View from the top healthcare and medical professional liability issues
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View from the Top – Healthcare and Medical Professional Liability Issues. Singin’ The PL Blues. MODERATOR: James Fasone, RPLU, ARM, Senior Vice President, Alliant Healthcare PANELISTS: James D. Hinton, CPA, Vice President, HCA, Inc.

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View from the Top – Healthcare and Medical Professional Liability Issues

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View from the Top – Healthcare and Medical Professional Liability Issues


Singin’ The PL Blues

MODERATOR:

  • James Fasone, RPLU, ARM, Senior Vice President, Alliant Healthcare

    PANELISTS:

  • James D. Hinton, CPA, Vice President, HCA, Inc.

  • William J. McDonough, MBA, RPLU, President & CEO, MMIC Group

  • Jeff A. Nelson, MHA, Partner, Tatum LLC

  • Andrew Shapiro, JD, Senior Vice President, Healthpro, CNA


Agenda

  • What Healthcare Reform may mean to Professional Liability Carriers

  • How the economy impacts the provision of healthcare services

  • How the quality of care issues impact providers

  • Is healthcare reform REALLY on the horizon?

  • Q&A


What Healthcare Reform May Mean to PL Carriers

  • The Latest from Washington

  • Our Customers Expectations are Low

  • Our Main Concerns: Capacity Stress and Reimbursement Pressure

  • Potential Warning Signs


Employed Physician Issues in the Hospital

  • Pay for Performance — One Hospital’s Response

  • Hospital Physician Strategies


P4P Initiatives

  • CMS, Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU)

    • Inpatient Quality indicators

  • CMS, Consumer Assessment of Healthcare Providers and Systems Hospitals survey (HCAHPS)

  • CMS, Hospital Outpatient Quality Data Reporting Program (HOP QDRP)

  • Managed Care Initiatives


RHQDAPU Background

  • CMS initiated the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) effective with patients discharged 7-1-03

  • The program applies to hospital inpatients

  • Failure to meet the program requirements and to submit data results in the hospital’s loss of the Inpatient Annual Payment Update (APU)

    • Current APU is 2% of Medicare reimbursement for inpatient care

    • This represents approximately $85 Million for HCA


RHQDAPU Current Measures

FY 2009 Measures (30)

FY 2010 Measures (44)

Abstraction Based

AMI:8 Measures

HF:4 Measures

PN:6 Measures

SCIP:8 Measures

Claims Based

Mortality: 3 Measures

Readmission: 3 Measures

Agency for Healthcare Research & Quality (AHRQ)

Patient Safety & Quality: 9 Measures

Nursing Sensitive

Nursing Sensitive: 1 Measure

Patient Experience

HCAHPS

Structural

Participation in a CV Database

Abstraction Based

  • AMI:8 Measures

  • HF:4 Measures

  • PN:6 Measures

  • SCIP:8 Measures

    Claims Based

  • Mortality: 3 Measures

  • Readmission: 1 Measures

AMI = Acute Myocardial Infarction

HF = Heart Failure

PN = Pneumonia

SCIP = Surgical Care Improvement Program


RHQDAPU Current Measures

Proposed FY 2011 Measures (46)

Abstraction Based

AMI:7 Measures

HF:4 Measures

PN:6 Measures

SCIP:10 Measures

Claims Based

Mortality: 3 Measures

Readmission: 3 Measures

Agency for Healthcare Research & Quality (AHRQ)

Patient Safety & Quality: 8 Measures

Nursing Sensitive

Nursing Sensitive: 1 Measure

Patient Experience

HCAHPS

Structural

Participation in a CV Database

Participation in a Stroke Database

Participation in a Nursing Sensitive Care Database

AMI = Acute Myocardial Infarction

HF = Heart Failure

PN = Pneumonia

SCIP = Surgical Care Improvement Program


CMS HQA Market Performance

  • Hospitals are scored on their performance as compared to the CMS National Benchmarks:

    • Red < CMS 75th Percentile

    • Yellow > CMS 75th Percentile but < CMS 90th Percentile

    • Green > CMS 90th Percentile

  • Hospital are scored on their performance against competing hospitals in their markets


HCAHPS

  • Pronounced “H-caps”

  • First national, standardized, publicly reported survey of patients perspectives of hospital care

    • CMS first reported results in March 2008

  • Goals of survey

    • Produce data that allow objective and meaningful comparisons of hospitals on topics important to consumers

    • Public reporting creates incentives to improve quality

    • Public reporting enhance accountability and transparency


HCAHPS

Eight Composites

Communication with Nurses (Q1 to Q3)

Communication with Doctors (Q5 to Q7)

Responsiveness of hospital staff (Q4 & Q11)

Pain management (Q13 & Q14)

Communication about medicines (Q16 & Q17)

Cleanliness of hospital environment (Q8)

Quietness of hospital environment (Q9)

Discharge information (Q19 & Q20)

Overall rating of hospital (Q21)

Recommend this hospital (Q22)

  • 27 Question Survey:

  • 1-22: “core questions”

    • Rolls up to eight composite areas and two overall ratings

  • 23-27: demographic


  • Financial success in healthcare is directly related to quality of clinical care

  • Operational, financial and improvement agendas are aligned

  • Seize opportunity to mitigate risk and achieve better outcomes for patients

  • Claim victory in eliminating adverse events that lead to patient harm

Quality is the Best Business Case

Our Time is NOW!


Employed Physician Strategies

  • Use of hospitalists

    • Response to hospital call issues

    • Integration with patient safety programs

  • More specialists

    • Only 50% are primary care in 2009

  • New contracts have performance/efficiency requirements


HCA Employed Physicians


One of the few things physicians can count on is change


Overview

  • Consolidation will continue to occur

  • 90% of MN Physicians are in groups of 3 or more

  • Competition is rapidly changing – Out of 33,000 physicians in our territory 12,000 are in SIRs


Changes in Physician Practices

  • Shift toward cash services

  • Medical Home and other like models geared toward disease management

  • Higher numbers of sicker patients

  • The push toward ElectronicHealth Records


Electronic Health Records

  • Less than 20% of physicians currently use EHRs

  • Medicare and Medicaid will provide incentives to assist physicians who demonstrate meaningful use of EHRs through HITECH Act

  • Beginning in 2015 Medicare penalties will apply to physicians who do not use EHRs


Benefits of Electronic Health Records

  • Enhanced Patient Care – e-prescribing, results follow-up, automated chart review

  • Improved Efficiency – reduced dictation, virtual access to medical records, index-based reports

  • Increased Profitability – More timely documentation, reduce coding errors, reduce or eliminate dictation, reduce number of refused charges


Risks of EHRs

  • Defining the Legal Health Records

  • Maintaining Integrity of the Record

  • Locking Records

  • Using Templates


New Technology on the Horizon

  • Pulse oximeter

  • Improved fetal monitoring

  • Improved placental pathology

  • Treatment for pancreatic cancer


Art of Becoming Insanely Great(Transforming Health Systems and Their Quality of Care Measures)


Remarkable healthcare people…


With leadership, resources and patient centered hearts


50% of acute hospitals are distressed


60% the MDs and partners are in trouble


“Houston, we have a problem.”

Universal challenges


Public spotlight on quality, risks and costs is growingSystem leadership is the answer.


The Need: Make Competitors Irrelevant


Use of Improvement MethodologiesJust what the doctor ordered


Generate Compelling Results


Questions&Answers


Many thanks to …

  • James Fasone

  • James Hinton

  • William McDonough

  • Jeff Nelson

  • Andrew Shapiro


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