mhcc update: the mission continues -...
TRANSCRIPT
MHCC UPDATE: THE
MISSION CONTINUES
Presented by Ben Steffen
to the
Maryland Health Care Financial Management Association
October 12, 2013
Realign MHCC Centers with Commissioners’
Priorities
� Assume leadership roles in areas of Health Care Reform
� Align health planning and the Certificate of Need program with incentives in health care reform and Maryland’s evolving health care system
� Diffuse health information technology to support clinical decision-making and delivery system reforms
� Expand quality reporting and align with other quality efforts of public and private partners.
� Focus on cost and system efficiencies
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THE MARYLAND HEALTH CARE COMMISSION
EXECUTIVE DIRECTION
Center for
Analysis &
Information
Services
Center for
Health
Information &
Innovative Care
Delivery
Center for
Quality
Measurement &
Reporting
Center for Health
Care Facilities
Planning &
Development
APCD expansion as a tool for:
• Measuring practitioner
performance
• Increasing price transparency
• Monitoring population
health
• Accelerate EHR
adoption
• Expand advanced
primary care
initiatives
• Continue to integrate
quality domains in
hospital reimbursement
• Expand Hospital
Performance Guide
• Streamline CON
• Align health planning with
‘new waiver’ & ACA
• Modernize oversight of
specialized services
Center for Quality Measurement &
Reporting
Continue to integrate quality domains in
hospital reimbursement
Expand Hospital Performance Guide
Hospital Performance Evaluation System
A data collection and management system established for:
� Monitoring and publicly reporting on hospital performance and
quality
� Supporting our all-payer hospital rate setting system and its quality
programs that focus on patient health outcomes and cost savings
� Aligning with CMS hospital quality programs to demonstrate
Maryland’s ability to meet or exceed federal requirements
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Hospital Performance Evaluation System –
Components
� Web-based Quality Measures Data Center (QMDC)
� Process of Care measures
� Patient experience measures
� Outcome Measures (30-day Readmission; 30-day mortality)
� Common Medical Conditions (DRGs)/Maternity & Newborn
� Data validation
� Healthcare Associated Infections Initiative
� Healthcare Worker Influenza Vaccination
� Use of CDC NHSN Surveillance System
� Surgical Site Infections
� Central Line Associated Bloodstream Infections
� Public Reporting on Hospital Guide -- New Website Planned in 2014
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Hospital Performance Evaluation System –
Enhancements
� Joint MHCC/HSCRC Policy on Expanded Data Collection
� January 2014 Full Implementation
� Outpatient Measures – Claims Based & Chart Abstracted
� New HAI measures (CAUTI, MRSA, Colon, SSIs added)
� Use of CDC HCW Flu Vaccination Module for national comparison
� New Vendor for Quality Measures Data Center
� Advanta Government Services, LLC
� Focus on System Redesign
� Enhanced Data Infrastructure to support HSCRC QBR/Waiver Test
� Enhanced Communication with Hospitals
� Price Transparency Initiative
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Comparison of 2010-11 through 2012-13 Hospital HCW Vaccination Rates
Statewide Stats 2010-11 2011-12 2012-13
Vaccination Rate 81.4% 87.8% 96.4%
Number of Hospitals at or Above 85% 21 31 39
Number of Hospitals with Mandatory
Vaccination Policy 15 25 37
Number of Employees Vaccinated 79,504 89,206 99,724
Number of Employees 97,639 101,565 103,436
Average Declination Rate 15.2% 10.5% 4.5%
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Hospital Performance: Central Line Associated
Blood Stream Infections (CLABSI)
Performance Measure FY2010 FY2011 FY2012 Difference
All ICU CLABSIs 472 296 206 Improvement (56.36% reduction)
Adult/Pediatric Intensive Care Units
CLABSIs 424 262 166 Improvement (60.85% reduction)
Hospitals with 0 Infections 6 12 20 Improvement
Hospitals Better than National Experience 0 4 8 Improvement
Hospitals Same as National Experience 37 39 36
Hospitals Worse than National Experience 8 2 1 Improvement
Maryland Standardized Infection Ratio (SIR)* 1.35 0.85 0.57 Improvement
Maryland Performance (using SIR) Worse Better Better
Maryland Adult/Ped ICU Central Line Days 163,757 157,706 149,736
Neonatal Intensive Care Units (NICUs)
Hospitals with NICUs 15 16 16
CLABSIs (total) 48 34 40 Improvement (16.67% reduction)
Hospitals with 0 Infections 4 3 4 No Change
Hospitals Better than National Experience 1 2 1 No Change
Hospitals Same as National Experience 14 14 14 No Change
Hospitals Worse than National Experience 0 0 1 Decline
Maryland NICU Central Line Days 27,299 26,817 25,926
* The Standardized Infection Ratio (SIR) is a summary measure used to compare the infection rate of one group of patients to that of a standard population.
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Center for Health Information &
Innovative Care Delivery
Accelerate EHR adoption
Expand advanced primary care initiatives
An HIICD Goal – Serve as a Resource to Hospitals
� Information regarding electronic health records (EHRs), health information exchange (HIE), and telemedicine
� Health IT implementation strategy development support and evaluation
� Convener of CIOs and Chief Medical Informatics Officers
� Link to community-based ambulatory practices
� Shed light on best practices through reporting
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Specific results on HIT adoption
� Since 2008, the health IT adoption rate has increased roughly 25 percent
� Maryland hospitals exceed national adoption rates for 8 out of 10
technologies assessed
� Hospitals continue to take advantage of the federal incentives for the
adoption and MU of health IT
� As of 2012, approximately 83 percent of hospitals had received an
incentive payment, totaling approximately $67.9M
� Approximately 54 percent of hospitals have attested to MU
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How do Maryland and US Hospitals Compare on
Adoption Rates?
US Maryland
Adopted Basic EHR 44% 83%
Computerized physician order entry (CPOE) 72 85
Implemented Clinical Decision Support 87 67
Established E-prescribing 61 22
Adopted electronic medication administration
record (eMAR),
60 91
Adopted Barcode Medication Administration
(BCMA)
27 78
Number of hospitals with patient portals (in
place/planning)
- 14/27
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� ACA and ‘new waiver’ envision closer integration between hospital and community care
� Practices organized around PCMH programs are best equipped to keep patients out of the hospital and to manage patients’ transition back into the community
� 5 large commercial carriers, Medicaid, some self-funded employers
� Practice transformation agent – Maryland Learning Collaborative
� About one quarter million “attributed” patients
� MHCC expects that PCMH practices will adopt HIE services such as the Encounter Notification system (ENS)
� External Evaluation – lower cost, improved quality, increased satisfaction, reduction in disparities
Advanced Primary Care Initiatives – Multipayer PCMH
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Center for Health Care Facilities
Planning & Development
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Streamline CON Processes
Align health planning with requirements of ‘new
waiver’ and health care reform
Modernize approach to oversight of specialized
services
Current HFPD Priority Activity –
Planning and CON
Streamline project review processes
� Implement new approaches for completeness review and
analysis of regulations
� More interaction with prospective applicants prior to
submission of CON
� MHCC will monitor application review times and
uncontested review standards (90 days for
uncontested/150 days for contested matters)
� Overhaul procedural regulations – govern how MHCC
reviews applications
� Look for streamlining opportunities in SHP updates –
recognize new roles for planning post 2014
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Current HFPD Priority Activity –
State Health Plan Updates
State Health Plan Chapters will be updated consistent with MHCC’s statutory requirements
� Acute Inpatient Rehabilitation Services (2013)
� Hospice Services (2013)
� Acute Care Hospital Services (2013-14)
� Cardiac Surgery and PCI Services (Major revision underway -2014 completion)
� Organ Transplant Services (Need projections updated in October 2011- full overhaul in 2013-14)
� Freestanding Medical Facilities (Coming in 2014/2015)
� Acute Psychiatric Hospital Services (initiate in 2014)
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Current HFPD Priority –
Oversight of Cardiac Services
� Cardiac Surgery with Full Spectrum PCI services at 10 Hospitals
� PCI services without cardiac surgery backup at 13 hospitals
� Primary (Emergency) PCI Waiver Program at 13 Hospitals without on-
site cardiac surgery
� Elective PCI at 8 Hospitals without on-site cardiac surgery (all are
primary PCI waiver hospitals)
� C-PORT-E (Elective) PCI Research Waiver Program C-PORT-E research
study was completed in 2012
� MHCC and hospitals agree that PCI should be defined as a regulated
service (eliminate need for waiver programs)
� Transition to a mode of regulation requiring ongoing performance
evaluation and compliance with minimum standards
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Overview of Draft Regulations
� MHCC will place greater emphasis on the quality of programs, in addition to
enforcing volume standards
� For cardiac surgery, the data registry of the Society of Thoracic Surgeons (STS)
will be used for performance evaluation and monitoring
� For PCI programs, the data registries of the National Cardiovascular Data
Registry of the American College of Cardiology will be used
� Physicians performing primary PCI must meet the ACCF/AHA/SCAI competency
criteria, which is currently an average of 50 PCI cases over a 24 month period.
� PCI programs that offer primary and non-primary PCI services shall perform 200
cases annually
� PCI programs that offer primary only shall perform at least 49 cases annually (34
for rural programs)
� Continue to use process and outcome measures and align with ACC-NCDR and STS
to the extent possible
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Overview of Draft Regulations(continued)
� Hospitals required to conduct external (5%) and internal review (10%) of
both PCI and cardiac surgery cases
� Revised cardiac services planning regions
� Revised methodologies for projecting demand for cardiac surgery and for
PCI services
� Closure built off nationally recognized guidelines…
� Cardiac surgery programs with a one star composite rating for CABG
surgery using the rating scale developed by STS-ACSD for 4 consecutive
six-month reporting periods or cardiac surgery case volume of less
than 100 cases for 2 consecutive years.
� PCI programs that failed to meet standards would not receive
Certificates of Ongoing performance
� Standards for closure of cardiac and PCI programs will include an
opportunity to address deficiencies identified before program closure is
ordered by the Commission.
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Overview of Draft Regulations(continued)
� Criteria and standards for allowing the addition of new programs
� Preferences for primary PCI programs that wish to add elective PCI
� MHCC will consider impact on the financial viability of existing
programs when evaluating new primary PCI, elective PCI, or cardiac
surgery programs.
� No interested parties permitted in new PCI program reviews
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Center for Analysis & Information
Services
APCD expansion as a tool for …
Monitoring population health
Increasing price transparency
Measuring practitioner performance
Expand the All Payer Claims Data Base (APCD)
� All commercial carriers are required to submit under State law
� CMS shares Medicare data under a federal data use agreement
� Historical uses….
� Legislatively required analyses,
� MHCC programs (medical home), and
� Commission-originated studies
� Future of the APCD
� Source of information for state-administered reinsurance program
� Foundation of a practitioner performance measurement system
� Source for measuring spending per capita (enhanced waiver)
� Monitoring the impact of health reforms on population health
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Content Changes Driven by New
Information Needs
� Complete information on enrollee utilization/spending
� Self-insured employer plans
� Enrollees who change carriers
� Information on plan benefit design – copayments, coinsurance and deductible levels
� Information for plans sold in the Health Benefit Exchange.
� Qualified Health Plans
� Qualified Dental Plans
� Inclusion of Medicaid data
� Accelerate collection of information on utilization/spending.
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New information needs require regulatory
and technology changes
� Expands the universe of data submitters
� Pharmacy benefit and behavioral health administrators (“carved out” services)
� Stand-alone third party administrators
� Carriers (including dental plans) selling in the Exchange
� Adds 3 new report files
� Plan benefit design;
� Non-claims-based payments to providers;
� Dental claims (carriers in HBE)
� Requires submitters to obtain Master Patient Index (MPI) for enrollees
� CRISP will supply MPI to submitters, submitters will append MPI to
eligibility files on the APCD
� MPI will be unique to resident
� Potential to link with hospital discharge and outpatient records
� Quarterly submissions of data files – accelerate timeliness of data
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New Initiatives 27
� Make APCD information available for examining population health –develop a resident summary file
� Mirrors Medicare beneficiary level cost and utilization file
� Demographics of the patient/resident
� Summarized information on spending by broad service ‘buckets’
� Resident summary file starts with privately insured, would also include Medicare and eventually Medicaid
� Further Price Transparency (CCIIO will provide some funding)
� MHCC and MIA will work together to use APCD for MIA’s rate review processes
� MHCC will accelerate data collection to align data with information reported by
carriers in rate applications
� MHCC and MIA will work together to build analytic tools that will enable APCD used in
dynamic rate review environment
New Initiatives 28
� Practitioner performance measurement
� Planning underway as part of State Innovation Grant activities
� Measurement system will be based on APCD data provided by private carriers, Medicaid, and Medicare
� Use of Medicare claims for measurement will require MHCC to obtain authorization from CMS as a Qualified Entity
� Initial program likely will focus on NQF-recognized quality metrics
� System will have an initial testing period in which data will be released to practices only