013098-140404

1. 013098-140404 

2. • What trends are you noticing that are impacting the hospital? • How are these trends impacting you?

3. • ACA: What is it? • ACA Objectives • ACA Programs • Hospital Value Based Purchasing (HVBP)

4. The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010. The intent is to increase the rate of health care insurance coverage for Americans while reducing the overall cost of health care. It is also known as Health Care Reform. The Bill is comprised of ten titles, each title covering an area of Health Care Reform: Title I. Quality, Affordable Health Care for All Americans Title II. The Role of Public Programs Title III. Improving the Quality and Efficiency of Health Care Title IV. Prevention of Chronic Disease and Improving Public Health Title V. Health Care Workforce Title VI. Transparency and Program Integrity Title VII. Improving Access to Innovative Medical Therapies Title VIII. Community Living Assistance Services and Supports Act (CLASS Act) Title IX. Revenue Provisions Title X. Reauthorization of the Indian Health Care Improvement Act Kaiser Health News http://www.Kaiserhealthnews.org; The Henry J. Kaiser Family Foundation http://kff.org/healthreform

5. The “triple aim” objectives of the ACA: • Improve the individual experience of care • Improve the health of populations • Reduce the per capita costs of care for populations To read the law in full, or for section by section overviews, visit http://www.healthcare.gov/law/full/. The IHI Triple Aim. http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx

6. • Medicaid Expansion • Health Care Exchange • Meaningful Use • Accountable Care Organizations Shifts in Reimbursement & Financial Incentives https://www.healthcare.gov/get-covered-a-1-page-guide-to-the-health-insurance-marketplace

7. • Market Basket Reductions • DSH Reductions for CMS Services • Bundled Payments for Episode of Care • CMS Pay for Performance Programs Source: McKinsey & Company. The Trillion Dollar Prize. Tom Latovick. February 2013. Source: https://www.aamc.org/advocacy/medicare/155102/dsh.html Souce: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8070.pdf Source: http://www.hrsa.gov/healthit/toolbox/HealthITAdoptiontoolbox/QualityImprovement/whatispay4perf.html

8. • Hospital Readmissions Reduction Program (HRRP) • Hospital Acquired Conditions (HAC) • Meaningful Use • Hospital Value Based Purchasing (HVBP) Kaiser Family Foundation, Implementation Timeline, http://healthreform.kff.org/timeline.aspx. Accessed 1/20/20130

9. CMS initiative that rewards acute-care hospitals with the quality of care they provide to Medicare patients. • • Built off CMS’s Inpatient Quality Reporting (IQR) Program • • Funded by 1.25% Diagnostic-Related Group (DRG) payment reduction to participating hospitals • • Affects ~ 3000 hospitals • • Hospitals can recoup this loss through incentive payments determined by Quality Measures Department of Health and Human Services, Centers for Medicare & Medicaid Services, Medicare Learning network, Hospital Value-Based Purchasing Program, ICN 907664, Mar 2013 Department of Health and Human Services, Centers for Medicare & Medicaid Services, Medicare Learning network, Hospital Value-Based Purchasing Program, ICN 907664, Mar 2013

10. 1. AMI-7a Fibrinolytic Therapy Received within 30 Minutes of Hospital Arrival 2. AMI-8 Primary PCI Received within 90 Minutes of Hospital Arrival 3. HF-1 Discharge Instructions 4. PN-3b Blood Cultures Performed in the ED Prior to Initial Antibiotic Received in Hospital 5. PN-6 Initial Antibiotic Selection for CAP in Immunocompetent Patient 6. SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour Prior to Surgical Incision 7. SCIP-Inf-2 Prophylactic Antibiotic Selection for Surgical Patients 8. SCIP-Inf-3 Prophylactic Antibiotic Discontinued within 24 Hours of Surgery 9. SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m. Postoperative Serum Glucose 10. SCIP-Inf-9 Postoperative Urinary Catheter Removal on Postoperative Day 1 or 2* 11. SCIP-CArd-2 Surgery Patients on a Beta Blocker Prior to Arrival that Received a Beta Blocker During the Preoperative Period 12. SCIP-VTE-1 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered 13. SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis within 24 Hours * Represents a new measure not instituted FY 2013 HVBP Program Department of Health and Human Services, Centers for Medicare & Medicaid Services, Medicare Learning network, Hospital Value-Based Purchasing Program, ICN 907664, Mar 2013

11. * 1. Nurse Communication 2. Doctor Communication 3. Hospital Staff Responsiveness 4. Pain Management 5. Medicine Communication 6. Hospital Cleanliness and Quietness 7. Discharge Information 8. Overall Hospital Rating 1. MORT-30-AMI Acute Myocardial Infarction (AMI)30-day mortality rate 2. MORT-30-HF Heart Failure (HF) 30-day-mortality rate 3. MORT-30-PN Pneumonia (PN) 30-day mortality rate *Represents a new measure not instituted FY 2013 HVBP Program Department of Health and Human Services, Centers for Medicare & Medicaid Services, Medicare Learning network, Hospital Value-Based Purchasing Program, ICN 907664, Mar 2013

12. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Medicare Learning network, Hospital Value-Based Purchasing Program, ICN 907664, Mar 2013

13. In 2011, over 20% of not-for-profit hospitals had negative operatingmargins; 63% of hospitals had operating margins between 0-5%. Source: Avalere Health Analysis of American Hospital Association Annual Survey data, 2011, for community hospitals

14. • 57% of all care provided by hospitals comprise of Medicare and Medicaid patients. • In 2010, hospitals received only 92 cents for every dollar spent caring for Medicare patients. • In 2010, 53% of hospitals received Medicare payments less than cost. Aggregate Hospital Payment-to-Cost Ratios for Medicare & Medicaid (1990-2010) Health Analysis of American Hospital Association Annual Survey data, 2011, for community hospitals. Includes Medicare and Medicaid Disproportionate Share payments.

15. The Clinical lab represents 2% of Medicare Spending yet influences 70% of Clinical Decisions. Laboratory Medicine: A National Status Report, The Lewin Group, May 2008, pg. 2 A Policy Primer on Diagnostics, AdvaMedDx, June 2011, pg. 3 ARUP Laboratories, The Role of Laboratory Medicine in Accountable Care Organizations, Joe Miles, MT(ASCP, MHS & Ronald L. Weiss, MD, MBA, 2011