2012 Health Care By the Numbers Part One


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Reform of the U.S. health care system is at hand. On June 28, 2012, the Supreme Court of the United States (SCOTUS) upheld one of the most historic health care laws in the U.S. since the establishment of the Medicare and Medicaid programs in 1965 under President Lyndon Johnson—the Affordable Care Act (ACA). Last year, 21.4 cents of every Federal income tax dollar received went to Medicare and health care spending, second only to the military in U.S. expenditures. According to the last report by the Congressional Budget Office (CBO) issued in March 2012, ACA will cost $1.76 trillion (net cost of $1.1 trillion) to fully implement between now and 2022. That amount represents significant provisions to fuel reform.

Prior to ACA, use of electronic health records (EHR) was triggered under the American Recovery and Reinvestment Act of 2009 (ARRA). The HITECH component of this law is specifically designed to reward and accelerate interoperable EHR adoption by hospitals and providers through an incentive program known as Meaningful Use.

Between ARRA and ACA, delivery of health care in America will look very different in the next five years. The following numbers and metrics are brought to you by SuccessEHS and tell the tale of health care transformation. Enjoy!

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2012 Health Care By the Numbers Part One

  1. Part One the american patient meaningful use the affordable care actaccountable care organizationspatient-centered medical home
  2. THE American PatientMore and more in policymaking, the U.S. government is seeking to activelyengage the American patient or their caregiver as a participant in the caremanagement process. With chronic disease impacting nearly 140 millionAmericans today, it remains a critical factor to reining in health care spending.Experts believe one of the principal causes of chronic disease is that the Americanpatient is unengaged and not held accountable for lifestyle choices made. Theprovider community can expect this point to be pressed in future policymakingand their ability to successfully deliver patient-centric care linked toreimbursement in the near future.
  3. THE American patient 309 Millions of people living in 51% Percent of the U.S. population that is male (49 percent) & 78.7 Life expectancy for allthe United States of America 49 % female (51 percent) genders & demographics in the40.3 Millions of Americans ages 65+ (17.3 percent live in U.S., as compared to Florida); this demographic is expected to grow to 88.5 83.9 in Japan & 49.4 million by 2050 in South Africa1.4 Millions of men & women who serve as active duty military in defense of America 35.7 Percent of American14.1 Billions of dollars spent on medical services directly attributed to childhood obesity alone adults who are obese
  4. THE American patient 190Thousands of 2012 expected cancer 7.1 Millions of Americans that are 20 deaths in the U.S. that are linked to estimated to have undiagnosed obesity, physical inactivity & poor diabetesnutrition - all of which is preventable 5.4 Percent of U.S. adults who meet the 573 criteria for substance dependence or abuse Millions of Americans of all ages that Thousands of Americans who die will have Alzheimer’s in 2012, thefrom heart disease, the leading cause sixth leading cause of death in the of death in the U.S. U.S. 10 18.3 Millions of Americas that were 2.7 Trillions of dollars that was estimated Percent of Americans ages 12+ who are on antidepressant medication, thephysician-diagnosed with diabetes by as the U.S. national health third most commonly prescribed drug 2008 expenditure in 2011 in the U.S.
  5. THE American Patient 31 356 Dollars per person that was spent on 75 Billions of dollars spent total on health care in the U.S. in 1970 health care in the U.S. in 1970Percent of U.S. health expenditures that are attributed to hospital care 20 8,402 Dollars per person that is spent on 250 Billions of dollars that were spent on health care in the U.S. today prescription drugs, representing 12 percent of personal health carePercent of U.S. health expenditures that are expenditures in 2009 4,072 attributed to physician or other clinical services Dollars per person that is spent on 60 health care in the Germany today Percent of adult Americans with private health care coverage as of 2010
  6. meaningful useEnacted under the American Recovery and Reinvestment Act of 2009 (ARRA),HITECH promotes adoption of interoperable electronic health records (EHRs) byhealth care providers through financial incentives under the Medicare or MedicaidEHR Incentive Programs, also known as “Meaningful Use.” This piece oflegislation is designed to reward and accelerate the adoption of interoperable,certified electronic health records (CEHRT). Meaningful Use was launched onJan. 1, 2011, bringing the carrots of incentive dollars to many providers andhospitals. The threat of sticks for non-adoption lurks as of 2015 through paymentadjustments in Medicare provider reimbursement.
  7. meaningful use 3,662Eligible hospitals that have registered 51.3 3.7 Billions of dollars that has been paid for the CMS Medicare & Medicaid to eligible hospitals for successful EHR Incentive Program attestation to Stage 1 Meaningful Use Percent of all physicians in the U.S. 163,748 995 who report that they intend to pursue the Meaningful Use incentives under Medicare or Medicaid Eligible professionals that have Millions of dollars that has been paidregistered for the CMS Medicare EHR to eligibile professionals for Incentive Program successful attestation to Stage 1 57.6 Meaningful Use under Medicare 81,029 Eligible Professionals that have Percent of physicians under age 45 who plan to apply for Meaningful Use, 11,588 as opposed to only 44 percent of Family practice physicians that haveregistered for the CMS Medicaid EHR physicians ages 55+ successfully attested to Stage 1 Incentive Program Meaningful Use under Medicare
  8. meaningful use 10,597 215 30,204Physicians that have attested to adopt, Internal medicine physicians that have successfully attested to Stage 1 Meaningful Use under Medicare Eligible professionals that have successfully attested to Stage 1 implement or upgrade (AIU) certified Meaningful Use under Medicaid EHR technology under Medicaid 3,884 7,859 8,045 Mid-level eligible professionals who Cardiologists that have successfully attested to Stage 1 Meaningful Use under Medicare Hospitals & eligible professionals that have attested under the CMS EHR 44have attested to to year one AIU under Incentive Programs in Texas for a total Medicaid; this includes Nurse of $483,550,804 in incentive paymentsPractitioners (6,812), Mid-wives (886) (highest performing state) & Physician Assistants (347) 101 States that have launced the Medicaid EHR Incentive Program 2,237Dentists that have attested to year one 852 Hospitals & eligible professionals that have attested under the CMS EHR Incentive Programs in North Dakota for AIU under Medicaid Millions of dollars that have been paid to a total of $2,307,325 in incentive eligible professions for successful Stage payments (lowest performing state) 1 Meaningful Use under Medicaid
  9. THE AFFORDABLE CARE ACTIn March 2010, President Obama signed the most substantial bill transforming the deliveryof health care in the U.S. into law since creating Medicare and Medicaid – The AffordableCare Act (ACA). On June 28, 2012, the Supreme Court of the United States (SCOTUS)ruled that ACA, including its individual mandate that virtually every American must buyhealth insurance, is constitutional. Under §3007 of ACA, the government will be usingquality and cost data to move from being a purchaser of health care services into apurchaser of value. Beginning in 2015, HHS must establish a payment modifier forvalue-based purchasing to physicians and physician groups. These differential paymentswill be delivered by HHS under a fee schedule based on quality as compared to cost.Quality will be based on a combination of measures such as outcomes, functional status,shared decision-making, use of health IT, timeliness and patient experience (many of theitems required under NCQA’s patient-centered medical home model). Cost measures willinclude such items as socioeconomic and demographic characteristics (e.g. race,ethnicity, language, etc.) and patient health status. The big point to note is that matters ofestablishing quality, costs and the value-based payment modifier are to be done totally byHHS without being subject to administrative or judicial review.
  10. THE AFFORDABLE CARE ACT 2,409 Number of pages contained in the 12 73 Number of times Accountable CarePatient Protection & Affordable Care Number of times Payment Modifier is Organization is mentioned in ACA Act of 2010 15 referenced as it relates to physician 55 reimbursement for Meicare Part B Physician Fee Schedules 29 Number of times the Medical Home is Number of pages contained in the mentioned in ACA Health Care & Education Reconciliation Act of 2010 Number of times Quality Reporting is 36 193 discussed as it relates to clinical data Number of times Number of pages in the Supreme Court’s final opinion of the ACA 58 Patient-Centeredness is referenced in ACA 8 Number of times Federally Qualified Health Centers (27), Rural Health Clinics (14) & Community Health Centers (17) are referenced 84 Number of times Value-Based is Number of pages contained in the mentioned as it relates to reforming Constitution of the United States hospital & provider reimbursement
  11. THE AFFORDABLE CARE ACT Number of states enjoining lawsuit against the Medicaid Expansion issue of the ACA Number of Justices who heard Oral Arguments on ACA’s Individual Mandate & Medicaid Expansion issues Number of Justices rendering the majority favorable decisions on the Number of times the constitutionality of Supreme Court Opinion the ACA mentions broccoli
  12. Accountable Care OrganizationsCreated under ACA, CMS began contracting with Accountable Care Organizations(ACOs) to provide services for a defined population of Medicare patients with twolaunch dates: April 1, 2012 and July 1, 2012. There are three ACO models: onewith no risk, one with risk and one deemed a “Pioneer” model. Each ACO willneed to be armed with technology tools such as EHR, HIE and Patient Portals as afoundation for achieving cost-effective and patient-centric quality of care. Therules governing assignment of Medicare beneficiaries, the 33 quality measures,eligibility considerations for FQHCs and RHCs, NCQA’s ACO recognition program,and the desired reformation being sought by CMS were released in final on Oct.20, 2011. Since that date, not only has CMS has been moving forward with thisinnovative care delivery model, but the private industry has also joined the mix.
  13. Accountable Care Organizations 118 Hospital-sponsored 70 Physician-sponsored 29 Health Plan-sponsored 8 Community-Based ACOs in 22 states ACOs in 23 states ACOs in 22 states Organization-sponsored (99 in Oct. 2011) (38 in Oct. 2011) in 4 states 148 32 Pioneer ACOs contracted to the Centers for Medicare and Medicaid Innovation (CMMI) under the Affordable Care ActSingle Provider ACOs - meaning 27 typically an integrated deliverysystem that receives risk-based Medicare Shared-Savings ACOs contracted reimbursement from the payer to CMMI under the Affordable Care Act 5 Advanced Payment ACOs contracted to CMMI under the Affordable Care Act
  14. Accountable Care Organizations221 45 Number of public Number of 25 & private ACOs in states with an the U.S. ACOStates without an ACO: States with only one ACO: Alaska, Number of ACOs inDelaware, Idaho, Rhode Arkansas, Hawaii, Kansas, Louisiana, California, the state Island, South Dakota, Mississippi, Nevada, Oklahoma, South with the highest West Virginia Carolina, Utah, Virginia, Wyoming number of ACOs States advancing the Medicaid ACO models: Colorado, Minnesota, New Jersey, Oregon, Utah
  15. Patient-centered medical homeThe patient-centered medical home (PCMH) is a care delivery model that partnersa primary care provider to other teammates for a coordinated effort at managingpatients, the goal being to deliver quality of care and value to the patient as a careteam. The returns on improved patient quality, improved patient health andreduced costs of care are measurable. Because prevention, wellness andlong-term healing not only promotes quality of care but saves money, both publicand private payers are beginning to pay differentially to providers with PCMHrecognition. There are four organizations that offer PCMH accreditation,certification, achievement or recognition, namely: The National Committee forQuality Assurance (NCQA), The Joint Commission, URAC and the AccreditationAssociation for Ambulatory Health Care.
  16. Patient-centered medical home 75 4 Million 176 Organizations & locations that have Of the 149 NCQA PCMH 2011 factors that Blue Cross Blue Shield members in 39 states across the country that are received Joint Commission accreditation directly relate to improving patient & Primary Care Medical Homeengagement, population management & care benefiting from care delivered through BCBS PCMH initiative certification management for primary care providers 8 $2.26 41 States that have adopted policies & Amount per patient increase in operating Federal agencies are engaged in programs to advance medical homes costs that is realized on average for PCMH research, technical assistance, 8 delivering PCMH levels of care demonstrations & funding projects, including AHRQ, CMS, DOD, HRSA, SMAHSA, NIH, NCI & VA $18 States that are strengthening primary 24,020 care through ACA Section 2703 for Amount per patient per month that is improved outcomes & lower costs saved on average through the PCMH under Medicaid (AL, IA, KS, MD, MT, from reduced emergency department NE, TX, VA)Providers & clinic sites recognized for either visits & hospitilizations the NCQA PPC PCMH or the NCQA PCMH 2011 programs in the U.S.
  17. Patient-centered medical home 72 Percent of a given Millions of obese adults in the population on average that U.S., representing one-third of 10 drives 60-70 percent of the total health care costs for the population; for U.S. children, 17 percent are obese that population147 Billions of dollars spent in the U.S. on overall medical care costs due to obesity 44 Number of Type 2 diabetes cases per 1,000 patients 443,000 Americans who die each 26Millions of people 79 Millions of people that can be delayed with early intervention & prediabetes screening over a period of 3 years year because of smoking or exposure to secondhand smoke in the U.S. with in the U.S. with 48.3 5,455 diabetes pre-diabetes174 Billions of dollars spent in the Dollars more that are spent per patient per U.S. directly or indirectly on Percent of smokers who year to care for the health of a smoker as costs related to diabetes quit in the past year after compared to a non-smoker being advised to do so by a physician
  18. Stay Tuned for Part Two electronic Health Record Adoption & Health information Exchange HIPAA privacy, Security & Breach Notification Priority Primary Care Providers Community Health Centers B.R.I.E.F SURVEY RESULTS CITATIONS