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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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Singin the pl blues
Singin’ The PL Blues Liability Issues

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
Agenda Liability Issues

  • 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
What Healthcare Reform Liability IssuesMay 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
Employed Physician Issues Liability Issuesin the Hospital

  • Pay for Performance — One Hospital’s Response

  • Hospital Physician Strategies


P4p initiatives
P4P Initiatives Liability Issues

  • 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
RHQDAPU Background Liability Issues

  • 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
RHQDAPU Current Measures Liability Issues

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 measures1
RHQDAPU Current Measures Liability Issues

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
CMS HQA Market Performance Liability Issues

  • 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
HCAHPS Liability Issues

  • 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


Hcahps1
HCAHPS Liability Issues

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


Quality is the best business case

  • 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
Employed Physician Strategies quality of clinical care

  • 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
HCA Employed Physicians quality of clinical care



Overview
Overview quality of clinical care

  • 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
Changes in Physician Practices quality of clinical care

  • 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
Electronic Health Records quality of clinical care

  • 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
Benefits of Electronic Health Records quality of clinical care

  • 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
Risks of EHRs quality of clinical care

  • Defining the Legal Health Records

  • Maintaining Integrity of the Record

  • Locking Records

  • Using Templates


New technology on the horizon
New Technology on the Horizon quality of clinical care

  • 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
Art of Becoming Insanely Great quality of clinical care(Transforming Health Systems and Their Quality of Care Measures)


Remarkable healthcare people
Remarkable healthcare people… quality of clinical care


With leadership resources and patient centered hearts
With leadership, resources quality of clinical careand patient centered hearts


50% of acute hospitals are distressed quality of clinical care


60 the mds and partners are in trouble
60% the MDs and partners quality of clinical careare in trouble


Universal challenges

“Houston, we have a problem.” quality of clinical care

Universal challenges


Public spotlight on quality risks and costs is growing system leadership is the answer
Public spotlight on quality, risks and costs is growing quality of clinical careSystem leadership is the answer.


The need make competitors irrelevant
The Need: Make Competitors Irrelevant quality of clinical care


Use of improvement methodologies just what the doctor ordered
Use of Improvement Methodologies quality of clinical careJust what the doctor ordered


Generate compelling results
Generate Compelling Results quality of clinical care


Questions answers
Questions quality of clinical care&Answers


Many thanks to
Many thanks to … quality of clinical care

  • James Fasone

  • James Hinton

  • William McDonough

  • Jeff Nelson

  • Andrew Shapiro


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