Public Policy & Health Care Reform

1. Public Policy &Health Care Reform AMSPDC March 2009

2. US Unemployment Rate2008-2009 Each 1% increase in unemployment rate leads to an increase of 1 million in Medicaid/SCHIP Source: 2008 - US Bureau of Labor Statistics, January 9, 2009 Forecast - Moody’s Economy.com

3. Federal Budget ProjectionsFY 2008 - 2017 Projected January 2009 In Billions Actual Source: Congressional Budget Office

4. NACHRI Members and State Budget Shortfalls, SFY2009 State Budget Shortfalls, SFY2009* 1-5% 6-10% 11-15% 16-36% na Freestanding Acute CH Specialty CH CH within a Hospital Associate Supporter *Per Kaiser State Health Facts. US = 14.2%

5. Revenue & Medicaid SpendingFY1996 - 2008 Medicaid Spending State Revenues Source: American Hospital Association January 2009

6. President Obama’s Health Plan • Lower costs to make the system work for people • $50 billion over five years for health IT • Providers to report costs and quality • Affordable, accessible coverage options • Mandate for covering all children • National Health Insurance Exchange • Use of comparative effectiveness research • Promoting prevention and public health • Workplace health clinical preventive services • Expand funding for primary care workforce

7. Chairman Baucus Plan • Health care coverage for all Americans • Create National Insurance Exchange • Medicare buy-in for ages 55-64 • Medicaid coverage for 100% poverty level • CHIP coverage for 250% poverty level • Improve quality and value of care • Strengthen role of primary care • Support comparative effectiveness • Health IT for quality reporting • Efficiency and Sustainable Financing • Elimination of fraud and waste • Increase transparency

8. GOP Health Care Task Force • Congressman Roy Blunt (R-MO), chair • 16 member Health Care Task Force • Charged with crafting Republican solution • Focus on increase access to quality, affordable care • Consequences of a government-run system • Addressing paperwork and frivolous lawsuits Source: House Republican Leader John Boehner February 4, 2009

9. DNA of Health Care Reform Health IT Transparency Focus on Prevention Comparative Effectiveness Medicaid/SCHIP

10. 9

11. Children’s Health Insurance Program • Schedule • House passed legislation 289 - 139 • Senate passed 66 – 32 • Signed as Public Law 111-3 on February 4 • Summary • Reauthorizes the program for 4.5 years • $34.3 billion in new spending • Program supported by increase in tobacco tax • Removes 5-year waiting period for legal immigrants • Funding for pediatric quality measures and demos 10

12. Economic Stimulus Summary Conference Committee Report • $500M Community Health Centers • $1.5B Community Health Centers Modernization • $500M Training for Primary Care and Nurses • $1.3B NIH University Research Facilities • $8.2B NIH Research • $1.1B AHRQ Comparative Effectiveness Research • $2B Health IT

13. Economic Stimulus Summary • Conference Committee Report • Medicaid Regulations • Extends moratoria on three pending rules and the outpatient rule until June 30, 2009 • Medicaid Federal Matching Funds • 6.2% temporary increase to FMAP for states • Increase for states with high unemployment • 2.5% increase in federal DSH allotments • Health IT • $19B through Medicaid and Medicare • Requires standards by December 31, 2009 • Expand privacy and security provisions

14. President Obama Budget • Plan expected February 26 • Proposed to reduce deficit to $533 billion in 2013 • Increase collections by eliminating tax cuts • Budget will kick off or facilitate a focus on health

15. Children’s Hospitals GME - Authorized to receive $330 million annually - FY 2009 Continuing Resolution $301.7 million In millions Continuing Resolution March 6 2009 Labor-H Bill Request 14

16. Challenges to Health Reform • Fiscal Realities • Economic Stimulus • PAYGO Rules • Committee Jurisdiction • New leadership • State’s rights • Serious challenges at the state level • “Creative Destruction” • Changing current delivery system

17. Card Check Neutrality Drug Imports Follow-on Biologics Medicare Advantage Stem Cell Research Other Issues for 111th Congress 16

18. Quality Transformation UpdateMarlene R. Miller, MD, MScVice Chair, Quality and SafetyJohns Hopkins Children’s CenterVice President, Quality Transformation, NACHRI

19. Quality Transformation Efforts • PICU Catheter-Associated Blood Stream Infections • Heme/Onc Catheter-Associated Blood Stream Infections • Pediatric Emergency Medicine effort

20. PICU CA-BSI Collaborative:Long Term Goals Eliminate pediatric CA-BSI events Produce effective and sustained changes in PICUs via reliably doing best practice & building colleagues Engage and educate providers in QI Reliably implement best practices Improve PICU safety culture and teamwork Spread to all PICUs in USA Generate new knowledge

21. Where are we now in national PICU CA-BSI Collaborative efforts? • Sustain • Spread • Further improve

22. Phase I Efforts as of December 2008 (29 PICUs) We can sustain NHSN 50%

23. Phase II CA-BSI Efforts as of November 2008 (32 PICUs) We can spread! NNIS 50%

24. What is After Reliable Performance of Basics? Supplemental Maintenance-Related Factors (SMRFs) Group 1 = Biopatch Group 2 = CHG scrub for all line entries Group 3 = Both Biopatch and CHG Group 4 = Neither Biopatch nor CHG Comparative Effectiveness efforts to further improve the collaborative bundles

25. To date, no significant differences in CA-BSI rates between these 4 groups evaluating comparative effectiveness

26. ‘Take Home’ Messages PICU CA-BSI Collaborative impact: >550 CA-BSIs prevented >$19 million dollars saved > 65 deaths prevented Reliable use of ideal Maintenance practices seems to have greatest impact New Knowledge for children’s healthcare

27. Where are we going? Spread, spread, and more spread

28. What’s Next: Heme-Onc CA-BSI Collaborative • Draft Charter created & disseminated in QI groups of both Heme and Onc subspecialties • Multiple Expert Meetings Nov - Feb with ~20-25 institutions in Heme-Onc to ‘finalize’ charter, goals, & bundles • Begin recruiting early Summer 2009

29. What’s Next: Pediatric Emergency Medicine QI Collaborative • Multiple Expert Meetings Nov - Feb with ~20 institutions in PEM to ‘finalize’ goals and bundles • Asthma/bronchiolitis • Closed Head Trauma • Pain Mgmt • Finalize charter in late 2009 • Begin recruiting early 2010?

30. NACHRI Quality Program Ellen Schwalenstocker, PhD Acting Vice President Quality Advocacy and Measurement

31. NACHRI Quality Program

32. APQ History • Formed in 2005 – Initial focus HIT, Measurement • Includes NACHRI, American Academy of Pediatrics, American Board of Pediatrics, Child Health Corporation of America • Main Efforts: • Improving care for children by endorsing and spreading successful improvement initiatives (Improve First) • Developing and promoting national HIT standards for child health • CEO’s met in January 2009 – Move to decentralized model

33. Improve First • Preliminary Areas • NACHRI PICU CA/BSI • Trailblazer Improvement Collaborative for Pediatric Inflammatory Bowel Disease • Cystic Fibrosis Foundation Quality Improvement Initiative • Improving Performance in Practice Asthma Initiative • Successful Web Seminar Series

34. Health Information Technology • Focus on CCHIT, HL-7 with significant achievements • HL7 Child Health Profile becoming ANSI standard • CCHIT certified vendors for pediatric functionality • CCHIT formed standing pediatric expert panel • Growing pediatric representation – CCHIT and other entities