Tmp Cms Quality Lunch & Learn Final

SWO-HFMA : Lunch and Learn Quality of Care Cost Leadership, Methodology and Technology October 30, 2009 Presenters: Sunil Rao, MD, MBA, Chief Medical Officer, TMP Jeff Burke, MBA, Managing Partner, TMP 1

You will Learn The importance of Quality to national healthcare reform The financial impact Quality can have on every part of your hospital The connection between “Meaningful Use”, the ARRA and EHR use; and the reporting of CMS Quality Core Measures How to move from "just reporting" quality measures to a Quality Management Program for Improved Patient Outcomes based on methods and technology The importance of real time data and process improvement methodologies to the critical issue of improving quality of care processes in healthcare The critical part that (IT) information technology plays in the sustaining platform for continuous improvement www.T-M-Partners.net 3

Agenda What is Quality in Healthcare? Why is Quality so Important? Finance and Executive Buy-in Methodologies Technologies Q&A www.T-M-Partners.net 4

Thoughts for Today Consider these issues: Is Quality Improvement a “Burning Platform”? In the long run, everything is focused on improving Quality CMS says, Quality will improve their financial health CMS may not care about your bottom line CMS will pay the winners and penalize the others ARRA will pay to accelerate IT adoption, but only based on Quality Methods and Technologies can help You need a Quality Improvement Roadmap and CEO Backing www.T-M-Partners.net 5

Healthcare IndustryKey Quality Drivers Patient-Centered Quality Care Quality is a Board Level issue Compliance is Required CMS Pays for Performance www.T-M-Partners.net If Quality Outcomes had been improved by 2% in 2004, the national savings would have been: ,[object Object]

$1.4 billionPatient Care Better patient care costs hospitals less and improves patient outcomes

8 Eliminate Underuse B The Goal A The Industry Today

Health Care Today | Misuse Definition of Misuse “Misuse” of care is another way of describing medical errors, which can be defined as either the failure to properly carry out appropriate treatment plans or the use of inappropriate plans. Committee on Quality of Health Care in America, Institute of Medicine. To Err is Human: Building a Safer Health System. Washington: National Academies Press, 1999.

Health Care Today | Misuse Deaths Due to Preventable Errors Committee on Quality of Health Care in America, Institute of Medicine. To Err is Human: Building a Safer Health System. Washington: National Academies Press, 1999.

Health Care Today | Misuse Deaths Due to Health Care-Associated Infections Klevens RM, Edwards JR, Richards CL, Jr., et al. "Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002." Public Health Reports, 122: 160-166, 2002.

Health Care Today | Overuse Definition of Overuse When treatments are given without medical justification, such as antibiotics for simple infections, or when an equally effective option could have been followed that would have cost less or caused fewer side effects.

Health Care Today | Overuse Unnecessary—and Possibly Harmful—Services Fisher ES, Goodman DC, Chandra A. Disparities in Health and Health Care among Medicare Beneficiaries: A Brief Report of the Dartmouth Atlas Project. Princeton, NJ: Robert Wood Johnson Foundation, 2008.

Health Care Today | Underuse Definition of Underuse When patients do not receive medically necessary care, or when proven health care practices are not followed, e.g., when people who have heart attacks are not given beta-blocking drugs.

Health Care Today | Underuse Recommended Care McGlynn EA, Asch SM, Adams J, et al. "The Quality of Health Care Delivered to Adults in the United States." The New England Journal of Medicine, 348: 2635-2645 (26): 1, 2003.

Health Care Today | Underuse Deaths Due to Improper Care Essential Guide to Health Care Quality. Washington: National Committee for Quality Assurance, 2007. (No authors given.)

News about Quality Every Day CMS chief says Medicare should consider cost to determine coverage CMS Director Dr. Barry Straube is expected to play a critical role in ensuring that health care spending is closely linked with the quality of care as White House officials and lawmakers scramble to pass a health care reform bill. Straube says cost should be considered in deciding which treatments should be covered by Medicare in order to address rising health care costs. www.T-M-Partners.net 18 The Wall Street Journal (10/27/09)

www.T-M-Partners.net “Payment reform will strengthen, if not codify, the relationship between payment and quality, with a significant amount of revenue at risk if quality goals are not achieved.” Catherine Jacobson, FHFMA, CPA, Chair HFMA The HFMA believes that achieving the nation’s health goals requires effective reform of the payment system Breaking Barriers 19

Why is Quality so Important? In the long run, everything is focused on improving Quality CMS says, Quality will improve their financial health Meaningful Use = CMS Quality Core Measures (Plus other items) CMS Pay for Reporting Pay for Performance Value Based Purchasing ARRA Certified EHR Meaningful Use www.T-M-Partners.net 20 CMS has been pursuing this since before 2005 Quality is worth it. What is your Plan? ARRA raises the ante and pays for faster action

What Does VBP Mean to CMS? ,[object Object]

Tools and initiatives for promoting better quality, while avoiding unnecessary costs

Tools: measurement, payment incentives, public reporting, conditions of participation, coverage policy, QIO program

Initiatives: pay for reporting, pay for performance, gainsharing, competitive bidding, bundled payment, coverage decisions, direct provider support,[object Object]

Health Care Today | Variations in Care Overall Improvement is Slowing National Healthcare Quality Report. Rockville, MD: Agency for Healthcare Research and Quality, 2008. (No authors given.)

Additional Measure Topics for FY 2010 and Beyond

HACs Selected During IPPS FY 2008 Rulemaking Foreign object retained after surgery Air embolism Blood incompatibility Catheter-associated urinary tract infection Vascular catheter-associated infection Surgical site infection – mediastinitis after CABG Pressure ulcers Falls – specific trauma codes

HAC, POA “Since 2008, hospitals that cannot document certain conditions as POA have faced Medicare payment reductions. Medicare has also stopped paying for … Never Events. Next on the radar screen; Preventable Readmissions. “Financial leaders should engage with clinicians to work toward avoiding preventable complecations – something both groups want. And we need to develop costing capabilities so we know what these events are costing us. “It isn’t about the lost revenue anymore; it’s about preventing the complications and the associated costs in the first place.” Catherine Jacobson, FHFMA, CPA, Chair HFMA Letter from the Chair, HFM Magazine, October 2009 www.T-M-Partners.net 26

ARRA – Hospital HIT Medicare Funding Is Provided to Encourage the Adoption of HIT ARRA Provisions Implications for Hospitals ,[object Object]

Payment for Qualified Facilities Is Based on the “Medicare Share.”

Payments Are Phased Over Four Years Beginning in 2010.

Non-Adopting Hospitals Face Reduction to Three-Quarters of Their Medicare Market Basket Update, Starting in 2015

Early adopters will receive payments from Medicare during the implementation corridor, 2010 to 2015.

Laggards will see reductions in Medicare payments beginning 2015.

Monitor the Office of the National Coordinator for HIT to stay abreast of standards, specifications and certification criteria.

Instead of bolting EHR on top of existing processes, facilities should re-engineer patient care and billing workflows to increase efficiency and quality.

Base payment is $2M plus $200 per discharge for additional discharges from 1,150 to 23,000th

Reduced using a ratio based on Medicare utilization adjusted for charity care.,[object Object]

Meaningful Use “CMS is expected to publish a formal definition of meaningful use, for the purposes of receiving the Medicare and Medicaid incentive payments, by December 31, 2009.” “Meaningful use of EHRs, we anticipate, will also enable providers to reduce the amount of time spent on duplicative paperwork and gain more time to spend with their patients throughout the day. “Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety, and quality. A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology www.T-M-Partners.net 29

Meaningful Use is Being Defined and Will Follow an “Ascension Path” Over Time* 2009 2011 2013 2015 HIT-Enabled Health Reform Meaningful Use Criteria HITECH Policies 2011 Meaningful Use Criteria (Capture/share data) 2013 Meaningful Use Criteria (Advanced care processes with decision support) 2015 Meaningful Use Criteria (Improved Outcomes) *Report of sub-committee of Health IT Policy Committee

Policy Committee Recommendations for the Definition of Meaningful Use

Cost of Poor QualityGeneric Model Direct poor-quality cost A. Controllable poor-quality cost (1) Prevention cost --- Work to avoid an error (2) Appraisal cost --- Work to assess error (3) No-value-added cost --- Rework, Fix it B. Resultant poor-quality cost (1) Internal error cost --- LOS, Denials, HAC/POA (2) External error cost --- Malpractice, UnPaid Care Indirect poor-quality cost A. Patient-incurred cost --- Time, Emotion, MoneyB. Patient-dissatisfaction cost --- ReputationC. Lost-opportunity cost --- Time and Capacity LostD. Loss-of-reputation cost --- Repeat, Referral, Payer www.T-M-Partners.net 32

Cost of Poor QualitySpecific Direct Costs (Unpaid) www.T-M-Partners.net 33

Poor Quality Impacts www.T-M-Partners.net 34

SummaryTop 10 Things to do Establish Executive Priority Assess your current situation Start Fast Identify the Baseline Align Incentives Establish a repeatable approach (Program) Data Flow Work Flow Cash Flow Repeat www.T-M-Partners.net 36 Better patient care costs hospitals less and improves patient outcomes. Can you identify quality problems and fix them promptly? Do you have the: Methods ,[object Object],Experienced People ,[object Object],Technology ,[object Object],[object Object]

Establish Executive Priority How important are Quality of Care, Core Measure Scores, and Patient Safety to the overall executive leadership? How fast does the board know about the last “Never Event”? Do you look at the public quality core measures of your competition? In relation to the many other issues, how does this stack up? What is the “Burning Platform” for this to take precedence? What is it worth to improve? Budget? ROI? www.T-M-Partners.net 38 Competitive Advantage Patient Satisfaction Budget, Cost, Compliance, Revenue, ROI Best Practices, Improved Process Efficiencies

Dr. Sunil Rao A Physician’s View Evidence Based Medicine = Best Practice Learn and Improve Benchmark Performance Quality Feedback On errors in real time A Desire to follow proper procedure Physician’s need for Core Measure data In the simplest format possible With easy accessibility Up to date and relevant www.T-M-Partners.net 39

How We Get There | Performance Measurement and Public Reporting Doctors and Performance Data Audet AJ, Doyt MM, Shamasdin J, et al. Physicians' Views on Quality of Care: Findings from the Commonwealth Fund National Survey of Physicians and Quality of Care. New York: The Commonwealth Fund, 2005.

How We Get There | Performance Measurement and Public Reporting Doctors and Process-of-Care Data Audet AJ, Doyt MM, Shamasdin J, et al. Physicians' Views on Quality of Care: Findings from the Commonwealth Fund National Survey of Physicians and Quality of Care. New York: The Commonwealth Fund, 2005.

How We Get There | Performance Measurement and Public Reporting Doctors and Clinical Outcomes Data Audet AJ, Doyt MM, Shamasdin J, et al. Physicians' Views on Quality of Care: Findings from the Commonwealth Fund National Survey of Physicians and Quality of Care. New York: The Commonwealth Fund, 2005.

How We Get There | Performance Measurement and Public Reporting Doctors and Quality Data Audet AJ, Doyt MM, Shamasdin J, et al. Physicians' Views on Quality of Care: Findings from the Commonwealth Fund National Survey of Physicians and Quality of Care. New York: The Commonwealth Fund, 2005.

Flash Poll Is there a CEO or Board Level mandate to improve Quality? Does this relate to Core Measure scores or your reporting process? www.T-M-Partners.net 44

How We Get There | Performance Measurement and Public Reporting Improving Health Plan Performance with Public Reporting Health plans that willingly allow public reporting perform at a higher level than those that choose not to do so. In 2006, publicly reporting health plans outperformed non-publicly reporting plans on 37 of 40 measures. The State of Health Care Quality 2007. Washington: National Committee for Quality Assurance, 2007. (No authors given.)

Quality Reporting National IT Coordinator David Blumenthal, MD, emphasized that quality measures are at the heart of his office’s strategy for using IT to transform the U.S. healthcare system “The key to Meaningful use is to know how to measure for performance and to be able to give feedback to providers” “just the act of measuring will continually cause us to improve” “Providing better information is the foundation for change” A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology at a National Quality Forum www.T-M-Partners.net 46

www.T-M-Partners.net ImprovingProcess ,[object Object]

Rapid Changes to process of care

Access to useful real time data

Incentives for change Moving from Reporting to Quality Management How does your Quality process stack up? Retrospective Review of Quality Data? Concurrent Review of Core Measures? Ability to drill down and analyze Core Data? Process changes easily deployed? Strategic Quality Goals being met? Financial Impact ,[object Object]

Tmp Cms Quality Lunch & Learn Final

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