medicare incentives and penalties: critical lessons learned (kim henrichsen)
TRANSCRIPT
Intermountain’s Journey Kim Henrichsen, RN, MSN
Vice President, Clinical Opera2ons and CNO
GETTING TO KNOW INTERMOUNTAIN Who are we?
Since 1975 • 22 hospitals • 2,784 licensed beds
Since 1983 • Health plans • 700,000+ members
Since 1994 • 1,200 employed physicians • 558 advanced pracOce clinicians • 30 Instacare Clinics
Since 1997 • 10 key service lines
Highly Integrated Health System Hospitals
SelectHealth
Medical Group
Clinical Programs
Our Charge: To become a “Model Healthcare System”
OUR M I S S ION Helping people live the healthiest lives possible
OUR V I S ION Be a model health system by providing extraordinary
care and superior service at an affordable cost
GETTING TO KNOW INTERMOUNTAIN How are we doing?
The Intermountain Way Engage paGents & align incenGves
Evidence-‐based best pracGces
SystemaGc approach-‐ measure & improve
OpOmal Outcomes
High Quality Clinical Care Utah Rank
Utah Amount
U.S. Median
Utah Differ.
Healthcare expenditures per capita* 1 $5,031 $6,815 -‐26%
Medicare admits 75 yrs+ / 1,000 beneficiaries 2 42.0 68.0 -‐38%
Medicare 30-‐day hospital readmission rate 3 28.0 45.0 -‐38%
Mortality amenable to healthcare / 100,000 4 62.0 82.0 -‐24%
Home health paOents with hosp. admission 1 14.0 17.0 -‐18%
Source: Commonwealth Fund State Scorecard, April 2014; *Wall Street Journal, April 8, 2013
• There is usually wide variaOon in
clinical pracGce • ObjecOve data measurement will
demonstrate opportunity for improvement
• Performance improves with systemaGc adopGon of best pracOces
• Intermountain’s main physician engagement strategy: OpGmal paGent outcomes
Clinical Program Principles
Our Experience Value Based Purchasing
Intermountain Discharge MedicaOons in 2000
99%95%
91%94%
90%
30%
40%
50%
60%
70%
80%
90%
100%
ASA HmG BB p MI ACE for CHF Coumadin
% Eligible Patients Treated at Discharge with Appropriate Medications
2000 National Statistics
Impact of Intermountain Discharge Med Program on Heart Failure Readmissions/Mortality
ACE inhibitor prescripGon at hospital discharge increased from 65% in 1997 to 95% in 1999-‐2001 and for these IHC heart failure paGents:
• One-‐year readmissions were reduced from 46.5 % to 38.5% • 551 readmissions are prevented per year • $2,480,000 are saved based on avoided readmissions • One-‐year mortality rate reduced from 22.7% to 17.8% • 331 lives are saved per year
CMS Pay for Performance Programs
VBP, Readmission ReducGon, HAC Intermountain Healthcare
Hospital Acquired CondiOons
Value Based Purchasing
Readmission ReducOon Program
FY 2015 9 of 22 (penalty) 1 of 22 (penalty) 3 of 22 (penalty)
FY 2016 9 of 22 (penalty) 2 of 22 (penalty) 5 of 22 (penalty)
Awards & RecogniOon Benefits
Cred
ibility
Strategic Fit Low Low
High
High
Public Quality ReporGng
• Intermountain Healthcare hospitals score very well on some surveys and poorly on others with similar metrics.
• There is variability exisGng even between our faciliGes
• Intermountain was an early leader in core measures, we fell in ranking, not in performance as public reporGng increased
Summary
Closing Thoughts • CMS Pay for Performance metrics are
aimed at improving care for paGents • CMS should conGnue to replace process
measures with outcome measures • OrganizaGons should conGnue to focus
on areas where literature supports improved paGent outcomes
• ConsideraGon should be given to reducing complexity for those delivering the care (and burden of measurement)
Right Thing
Right Time
Every Time