healthcare financing reform in the u.s.: trumping the …87841d2a-194e-4398-add1... · 2019. 6....
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HEALTHCARE FINANCING REFORM IN
THE U.S.: TRUMPING THE ACA AND
MEDICARE?
TRANSFORMING HEALTHCARE
SWISS RE CENTRE FOR GLOBAL
DIALOGUE
William A. Bornstein, MD, PhD
Chief Medical Officer and Chief Quality Officer
Emory Healthcare
WHSC Strategic Planning Office 2
Emory – At a Glance
● Most comprehensive system in Georgia
● 7 hospitals
● 1,958 beds
● 1,400+ physicians
● 575 medical students
● 510 allied health
● 1,266 residents/ fellows
● 104 accredited programs
● 2,555 full/part-time faculty
● $348m in research funds (#17 nationally)
● 1,140 master degree students
● 189 PhD students
● 296 full/part-time faculty
● $95m in research funds (#9 nationally)
● 374 bachelor degree students
● 291 master/PhD/ doctoral students
● 121 full/part-time faculty
● $15m in research funds (#1 nationally)
● Only NCI cancer treatment center in Georgia
● $83 million in research funds1
● One of 7 NIH funded primate centers in the U.S.
● 357 staff members
● 58 faculty scientists
● 3,000 non-human primates
● $79m in research funds (#1 nationally)
●3,035 faculty
●5,207 students / trainees
●24,067 employees
●$4 billion enterprise
●$540 million research funding
02/01/2017
1 Spread across multiple schools and included in school totals
Sources: 2016 WHSC At-A-Glance, SOM Strategic Initiatives Department, Press Releases, Websites
WHSC Strategic Planning Office 3
Overview of Clinical Platform
02/01/2017
2,555Faculty
631Volunteer Faculty
575Medical students
510Academic Health
Students in 5 programs
1,266Residents & Fellows in
104 training programs
16,000 + Employees
1,500+Employed Physicians
7 Hospitals
106Operating rooms
139,000Surgeries Annually
1,958Beds
597,000+Patients Served
Annually
200,000+Patient Portal Users
16,598Clinical Research
Patients On StudiesMagnet Designated
Hospitals
3
481Solid Organ
Transplants Annually
2,000 +Open Heart
Surgeries Annually
69,000+Inpatient Admissions
Annually
4,100,000Outpatient Visits
Annually
37%Retention rate of
Emory MD graduates
practicing in Georgia
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Emory Healthcare Network
Physician Membership Requirements• Alignment with EHC• Initial Application Fee of $1,500 per physician• Approved by EHN Participation Committee• Certified interoperable EMR with approved vendor• Connected to Emory Health Information Exchange
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WHAT ARE THE BIGGEST HEALTHCARE PROBLEMS
CONFRONTING THE US?
• Cost
• Quality (Health of
Americans)
– Access?
– Social Determinants?
– Public Health?
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• Value = Quality/Cost
Health Expenditures as a Percentage of Gross Domestic Product (GDP) in Selected OECD Countries, 1960–2009.
Fineberg HV. N Engl J Med 2012;366:1020-1027
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Blumenthal D et al. N Engl J Med 2015;372:2451-2458.
Percentage of Adults 19 to 64 Years of Age Who Are Uninsured.
Blumenthal D et al. N Engl J Med 2015;372:2451-2458.
Percent Change in Hospital-Acquired Conditions from 2010 to 2013.
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TECHNOLOGY AS A HEALTHCARE COST DRIVER
Uwe Reinhardt, Waste vs. Value in American Health Care,
NYT Blog, 9/13/2013,
http://economix.blogs.nytimes.com/2013/09/13/waste-vs-value-in-american-health-care/#more-168145
Average value=AB/OB
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WHO SHOULD CONSTRAIN THE HIGH COST “LOW
VALUE” TECHNOLOGIES
• The payer (including governmental payers)?
• The patient?
• The provider?
• The government (as regulator)?
16
These episodes usually pass quickly. But the
most recent one, which Jha experienced after a
bruising international business trip, was a
particularly bad bout. At half-an-hour, his heart
was still racing. After an hour, his wife
urged Jha to go to the Emergency Room.
"And I was resisting it. She actually asked me,
'if a patient of yours called you with this, what
would you recommend to them?' And I said, ‘oh,
yeah, that’s easy. Go to the [Emergency
Department],'" Jha said.
Though he knew he could be experiencing a
heart attack, Jha didn’t want to spend $2,000 or
more getting checked out in the ER — even
though he said he could afford that. In
retrospect, Jha said he should have gone to the
hospital.
"But, you know, I knew there was a big bill
waiting for me if I did, and I rolled the dice," he
said.
Jha got lucky. After an hour his heart rate began
to slow.
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SGRRepeal 2015
MACRA2015
APM2019
MIPS2019
Sustainable Growth RateWas positioned for a 25% cut
in Medicare FFS for 2015
Medicare Access and CHIP Reauthorization Act of 2015
New framework for value based care
Merit-Based Incentive Payment SystemPQRS+MU+VM
Quality, Resource Use, Practice Improvement, EHR Use
Alternative Payment ModelsAt-risk business model
ACO, Bundled Payments, Medical Homes
Medicare Moving to Population Health
Distribution of the IOM's Recommended CER Priorities.
Iglehart JK. N Engl J Med 2009;361:325-328.
CAN THIS PROBLEM BE SOLVED WITHOUT
REGULATORY FORCES?
Science, 1968
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SUMMARY
• Non-sustainable health care cost increases are occurring throughout
the world, with the US leading the pack
• In the US, there are major shifts of cost risks underway to patients and
to providers with mixed results
• These shifts constitute “grand experiments” and will have intended
and unintended consequences
• Inevitably, health care spending must be rationalized (or “rationed”)—
how this happens will in large part be a reflection of a society’s values
THE BEST OF TIMES AND THE
WORST OF TIMES
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"It was the best of times, it was the worst of times; it was the age of wisdom, it was the age of foolishness; it was the epoch of belief, it was the epoch of incredulity; it was the season of Light, it was the season of Darkness; it was the spring of hope, it was the winter of despair; we had everything before us, we had nothing before us; we were all going directly to Heaven, we were all going the other way."
-- Charles Dickens
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