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

David W. Martin, MD, FACSChief Medical Officer

St. David’s Round Rock Medical Center

Biggest Change: Costs

Quality in Health Care is Questioned:Successful Initiatives

Deployment of Rapid Response TeamsEvidence-based care for Acute MIPrevention of Adverse Drug EventsPrevention of Central Line InfectionsPrevention of Surgical Site Infections

Prevent Pressure UlcersReduce MRSA InfectionsPrevent Harm from High-Alert MedsReduce Surgical ComplicationsEvidence-based Care for Heart Failure

The 100,000 Lives Campaign

The 5 Million Lives Campaign

The Leapfrog Group Strategy for Healthcare Reform

Transparency

Standard Measurements

& Practices

Reimbursement:

Incentives & Rewards

Julie Hubbard Health Affairs 2003

The Wisconsin Experience:

That which is measured, tends to improve.That which is measured publicly, tends to improve faster.

• 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

The Challenge

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

Quality Based Payment Reforms

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

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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.

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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

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

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