Public Reporting of Quality in Healthcare: The Power of Transparency

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

4. Hospital Measurement: Then & Now --- 2000-2011 PPACA

5. Vast Improvement On Composite of Most Powerful Measures

6. Improvement By Clinical Area

7. Impact of Public Reporting - “Partnership for Patients:Better Care, Lower Costs” 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. 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. 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. • 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). • 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). • HACs reported through claims do not qualify DRG payment for severity adjustment. • Requires a 1% cut to those hospitals who rank in the top quartile of occurrences of HACs. • Hospitals that do not meet individualized hospital-specific readmissions benchmark face potential cut to up to a percentage ceiling . • 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)