insight in addition to the OBI scorecard page.

19) Is this initiative eligible for Merit-based Incentive Payment System (MIPS) at the physician level?

OBI is a Blue Cross Blue Shield of Michigan (BCBSM) funded Collaborative Quality Initiative. The Pay for Performance (P4P) Program pays the hospitals. BCBSM also has an incentive-based program called Value Based Reimbursement (VBR) that provides the incentive to the physicians. OBI may participate in VBR in 2020. OBI has a couple of P4P pages that might provide some additional insight in addition to the OBI scorecard page.

Questions?

Contact Clinical Site Engagement Coordinator, Jill Brown, RN at jillbrow@med.umich.edu or (734) 763-2740.