Medical Billing, Patient Centered Outcomes and Health Care Competitiveness
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1 + Today s Patient Centered Outcomes Seminar Getting to patient-centered high value healthcare Is the ACA enough? Ashish Jha, MD, MPH Professor of Health Policy and Management, Harvard School of Public Health PCERC Contact Information: Daniel Solomon, PCERC Co-Director (dsolomon@partners.org) Joel Weissman, PCERC Co-Director (jweissman@partners.org) Joshua Di Frances, Biomedical Research Institute Project Manager (jdifrances@partners.org) Please Josh to register for this Seminar
2 + Next Patient-Centered Outcomes Seminar Monday, February 24, 4 pm 5 pm Ken Mandl, MD, MPH, Professor of Medicine, Harvard Medical School Shawn Murphy, MD, MPH, Associate Professor of Neurology, Harvard Medical School Additional Seminar Speakers: John Hsu, MD, MBA, MSCE (March) Joseph Kvedar, MD (April) Sonya Shin, MD, MPH (May) David Blumenthal, MD, MPP (October)
3 + High Quality, Patient-Centered Care Will ACA Get Us There? Ashish K. Jha, MD, MPH PCERC Seminar January 27, 2014
4 + Agenda ACA has two goals: Expand coverage Fix the healthcare delivery system (C&Q) What s the problem with quality? What does the ACA do for quality? And how likely is it to be effective? How do we move forward?
5 + What are the big quality challenges?
6 + Patient Safety Care is often unsafe: 1 in 4 seniors injured during hospitalization 5% risk of injury PER DAY Each year: 1.8 million hospital-acquired infections 4 th leading cause of death 1.5 million preventable injuries due to medications Probably a top 10 cause of death
7 + Effectiveness Care is often unreliable 54.9% of evidence-based treatments
8 + Variations in AMI Mortality Number of Hospitals % 10% 15% 20% 25% 30% 35% 40% 45% Risk-adjusted 30-day Mortality Rates
9 + Suboptimal Patient Experience 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% HCAHPS Rating (% Negative)
10 + Summary of the state of care 2014 Care remains highly unsafe Too much variation in key outcomes With lots of underperforming institutions Patient experience not optimal Could be better, should be better
11 + Quality problems uniquely American?
12 + In-hospital case-fatality rates for AMI* Australia USA Finland OECD Belgium Japan Mexico *Age and sex adjusted
13 + Catheter-related bloodstream infection
14 + Fatality rates: hemorrhagic stroke
15 + What does ACA do to improve care? Major initiatives for costs and quality: Value-based purchasing Readmission penalties towards hospitals Accountable care organizations Bundled payments Primary care innovation Others
16 + Will it work?
17 Its tough to make + predictions, especially about the future Yogi Berra
18 + Value-based purchasing Changing how we pay for hospital care 1.25 % holdback on Medicare payments Increases to 2% Returned based on performance Based on processes, patient experience, mortality Modeled after Premier HQID
19 Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Premier HQID: Did It Work? 16.0% 14.0% 13.3% Premier Non-Premier 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 13.2% Onset of Pay-for-performance 11.2% 10.9% Jha et al. NEJM 2012
20 + Value-based purchasing Will it improve outcomes? Unlikely to move ball in meaningful way Is underpowered, unfocused Should improve patient experience Unclear yet how much Will add on HACs later this year Challenges ahead
21 + Reducing Readmissions
22 + Why Readmissions? Holy grail of healthcare: Improve care and lower costs! Big problem 1 in 5 Medicare patient is back within 30 days Quite straightforward Just stop patients from bouncing back
23 + Readmissions Policy Hospital Readmissions Reduction Program (HRRP) Initially 1% holdback on Medicare hospital payments Increases to 3% by 2015 Raises key questions What really predicts readmissions? How do we make progress? Can we make the policy better?
24 + Readmissions: what do we know? Preventability: wide range from literature Systematic review: 27% are likely preventable * Studies that rely on clinical data: 12% Jeff Schnipper s work at BWH 36% may be preventable * Van Walraven et al. CMAJ, 2011
25 + Readmissions: what do we know? Factors related to readmissions Sicker patients (the model tries to deal with that) Poor patients Medicaid patients 50% higher rates Hospitals in poor communities 15% higher rates* Minority patients Black patients 15% higher than whites** Hispanic patients about 15-20% higher than whites *Joynt and Jha, Circ:QCOR 2011; ** Joynt, Orav and Jha, JAMA 2011; Rordriguez et al. AHJ, 2012
26 + Readmissions and mortality Gorodeski et al. NEJM, 2010
27 + HRRP: Who gets hit in FY 2013? High Low No P- Penalties Penalties Penalty value N=1,098 N=1,087 N=1,081 Teaching COTH 44% 38% 18% <0.001 Not COTH 30% 33% 34% Joynt, Orav, and Jha, JAMA 2013
28 + HRRP: Who gets hit in FY 2013? High Penalties Low Penalties No Penalty P-value N=1,098 (N=1,087) N=1,081 Safety-Net 44% 35% 20% <0.001 Non-safety-net 28% 33% 37% Proportion of black patients 13% 9% 6% <0.001 Joynt, Orav, and Jha, JAMA 2013
29 + Readmissions Policy Good Focus on discharge planning, care coordination Creates accountability for hospitals Bad Punishes AMCs, safety-net Ugly Not sure it would be most patients top priority Worried about how much it distracts us
30 + Broader delivery system reform: ACOs
31 + Accountable Care Organizations No real data yet on impact Lots being written about them Basic demographics: 32 Pioneer ACOs SSP entities by 2013 ACOs cover 10% of Medicare beneficiaries
32 + Accountable Care Organizations Promising, challenging approach Promising: Allows real possibility for innovation Aligns incentives well Does focus a little on quality Challenges: Management issues IT issues
33 + What about ACOs and Quality? 8 in patient / caregiver experience 6 in care coordination and patient safety All-cause readmissions 2 ambulatory-care sensitive condition hospitalizations (CHF, COPD) Percent of PCPs who got EHR incentive program Medication reconciliation after discharge Fall screening in clinic 8 Screening/prevention Flu, pneumonia vaccine Mammograms, colorectal cancer screening Measuring weight, BP, assessing tobacco use 11 in chronic disease management (DM, HTN, IHD, CHF) No outcomes (a few intermediate outcomes)
34 + Summary of ACOs and Quality Much of the focus on savings Quality measures there as backstop Most of the measures are very old Not always focused on the most important things Unclear if they will drive improvements in care
35 + What did I not cover? Primary care Better incentives Innovation Early phase Bundled payments In demonstration/experimentation stage Unlikely to have broad impact anytime soon Payment cuts to hospitals Good evidence it will have deleterious effects Likely fuel further consolidation
36 + Summary: ACA and Quality Big opportunity for improvement ACA represents a good start Unclear if current efforts will get us there VBP likely underpowered, unfocused Readmissions helpful in some areas, needs work ACOs great experiment Will it save us money? (hopefully) Will it lead to higher quality (less clear)
37 + What we need: ACA 2.0
38 + ACA 2.0: What might it look like? Bigger incentives on the table for quality More focus on outcomes Especially over the longer run Across a broader set of measures Bigger focus on patient safety More experiments More nuanced approach to the safety net
39 + The End
40 + On
41 + Backup Slides
42 + Patient Experience and Quality Is better patient experience correlated with better quality? Hypothesis 1: Service and technical quality unrelated Hypothesis 2: Management matters
43 + Better Quality and Better Experience HCAHPS* 1 st quartile (high performers) AMI Process Score nd quartile rd quartile th quartile (low performers) 93.5 P-value < * HCAHPS rating based on percentage of patients who rated their hospital experience a 9 or 10 Jha et al. NEJM, 2008
44 + Better Quality and Better Experience HCAHPS* AMI CHF 1 st quartile (high performers) nd quartile rd quartile th quartile (low performers) P-value < <0.001 * HCAHPS rating based on percentage of patients who rated their hospital experience a 9 or 10 Jha et al. NEJM, 2008
45 + Better Quality and Better Experience HCAHPS* AMI CHF Pneumonia 1 st quartile (high performers) nd quartile rd quartile th quartile (low performers) P-value < <0.001 <0.001 * HCAHPS rating based on percentage of patients who rated their hospital experience a 9 or 10 Jha et al. NEJM, 2008
46 + Better Quality and Better Experience HCAHPS* AMI CHF Pneumonia SCP 1 st quartile nd quartile rd quartile th quartile P-value < <0.001 <0.001 <0.001 * HCAHPS rating based on percentage of patients who rated their hospital experience a 9 or 10 Jha et al. NEJM, 2008
47 4Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Process Measures P4P vs. Controls P4P 87.5 Controls
48 + P4P in England: more success Health Conditions Northwest Region (Under P4P) Rest of England (Controls) Mortality before Mortality after Difference Mortality before Mortality after Difference Acute MI 12.1% 10.7% -1.4% 11.3% 10.4% -1.0% Heart Failure 18.8% 17.5% -1.3% 16.9% 15.8% -1.1% Pneumonia 29.4% 27.0% -2.4% 27.1% 26.3% -0.7%
49 + Comparison of ACOs to HMOs Aligned incentives for saving $? HMOs ACOs
50 + Comparison of ACOs to HMOs HMOs ACOs Aligned incentives for saving $? Salaried physicians? No
51 + Comparison of ACOs to HMOs HMOs ACOs Aligned incentives for saving $? Salaried physicians? +/- Patients can move freely? No
52 + Comparison of ACOs to HMOs HMOs ACOs Aligned incentives for saving $? Salaried physicians? +/- Patients can move freely? - PCP as gatekeeper? -
53 + Comparison of ACOs to HMOs HMOs ACOs Aligned incentives for saving $? Salaried physicians? +/- Patients can move freely? - PCP as gatekeeper? - Common IT platform? +/-
54 + Comparison of ACOs to HMOs HMOs ACOs Aligned incentives for saving $? Salaried physicians? +/- Patients can move freely? - PCP as gatekeeper? - Common IT platform? +/- Close monitoring of quality? +/-
55 + Higher HQA Performance Associated with Lower Mortality AMI* CHF** Pneumonia* HQA Performance Risk-adjusted odds of death 1 st quartile nd quartile rd quartile th quartile Reference Reference Reference * P-value for trend <0.001 ** P-value for trend = 0.01 Jha et al., Health Affairs, July 2007
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