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

Biggest Change: Costs

Quality in Health Care is Questioned: Successful Initiatives 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 Prevent Pressure Ulcers Reduce MRSA Infections Prevent Harm from High-Alert Meds Reduce Surgical Complications Evidence-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

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 16

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. 17

Available data Compare care quality – – Compare hospitals – Compare nursing homes – Compare home health agencies – Compare dialysis facilities Pricing – THA – Link to Texas PricePoint

Other sites State sites – Pennsylvaniawww.phc4.orgwww.phc4.org – Californiawww.stayhealthy.comwww.stayhealthy.com – Floridawww.floridacomparecare.govwww.floridacomparecare.gov – Massachusettswww.mass.gov/healthcareqcwww.mass.gov/healthcareqc

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