Health Care Reform - Round Rock Chamber of Commerce

Health Care Reform: Now and 2014
Provider Response and Consumer Expectations
David W. Martin, MD, FACS
Chief Medical Officer
St. David’s Round Rock Medical Center
Biggest Change: Costs
Quality in Health Care is Questioned:
Successful Initiatives
The 100,000 Lives Campaign
Deployment of Rapid Response Teams
Evidence-based care for Acute MI
Prevention of Adverse Drug Events
Prevention of Central Line Infections
Prevention of Surgical Site Infections
The 5 Million Lives Campaign
Prevent Pressure Ulcers
Reduce MRSA Infections
Prevent Harm from High-Alert Meds
Reduce Surgical Complications
Evidence-based Care for Heart Failure
The Leapfrog Group Strategy for
Healthcare Reform
& Practices
& Rewards
The Wisconsin Experience:
That which is measured, tends to improve.
That which is measured publicly, tends to
improve faster.
Julie Hubbard Health Affairs 2003
Data Transparency
• If the other guy’s getting better, then you’d better be
getting better faster than that other guy’s getting
…Or you’re getting worse.
Tom Peters
The Challenge
Components of Reform
– to incentivize towards high quality, low cost care
– To reduce the overall spend of care
Major Components
• Reward Better performing providers
– Value Based Purchasing
• Reducing payment for poor outcomes
– Readmissions, hospital acquired conditions, infections, serious
preventable adverse events
• Encourage collaboration across the continuum
– Bundling of payments
Quality Based Payment Reforms
Quality Based Payment Reforms
• Readmissions
– Federal: PPACA imposes financial penalties on
hospitals with high readmission rates.
• Beginning October 2012, acute care hospitals with higher than
expected 30 day risk adjusted readmission rates will receive reduced
payments for every discharge. The reduced payment is the lesser of 1%
or a hospital specific readmission adjusted factor. [2% in Oct 2013; 3%
in Oct 2014]. CAHs exempt.
• In the first two years, the payment policy will apply to heart attack,
heart failure and pneumonia. Additional conditions will be added in
future years.
• Projected savings: $7.1 billion/10 years
Quality Based Payment Reforms
• Hospital Acquired Conditions (HACs)
– Federal:
PPACA imposes financial penalties on hospitals with high HAC
• Beginning October 2014, hospitals with HAC rate in bottom quartile of
national average (i.e. high rate) will suffer a 1% payment reduction for all
Medicare inpatient DRGs.
• Projected savings: $1.5 billion/10 years
– Other HAC provision
• Requires reporting of hospital specific information on HACs to the public
via Hospital Compare
• Public reporting was scheduled for September 23, 2010 but has been
indefinitely delayed due to a discrepancy in the calculation of HAC rates
by CMS.
Available data
• Compare care quality –
– Compare hospitals
– Compare nursing homes
– Compare home health agencies
– Compare dialysis facilities
• Pricing
– THA – Link to Texas PricePoint
Other sites
State sites
• Perfection is unobtainable. But if we chase it,
• we can catch excellence.
Vince Lombardi

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