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Payment for Healthcare. Alignment with Safety, Appropriateness, and Quality Accountable Payment Model Subgroup Bree Collaborative Meeting July 18, 2013. Goals for Today’s Presentation.

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Payment for Healthcare

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Payment for healthcare

Payment for Healthcare

Alignment with Safety, Appropriateness, and Quality

Accountable Payment Model Subgroup

Bree Collaborative Meeting

July 18, 2013

Goals for today s presentation

Goals for Today’s Presentation

  • Summarize findings from the public comment period for the draft warranty on total knee and total hip replacement (TKR and THR) procedures

  • Adoption of the revised warranty by the Bree Collaborative

  • Provide update on standards for appropriateness, a bundled payment model, and measures of quality

Four deliverables

Four Deliverables

1 a warranty for tkr and thr

1. A Warranty for TKR and THR

Aligning payment with safety

Overview of public comment process

Overview of Public Comment Process

  • APM subgroup developed an online survey

  • Posted survey announcement and link on the Bree Collaborative website

  • Local community partners and national groups promoted the survey through their networks

    • Complete list in the posted summary document

  • Survey was open for 2 weeks (6/19-7/3)

    • Modified on 6/20 to allow respondents to provide only general feedback due to clinical/technical nature of many of the warranty definitions

Profile of respondents

Profile of Respondents

62 people started the survey

46 people completed it

Key findings from public comments

Key Findings from Public Comments

  • Broad support for diagnostic codes (91%), procedure codes (96%), and age limits (84%)

  • Support for complications ranged from 35% (acute myocardial infarction) to 67% (surgical site bleeding)

  • 57% agree with the warranty periods in the first 90 days

  • 42% agree with the 10-year implant warranty

  • 53% agree with the term that holds the hospital performing the TKR/THR surgery accountable for treatment received for complications at another hospital of outpatient facility

    Note: Sample sizes for all of these percentages are included in the posted summary document

Recurring themes from public comments

Recurring Themes from Public Comments

Recurring themes from public comments1

Recurring Themes from Public Comments

Recurring themes from public comments2

Recurring Themes from Public Comments

Recurring themes from public comments3

Recurring Themes from Public Comments

Recurring themes from public comments4

Recurring Themes from Public Comments

Changes made in response to public comments

Changes Made in Response to Public Comments

Other efforts to aid implementation

Other Efforts to Aid Implementation

Content of warranty adults with tkr and thr surgery

Content of Warranty Adults with TKR and THR surgery

  • Periods of accountability are complication-specific

    7 days

    • Acute myocardial infarction (heart attack)

    • Pneumonia

    • Sepsis (serious infection that has spread to bloodstream)

      30 days

    • Death

    • Surgical site bleeding

    • Wound infection

    • Pulmonary embolism

      90 days

    • Mechanical complications related to surgical procedure

    • Periprosthetic joint infection (infected implanted joint)

  • Hospital/provider group performing surgery should be accountable for payment for care of complications treated in another facility according to single transparent market standard based on CMS fee schedule

  • Proposal to adopt draft warranty

    Proposal to Adopt Draft Warranty

    The APM subgroup proposes that the Bree Collaborative adopt the revised Total Knee and Total Hip Replacement (TKR and THR) Warranty.

    Note: The APM subgroup is planning to wait until all four components of the TKR/THR bundle are completed before submitting a report to the Health Care Authority.

    Outreach communication plan

    Outreach & Communication Plan

    • In process

    • To educate community about the warranty and other components of bundle

    • Partner with stakeholders:WSHA, WSMA, employers such as Seattle Chamber of Commerce, other employer groups

    Payment for healthcare

    The following slides contain information on the other parts of the bundle; there’s no new substantive developments to report to the Bree

    2 standards for appropriateness

    2. Standards for appropriateness

    Avoiding unnecessary surgery

    Payment for healthcare

    Evidence appraisal is complete for both sections of the standards for appropriateness:

    • Disability: reduced function and pain due to osteoarthritis despite conservative therapy

    • Fitness for surgery: physical preparation and patient engagement

      No action needed from the Bree at this time

    3 surgical bundle

    3. Surgical Bundle

    Transparent components of quality

    Payment for healthcare

    Evidence appraisal for both parts of the bundle (Surgical Repair and Return to Function) is almost complete

    Expect to present a draft bundle to the Bree Collaborative at the September meeting

    No action needed from the Bree at this time

    Progress with deliverables

    Progress with Deliverables

    4 measurement of quality

    4. Measurement of Quality

    The guide to purchasing

    Payment for healthcare

    Group has discussed 5 broad categories of measures:

    • Patient satisfaction

    • Evidence-based care

    • Functional improvement (Pre- and post-operation) 

    •  Avoiding readmissions

    • Others, such as time to return to function

    Payment for healthcare

    Progress made with several measures:

    • Endorse HOOS/KOOS as the preferred method for assessing disability, including pain

    • Agree NIH’s quality of life tool, PROMIS-10, is a promising tool

    • Agree HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey is a good tool for measuring patient experience

      No action needed from the Bree at this time

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