1. Public Reporting of Quality in Healthcare: The Power of Transparency Alliance for Health Reform Briefing April 27, 2011 Gerry Shea, AFL-CIO

2. Impact of Public Reporting Major Performance Improvement in Hospitals First Major Role for Purchasers Promise of Consumer Engagement

3. 1989-199819992000200120022003-04200520062007200820092010-11 Public-Private Efforts Rapid Advance of Quality Measurement & Reporting National Quality Forum established Hospital Compare website launched Medicare 2% hospital incentive for reporting performance measures Mortality data posted on Hospital Compare Patient Experience data posted on Hospital Compare Physician voluntary reporting begins (PQRS) IOM To Err is Human Presidential Commission Report on Quality IOM Crossing the Quality Chasm IOM Report: Performance Measurement Accelerating Improvement IOM Report: Rewarding Provider Performance CMS VBP Plan to Congress HQA* established Legislation Medicare Modernization Act of 2003 Deficit Reduction Act of 2005 Tax Relief & Healthcare Act of 2006 Medicare Improvements for Patients & Providers Act of 2008 Readmissions data posted on Hospital Compare The Patient Protection & Affordable Care Act of 2010 National Quality Strategy Released Release of NPP Priorities & Goals Pre- Rulemaking Consultative Process Launched (The MAP ) AQA* established AHRQ National Healthcare Quality and Disparities Reports NCQA Quality Compass (public reporting of health plan data) Health plan measures launched with HEDIS 1.0 AHIC* established QASC* all payer data aggregation EHR MU reporting begins CAHPS tool VBP/ACO* rules released AMA PCPI* established PCPI – Physician Consortium for Performance Improvement HQA – Hospital Quality Alliance AQA – Ambulatory Quality Alliance AHIC – Americas Health Information Community QASC – Quality Alliance Steering Committee VBP – Value-Based Purchasing SFQ – Stand for Quality ACO – Accountable Care Organization SFQ* launched

4. © Copyright, The Joint Commission Hospital Measurement: Then & Now --- 2000-2011 Hospitals - 2000Hospitals Today Few measures across relevant areas Many measures -- too many or not the right ones? Industry resistanceWilling participation No uniform data collection Increasing standardized data collection and reporting Little improvement driven by measures Major improvement No experience with measure use Wealth of experience with measure use PPACA ACA – Going Forward National strategy/national priorities to improve: Delivery of health care services, outcomes, population health Interagency Working Group on Health Care Quality; multi-stakeholder input Secretary to establish and implement overall framework public reporting; defined steps between measure identification and public reporting Use performance measures to track quality, form the basis of payment incentives or reductions, and help the public make informed choices AHRQ new authority to identify, develop, evaluate, and disseminate innovative strategies for QI practices

5. © Copyright, The Joint Commission Vast Improvement On Composite of Most Powerful Measures

6. © Copyright, The Joint Commission Improvement By Clinical Area

7. Impact of Public Reporting - Partnership for Patients: Better Care, Lower Costs 1. Reduce harm caused to patients in hospitals. By the end of 2013, preventable hospital-acquired conditions would decrease by 40%. Achieving this goal would mean some 1.8 million fewer injuries to patients with more than 60,000 lives saved over three years. 2. Improve care transitions. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased such that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge. Potential to save up to $35 billion dollars over three years.

8. Policy2011201220132014201520162017 Hospital Inpatient Quality Reporting Program /a -2.0% -1.0% Meaningful Use + Incentive Payments /b -.5%1.7% 1.3%1.4% -1.0%-2.0%-3.0% Hospital Acquired Conditions (Current) /c -.02% Hospital Acquired Conditions (ACA) /d -1.0% Readmissions /e-1.0%-2.0%-3.0% Hospital Value- Based + Purchasing /f - 1.0% - 1.0% 1.25% - 1.25% 1.5% - 1.5% 1.75% - 1.75% 2.0% - 2.0% Medicare Value-Based Purchasing Notes: Percentages reflect approximate maximum potential impact to an individual hospital. The values in the column labeled 2017 remain constant thereafter. a.Non-reporting hospitals lose 2% of their annual market basket update through 2014, then lose ¼ of that update from 2015 onwards. The actual percentage will vary depending on the market basket update each year (-1% is illustrative). b.Incentive payments approximate CMS Office of the Actuary estimates in the high adoption scenario. Payment reductions represent reduction to annual market basket update by ¼, ½, and ¾ in 2015, 2016, and 2017, respectively for hospitals that have not qualified as meaningful users. The actual percentage will vary depending on the market basket update each year (-1%, -2%, and -3% are illustrative). c.HACs reported through claims do not qualify DRG payment for severity adjustment. d.Requires a 1% cut to those hospitals who rank in the top quartile of occurrences of HACs. e.Hospitals that do not meet individualized hospital-specific readmissions benchmark face potential cut to up to a percentage ceiling. f.Percentage of base-DRG payment subject to meeting quality measure requirements. Policy must be budget neutral, so potential for high-achieving hospitals to earn bonuses depending on the number of non-achieving hospitals.

9. In Addition to Value-Based Payment Reform, The Two Major Models of Care in The ACA Depend on Public Reporting Advanced Primary Care Practices, Patient-Centered Medical Homes (PCMHs) New Comprehensive Care Systems, Accountable Care Organizations (ACOs) 9