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

View from the Top – Healthcare and Medical Professional Liability Issues


Singin the pl blues

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

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

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

Employed Physician Issues in the Hospital

  • Pay for Performance — One Hospital’s Response

  • Hospital Physician Strategies


P4p initiatives

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

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

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 measures1

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

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

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


Hcahps1

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


Quality is the best business case

  • 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

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

HCA Employed Physicians


One of the few things physicians can count on is change

One of the few things physicians can count on is change


Overview

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

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

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

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

Risks of EHRs

  • Defining the Legal Health Records

  • Maintaining Integrity of the Record

  • Locking Records

  • Using Templates


New technology on the horizon

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

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


Remarkable healthcare people

Remarkable healthcare people…


With leadership resources and patient centered hearts

With leadership, resources and patient centered hearts


View from the top healthcare and medical professional liability issues

50% of acute hospitals are distressed


60 the mds and partners are in trouble

60% the MDs and partners are in trouble


Universal challenges

“Houston, we have a problem.”

Universal challenges


Public spotlight on quality risks and costs is growing system leadership is the answer

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


The need make competitors irrelevant

The Need: Make Competitors Irrelevant


Use of improvement methodologies just what the doctor ordered

Use of Improvement MethodologiesJust what the doctor ordered


Generate compelling results

Generate Compelling Results


Questions answers

Questions&Answers


Many thanks to

Many thanks to …

  • James Fasone

  • James Hinton

  • William McDonough

  • Jeff Nelson

  • Andrew Shapiro


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