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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.

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Payment for Healthcare

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  1. Payment for Healthcare Alignment with Safety, Appropriateness, and Quality Accountable Payment Model Subgroup Bree Collaborative Meeting July 18, 2013

  2. 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

  3. Four Deliverables

  4. 1. A Warranty for TKR and THR Aligning payment with safety

  5. 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

  6. Profile of Respondents 62 people started the survey 46 people completed it

  7. 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

  8. Recurring Themes from Public Comments

  9. Recurring Themes from Public Comments

  10. Recurring Themes from Public Comments

  11. Recurring Themes from Public Comments

  12. Recurring Themes from Public Comments

  13. Changes Made in Response to Public Comments

  14. Other Efforts to Aid Implementation

  15. 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

  16. 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.

  17. 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

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

  19. 2. Standards for appropriateness Avoiding unnecessary surgery

  20. 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

  21. 3. Surgical Bundle Transparent components of quality

  22. 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

  23. Progress with Deliverables

  24. 4. Measurement of Quality The guide to purchasing

  25. 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

  26. 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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