2014 advances in inflammatory bowel diseases orlando, florida december 4, 2014 1 how recently...
TRANSCRIPT
![Page 1: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/1.jpg)
2014 Advances in Inflammatory Bowel Diseases
Orlando, FloridaDecember 4, 2014
1
How Recently Federally Mandated Changes are Altering
the Care of our IBD PatientsRobert Burakoff, MD MPHClinical Chief, Division of
GastroenterologyDirector, Center for Digestive Health
Associate Professor of Medicine Harvard Medical School
Brigham and Women’s Hospital
Richard Johannes, MD MSInstructor of Medicine
Harvard Medical School
![Page 2: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/2.jpg)
Agenda
• Background
• Goals of federal healthcare policy– Broaden coverage (ACA)– Modify payment incentives– Delivery system redesign
• The transition from Volume to Value
2
![Page 3: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/3.jpg)
A growing portion of annual GDP
3
![Page 4: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/4.jpg)
The number of uninsured Americans is down
4
![Page 5: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/5.jpg)
What is the proper target of resource allocation of the healthcare system?
1. Should we only provide care that avoids errors of harm but doesn’t provide care that could produce improved health (value)? OR
2. Should we target a level where the increased health benefits are balanced by the increased costs? OR
3. Should we target a level where we provide all care that is potentially beneficial regardless of cost?
5
![Page 6: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/6.jpg)
Graphical Depiction
#1Resources put into HealthcareResources put into Healthcare
#3
Maximum Impact
#2
Economic Optimum
Hea
l th
Ou
tco
mes
Hea
lth
Ou
tco
mes
0
6
![Page 7: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/7.jpg)
What is the proper target of resource allocation of the healthcare system?
• Choice 1 is unrealistic• What about choice 2? Many policy makers and
business leaders would suggest this choice.• However, practicing physicians, healthcare
professionals, patients, state and federal agencies (Medicaid, Medicare, FDA) and laws require or behave as though choice 3 was the best target.
7
![Page 8: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/8.jpg)
Graphical Depiction
#1Resources put into HealthcareResources put into Healthcare
#3
Maximum Impact
#2
Economic Optimum
Hea
l th
Ou
tco
mes
Hea
lth
Ou
tco
mes
0
#4
Harm
8
![Page 9: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/9.jpg)
Some Surprises in US healthcare
9
![Page 10: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/10.jpg)
5 Trends that will Impact Our Practices
• Cost containment• Consolidation at all
levels of health care• Accountability• Performance
measurement• Population
managementClinical Gastroenterology and Hepatology
10
![Page 11: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/11.jpg)
Cost ContainmentMerit based incentive payment system
11
2018 2019 2020 2021 2022 2023 2024
(+/-) 4% (+/-) 5% (+/-) 7% (+/-) 9%
PQRSEHR
Meaningful Use
Value Based Payment Modifier*
Resource Use
Resource Use
Clinical Practice
Improvement Activities
Clinical Practice
Improvement Activities
![Page 12: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/12.jpg)
Lower cost and fairness
• Hospital Acquired Infections for example
• Perhaps as many as 2 million, with costs between $17-$29 billion
• They are already on the CMS Hospital Acquired Conditions list
• There have been some great successes (esp. central line bloodstream infections)
• But without a cost sharing models nearly all of the economic benefits accrue to insurers despite all of the work being done by hospitals and providers
12
![Page 13: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/13.jpg)
Consolidation
• Potential for enhanced efficiency • Recent JAMA paper by Robinson & Miller at least
suggests consolidation has the potential to actually increase costs through larger overhead.
• After adjustment for severity and local factors between 2009-2012:– Hospital owned organizations incurred costs of 10.3% higher than
physician owned organizations
– Multi-hospital owned organizations incurred cost increases of 19.8% higher than physician owned organizations.
13Source: Robinson JC, Miller K. JAMA. 2014 Oct 22-29;312(16):1663-9.
![Page 14: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/14.jpg)
Will GI become an employed specialty?
Specialty2009 %
Employed
Family Medicine 56%
Internal Medicine 46%
Neurosurgery 41%
Neurology 41%
OB/GYN 39%
General Surgery 37%
Oncology 29%
Cardiology 26%
Otolaryngology 25%
Orthopedic Surgery 21%
Gastroenterology 19%
Urology 16%
Source: MGMA 2009 | Advisory Board 2009
Hospital Reasons for Employment
% Net Revenue from Employed Physicians
16%
2000 2004 2008 2012
18%
25%
35%
Gain LeverageFor GrowthStrategy
Stabilize Market /Secure Access
Transform Care Delivery
14
![Page 15: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/15.jpg)
Accountability
• ACOs and alternative delivery strategies• In September 2014 CMS reported their results• Encouraging but there are only 19 “pioneer”
ACOs • Experimental Payment models
1. Base payment
2. Quality component (Performance)
3. Warranty component?
15
![Page 16: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/16.jpg)
Performance
16
Most measures today are based on billing data only
![Page 17: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/17.jpg)
Population Health
• No one really knows what this is
• However, could one reimburse a region’s gastroenterologists by the size of the population and its risk adjusted colon cancer incident rate versus just the volume of colonoscopies performed?
• Regardless of how you feel, this would be a daunting task to implement.
17
![Page 18: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/18.jpg)
Where is this going?
• Getting people insured doesn’t answer how care will be financed or provided
• Do we have the appetite for “experiments” in provision of healthcare?
• Expect changes – but not too soon – ICD-10– Recent election
18
![Page 19: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/19.jpg)
Scenarios
19
2014
2016
ACA remainsmostly as is
Much better congressional pictureWin the Presidency
2016
Attempt repeal knowing it will be vetoed but to set stage forthe presidential election
Veto results in the 2014-2016 provisions moving forward
Hold the CongressWin the Presidency
ACA repealed
• Innovative Payment Approaches• Tort Reform
• Single Payer System• Rational Regulation
![Page 20: 2014 Advances in Inflammatory Bowel Diseases Orlando, Florida December 4, 2014 1 How Recently Federally Mandated Changes are Altering the Care of our IBD](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d9c5503460f94a85485/html5/thumbnails/20.jpg)
Summary
• ACA will go forward for the next two years because veto can’t be overridden
• So will we just see delay until 2016 or .. – Might bipartisan efforts lead to locating a
middle ground– Could discussions of a single payer system
resurface– Will tort reform resurface in the discussions
20