Texas Hospital Association Annual Conference February 2-3. 2011.

Texas Hospital Association Annual ConferenceFebruary 2-3. 2011

High-Quality

Low –Cost amidst

Payment System Reform

Questions:-How are these terms defined? What are the different perspectives on those definitions?- How is cost calculated? What is included in the new era?- What is the goal of Payment System Reform?- What exactly are all the components related to quality within Healthcare Reform?

% o

f fo

cus

Time

20%

Year 5Year 1

100%

Focus on hospital based careQuality and Cost

Focus on Continuum of CareQuality and Cost

Consider perspectives

-Provider

-Payer

-Patient

COST

Low

High

HighLow QUALITY

Characteristics ofLow cost and highQuality….

Safe, Efficient and Effective care

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

FY 2013 Measures for VBP Heart Attack – 3 measures Heart Failure – 3 measures Pneumonia – 4 measures Healthcare Associated Infections – 4

measures Surgical Care Improvement – 3 measures Patient Experience of Care – HCAHPS (10

domains)

Calculation Clinical measures account for 70% of

score HCAHPS will account for 30% of score

Levels of Performance National median score = threshold National top decile performance =

benchmark Below the median score = need to

demonstrate improvement over baseline

Measure Available Points

Actual points

AMI 30 20

HF 30 30

PN 40 30

SCIP 30 30

HAI 40 20

Total Clinical Measures (*70%) 170 130

HCAHPS (*30%) 100 80

Grand Total 270 210

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

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CLABSI and SSI Reporting Federal: To receive the annual payment

update from CMS, hospitals are required to report: ▪ January 2011: CLABSI. First quarter data must

be submitted by August 15, 2011. ▪ January 2012: SSI. First quarter data must be

submitted by August 15, 2012. State: Reporting of CLABSI and SSI

expected September 2011 Reporting will be to the CDC’s National

Healthcare Safety Network 13

Readmission (cont.) State: As per HB1218 (81st Session),

Medicaid potentially preventable readmissions (PPR) data will be shared confidentially with hospitals. A PPR means a return hospitalization of a person within a period specified by the commission that results from deficiencies in the care or treatment provided to the person during a previous hospital stay or from deficiencies in post-hospital discharge follow up. The term does not include a hospital readmission necessitated by the occurrence of unrelated events after the discharge.

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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.

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How can we continually improve on all the measures?

Where can we collaborate with others in the care of patients?

How can we be even more effective in achieving consistent outcomes?

Where do we start or how can we get even better as national performance improves?

And more……..