2014 Performance Implications for Payment Programs
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1 2014 Performance Implications for Payment Programs
2 2014 Assumptions Relative Readmission Rates 2
3 2014 Readmission Reduction Incentive Program Established April 2014 Readmission reduction target of 6.76% All-payer, case mix adjusted Incentive only policy 0.5% inpatient revenue 3
4 National and MD Readmissions Trends Nation Maryland Nation Vs. MD Readmissions Rate % Change in Rate of Readmissions Readmissions Rate % Change in Rate of Readmissions Difference Between % Changes in Rates of Readmissions % 18.60% 11.51% % -3.10% 17.82% -4.20% 10.24% % -2.34% 17.08% -4.14% 8.21% % -0.35% 16.94% -0.80% 7.72% Minimum Annual Improvement Target = 8.21% / 5 Years (1.64%) + National Reduction Source: HSCRC Performance Measurement presentation using data from the Centers for Medicare and Medicaid Innovation (CMMI), 2015 Note: CY 2014 rates have been estimated by applying the YTD October 2014 to YTD October 2013 change in readmissions rates to the CY 2013 readmission rates 4
5 Percent Difference Necessary Reduction Trend Actual and projected percent difference between Maryland s readmissions rate relative to the Nation s readmissions rate 12.0% 10.0% 8.0% 10.2% 8.2% 7.7% 6.0% Target 4.9% 4.0% 3.3% 2.0% 0.0% 1.6% 0.0% Calendar Years Source: Centers for Medicare and Medicaid Innovation (CMMI), 2015 Note: Actual CY 2014 rates have been estimated by applying the YTD October 2014 to YTD October 2013 change in readmissions rates to the CY 2013 readmission rates 5
6 Improvement in All-Payer Readmission Rate CY 2013 to CY % 10.00% 5.00% 0.00% -5.00% CY 2014 reduction target of 6.76% % % % % Source: HSCRC monthly inpatient case-mix data with CRISP identifier (inter-hospital readmissions) 6
7 Medicaid s Share of Inpatient Discharges and Improvement in Readmissions 2013 Payer Mix of Inpatient Discharges % 25% Medicaid Medicare Other 35% Total 629,276 44% Medicaid Proportion Has Increased by 17.9% 36% Total 609,053 39% Medicaid Medicare Other Reductions in the risk adjusted Medicaid readmissions rate has outpaced other payers Risk Adjusted Rate of Readmissions CY2013 Risk Adjusted Rate of Readmissions CY2014 % Change CY2013-CY2014 Medicaid 14.74% 13.02% % Total For All Payers 12.50% 11.99% -4.08% Source: Data extracted from HSCRC spreadsheet reflecting readmission rate reductions comparing CY 2013 Base Year Rates to CY 2014 (Jan Dec), preliminary data Note: Readmission rates exclude planned readmissions 7
8 Percent Difference Necessary Reduction Trend Actual and projected percent difference between Maryland s readmissions rate relative to the Nation s readmissions rate 12.0% 10.0% 8.0% 10.2% 8.2% 7.7% 6.0% Target 4.9% 4.0% 3.3% 2.0% 0.0% 1.6% 0.0% Calendar Years Source: Centers for Medicare and Medicaid Innovation (CMMI), 2015 Note: Actual CY 2014 rates have been estimated by applying the YTD October 2014 to YTD October 2013 change in readmissions rates to the CY 2013 readmission rates 8
9 2015 Readmission Reduction Incentive Program Approved March 11, 2015 Cumulative readmission reduction target of 9.3% CY 2013 Base Period All-payer, case-mix adjusted Rewards and penalties 2% inpatient revenue at risk 9
10 HSCRC Rationale for All-Payer Target Requires hospitals to focus on complex vulnerable patients driving majority of readmissions Hospitals are already focused on all-payer reductions Draws upon strengths of the all-payer system and is consistent with other MD quality programs Source: HSCRC presentation, March 11,
11 Challenges Improvement only policy, no attainment Declining admissions, impact on case mix Impact of sociodemographic factors 11
12 Improvement in All-Payer Readmission Rate CY 2013 to CY % 10.00% 5.00% 0.00% -5.00% % CY 2014 reduction target of 6.76% Cumulative reduction target of 9.30% % % % Source: HSCRC monthly inpatient case-mix data with CRISP identifier (inter-hospital readmissions) 12
13 Case Mix Index 1.13% increase overall Variation 3.6% increase in Academic Medical Centers 3.4% increase in Baltimore City 2.2% increase in Urban hospitals 1% decline in Northern border hospitals Payer Breakdown Medicare: highest CMI; experienced lowest growth (almost.75%) Medicaid: lowest CMI but experienced growth of nearly 2.5% Source: MHA analysis of HSCRC monthly inpatient case-mix data, final Notes: Overall and variation based on CMI change from CY 2013 Jan Sep to CY 2014 Jan - Sep; payer change based on CMI change from CY 2013 to CY 2014 Jan - Sep 13
14 Sociodemographic Factors 14
15 How Do We Get There? Rehospitalization is a system issue and the problem does not lie with one organization or one provider, but with the community and the local health care system. Addressing this issue will require organizations and providers to work together. - Anne-Marie Audet, VP, The Commonwealth Fund 15
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