Health Care Reform: Now and 2014 Provider Response and Consumer Expectations

1. Health Care Reform: Now and 2014Provider Response and Consumer Expectations David W. Martin, MD, FACS Chief Medical Officer St. David’s Round Rock Medical Center

3. Biggest Change: Costs

5. Quality in Health Care is Questioned: Successful Initiatives The 100,000 Lives Campaign Deployment of Rapid Response Teams Evidence-based care for Acute MI Prevention of Adverse Drug Events Prevention of Central Line Infections Prevention of Surgical Site Infections The 5 Million Lives Campaign Prevent Pressure Ulcers Reduce MRSA Infections Prevent Harm from High-Alert Meds Reduce Surgical Complications Evidence-based Care for Heart Failure

6. The Leapfrog Group Strategy for Healthcare Reform Standard Measurements & Practices Reimbursement: Incentives & Rewards Transparency

7. The Wisconsin Experience: That which is measured, tends to improve. That which is measured publicly, tends to improve faster. Julie Hubbard Health Affairs 2003

8. If the other guy’s getting better, then you’d better be getting better faster than that other guy’s getting better… …Or you’re getting worse. Tom Peters Data Transparency Change

11. The Challenge

14. Components of Reform Goals • to incentivize towards high quality, low cost care • To reduce the overall spend of care Major Components • Reward Better performing providers • Value Based Purchasing • Reducing payment for poor outcomes • Readmissions, hospital acquired conditions, infections, serious preventable adverse events • Encourage collaboration across the continuum • Bundling of payments

15. Quality Based Payment Reforms

16. Quality Based Payment Reforms • Readmissions • Federal: PPACA imposes financial penalties on hospitals with high readmission rates. • Beginning October 2012, acute care hospitals with higher than expected 30 day risk adjusted readmission rates will receive reduced payments for every discharge. The reduced payment is the lesser of 1% or a hospital specific readmission adjusted factor. [2% in Oct 2013; 3% in Oct 2014]. CAHs exempt. • In the first two years, the payment policy will apply to heart attack, heart failure and pneumonia. Additional conditions will be added in future years. • Projected savings: $7.1 billion/10 years

17. Quality Based Payment Reforms • Hospital Acquired Conditions (HACs) • Federal: PPACA imposes financial penalties on hospitals with high HAC rate. • Beginning October 2014, hospitals with HAC rate in bottom quartile of national average (i.e. high rate) will suffer a 1% payment reduction for all Medicare inpatient DRGs. • Projected savings: $1.5 billion/10 years • Other HAC provision • Requires reporting of hospital specific information on HACs to the public via Hospital Compare • Public reporting was scheduled for September 23, 2010 but has been indefinitely delayed due to a discrepancy in the calculation of HAC rates by CMS.

18. Available data • Compare care quality – www.healthcare.gov • Compare hospitals • Compare nursing homes • Compare home health agencies • Compare dialysis facilities • Pricing • THA – Link to Texas PricePoint

19. Other sites • www.whynotthebest.org • www.leapfrog.org • www.consumerreports.org • www.commonwealthfund.org • State sites • Pennsylvania www.phc4.org • California www.stayhealthy.com • Florida www.floridacomparecare.gov • Massachusetts www.mass.gov/healthcareqc

21. Perfection is unobtainable. But if we chase it, we can catch excellence. Vince Lombardi Change Change Change