The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 1

Toronto Boston Adelaide London

www.rlsolutions.com

Timothy Kelly, Vice President

Dialog Medical, a Standard Register

Healthcare Company

The Meaningful Care Organization –

Patient-Centered Strategies for the

Intersection of MU and ACOs

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The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 2

The Meaningful Care Organization –

Patient-Centered Strategies for the

Intersection of MU and ACOs

Timothy Kelly, MS, MBA

Dialog Medical A Standard Register Healthcare Company

MU and ACOs (Meaningful Use and Accountable Care Organizations)

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 3

Meaningful Use

American Recovery and Reinvestment Act of

2009

HITECH Act

Meaningful Use

Meaningful Use (MU)

5

Meaningful Use

$36 billion will be spent on the implementation of Electronic Health Records (EHRs)1

$6.9 billion paid through August2

• 3,884 hospitals have registered to receive incentive payments through the end of July

Medicare EHR incentive payments end in 2016 (Medicaid payments end in 2021)

Meaningful Use (MU)

6

1Rock and a hard place: An analysis of the $36 billion impact from health IT stimulus funding. Price Waterhouse Coopers. April 2009.

2Mosquera M, Healthcare IT News, September 7, 2012, http://www.healthcareitnews.com/news/government-ehr-incentives-near-7b (Accessed September 24, 2012)

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 4

Accountable Care Organizations

Patient Protection and Affordable Care Act of

2010

Medicare Shared Savings Program

Accountable Care Organizations

Accountable Care Organizations (ACOs)

7

Accountable Care Organizations

Voluntary groups of physicians, hospitals and other

healthcare providers:

Responsible for care of a clearly defined Medicare

population

Designed to foster patient-centered, coordinated care

If it succeeds in providing high-quality care while

reducing cost, it shares in savings achieved for

Medicare

Accountable Care Organizations (ACOs)

8

Source: Berwick DM. N Engl J Med 2011;365:1753-1756.

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 5

Accountable Care Organizations

32 Pioneer ACOs1

115 Medicare Shared Savings ACOs1

20 Advanced Payment Model ACOs1

221 total ACOs identified through the end of May2

118 are hospital-sponsored ACOs

Accountable Care Organizations (ACOs)

9

1CMS Center for Medicare & Medicaid Innovation. http://innovations.cms.gov/initiatives/ACO/index.html (Accessed September 24, 2012)

2Muhlestein D, et al. Growth and Dispersion of Accountable Care Organizations - June 2012 Update. Leavitt Partners, http://leavittpartners.com/wp-content/uploads/2012/06/Growth-and-Dispersion-of-ACOs-June-2012-Update2.pdf (Accessed September 24, 2012)

Accountable Care Organizations

Accountable Care Organizations (ACOs)

10

Source: January 2012 survey of hospitals, physician organizations and health

systems reported in: Tocknell MD. The Unsettled State of the ACO.

HealthLeaders Media Intelligence Report. April 2012.

Currently part of an

ACO?

11%

No - 89%

Plan to implement or join and

ACO?

Yes - 61%

No - 39%

Yes -

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 6

Accountable Care Organizations

$510 million in estimated Medicare savings in the first three years (2012-2014)1

$560 million to $1.13 billion in bonuses paid to those ACOs over that period2

Top Driver for the organization creating an ACO – To engage physicians (56 percent of the respondents that are or plan to be part of an ACO)3

Accountable Care Organizations (ACOs)

11

1Section III.F. of the Preamble to the ACO Regulations. Federal Register Vol. 76(67):19640.

2Section III.C.3. of the Preamble to the ACO Regulations. Federal Register Vol. 76(67):19639.

3Tocknell MD. The Unsettled State of the ACO. HealthLeaders Media Intelligence Report. April 2012.

MU and ACOs

Intersection of MU and ACOs

12

MU Goals1

• Improve caregiver decisions

• Better outcomes

ACO Goals2

• Better care for individuals

• Better health for populations

• Slower growth in costs through improvements in care

1Blumenthal D and Tavenner M. N Engl J Med 2010;363(6):501-504. 2Berwick DM. N Engl J Med 2011;364(16):e32.

Patient-

Centered

Strategies

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 7

Meaningful Use Objectives

Meaningful Use Objectives

Stage 1 Objectives for Hospitals

14 Core Objectives, 10 Menu Objectives (attain 5)

First eligible payment year: 2011

Stage 2 Objectives for Hospitals

16 Core Objectives, 6 Menu Objectives (attain 3)

First eligible payment year: 2014

Effectively incorporate all of the Stage 1 objectives,

along with additional objectives and higher

measurement thresholds

Meaningful Use Objectives

14

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 8

Meaningful Use Objectives

Stage 2 Meaningful Use Objectives

15

Core Objectives Demographics Vital Signs Clinical Decision Support CPOE Transitions of Care View, Download and

Transmit to Third Party Privacy and Security Smoking Status Lab Results into EHR Patient-Specific Education Medication Reconciliation

Patient Input

Output

Input

Output Input

Core Objectives Generate Patient Lists Immunization Registries Lab Results to Public

Health Agencies Syndromic Surveillance

Menu Objectives Imaging Results Advance Directives ePrescribing Electronic Notes Electronic Lab Results Family Health History

Patient

Input

Input

Why Focus on Patient-Centered

Strategies that are “Output Oriented”?

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 9

“Output Oriented” Strategies

Effective October, 1 percent of Medicare payments are

being withheld for payment to hospitals with above

average patient satisfaction scores.

$850 million in incentive payments

Patient Satisfaction

17

Rau J. Kaiser Health News; April 28, 2011,

http://www.kaiserhealthnews.org/Stories/2011/April/28/medicare-hospital-patient-satisfaction.aspx. (Accessed September 24, 2012)

“Output Oriented” Strategies

Survey metric: Nurses “always” communicated well

Top 3 states

• Louisiana – 81%

• South Dakota – 81%

• Maine – 80%

Bottom 3 states

• Washington DC – 68%

• Nevada – 69%

• California – 70%

Patient Satisfaction

18

Source: Hospital Compare hhs.gov

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 10

“Output Oriented” Strategies

Survey metric: Doctors “always” communicated well

Top 3 states

• Alabama – 86%

• Louisiana – 86%

• Mississippi – 85%

Bottom 3 states

• Nevada – 73%

• Washington DC – 76%

• New York – 76%

Patient Satisfaction

19

Source: Hospital Compare hhs.gov

“Output Oriented” Strategies

Survey metric: Given information for recovery

Top 3 states

• New Hampshire – 87%

• Vermont – 87%

• Utah – 87%

Bottom 3 states

• Washington DC – 77%

• New Jersey – 78%

• Mississippi – 78%

Patient Satisfaction

20

Source: Hospital Compare hhs.gov

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 11

“Output Oriented” Strategies

These metrics

are moving

beyond the

government

sites to

mainstream,

consumer sites

Patient

Satisfaction

21

Source: Kelly T. HIStalk, August

8, 2012

http://histalk2.com/2012/08/08/re

aders-write-8812/ (Accessed September 24, 2012)

“Output Oriented” Meaningful Use

Objectives

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 12

“Output Oriented” MU Objectives

Patient-Specific Education

23

Patients who are provided patient-specific education resources

Number of unique patients admitted to the hospital’s inpatient or emergency

departments during the reporting period

> 10%

“Output Oriented” MU Objectives

2 Measures for this Meaningful Use objective

Both must be satisfied in order to meet the objective

View, Download and Transmit to Third Party

24

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 13

“Output Oriented” MU Objectives

25

Patients whose information is available online within 36 hours of discharge

Number of unique patients discharged from the hospital’s inpatient or emergency

department during the reporting period

Patients who view, download or transmit to a third party the information provided online

Number of unique patients discharged from the hospital’s inpatient or emergency

department during the reporting period

> 50%

> 5%*

View, Download and Transmit to Third Party

*This measure was 10% in the Proposed Stage 2 Rule

Best Practices for Patient-Specific

Education Materials

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 14

Best Practices

The informed consent discussion conducted by the surgeon should include:

1. The nature of the illness and the natural consequences of no treatment.

2. The nature of the proposed operation, including the estimated risks of mortality and morbidity.

3. The more common known complications, which should be described and discussed. The patient should understand the risks as well as the benefits of the proposed operation. The discussion should include a description of what to expect during the hospitalization and post hospital convalescence.

4. Alternative forms of treatment, including nonoperative techniques.

American College of Surgeons

27

American College of Surgeons Statements on Principles. Revised September 18, 2008. http://www.facs.org/fellows_info/statements/stonprin.html#anchor171960 (Accessed 9/24/12.)

Best Practices

Only 39% of 3,269 closed claims against anesthesiologists were judged to have adequate informed consent1

Inadequate informed consent was pursued as a secondary cause in more than 90% of ophthalmologic malpractice cases2

Lack of informed consent is one of the top 10 reasons for hospital malpractice claims3

Argument for Informed Consent

28

1Caplan RA, Posner KL. ASA Newsletter 1995;59(6):9-12. 2Kiss CG, Richter-Mueksch S, Stifter E, et at. Arch Ophthalmol 2004;122:94-98. 3Glabman M. Trustee 2004;57(2):12-16.

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 15

Best Practices

Needs to be

electronic

Can’t be a

“Medical Miranda

Warning”

Argument for

Informed Consent

29

Best Practices

Need the consent for the Pre-Procedure Verification and/or the Time-Out

Verification of the consent is one of the most effective practices for avoiding wrong-patient/wrong-procedure/ wrong-site surgery1

Argument for

Informed Consent

30

1Clarke JR, Johnston J, Finley ED. Ann

Surg 2007;246:395-405.

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 16

Best Practices

WHO Surgical Safety Checklist

31

Best Practices

Argument for

Informed Consent

32

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 17

Best Practices

Reduce the risk of potentially life-threatening perioperative complications.

Pre-Procedure Instructions

33

Courtesy of the Baltimore VA Medical Center

Tea C. Perioperative concepts

and nursing management. In:

Smeltzer SC, et al, eds.

Brunner and Suddarth’s

Textbook of Medical-Surgical

Nursing. Philadelphia, PA:

Wolters Kluwer

Health/Lippincott Williams &

Wilkins; 2010:422-483.

Best Practices

Lower the incidence of

preventable surgery

cancellations.

Pre-Procedure Instructions

34

Henderson BA et al. Incidence and causes

of ocular surgery cancellations in an

ambulatory surgical center. J Catarct

Refract Surg. 2006;32(1):95-102

Pletta C et al. Efficiency improvement plan

through patient education on thyroid

imaging procedures. J Nucl Med.

2008;49(Supp 1):426P Courtesy of the Baltimore VAMC

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 18

Best Practices for Viewing, Downloading

and Transmitting Patient Information

Best Practices

Providing

patients with

incomplete

information at

discharge can

result in patient

harm.

Discharge Instructions

36

Courtesy of the Portland VA Medical Center

Pennsylvania Patient

Safety Advisory. 2008.

Jun;5[2]:39-43.

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 19

Best Practices

HRRP was created under the PPACA

Effective October 1, 2012

Establishes penalties for excessive readmissions with

maximum payment reductions of:

1 percent in 2013

2 percent in 2014

3 percent in 2015 and beyond

Hospital Readmissions Reduction Program

37

Source: Section 3025 of the Patient Protection and Affordable Care Act added

section 1886(q) to the Social Security Act. 42 CFR part 412 (§412.150 through

§412.154).

Best Practices

Anticipating $280 million in penalties in 2013

2,211 hospitals are projected to forfeit Medicare funds

278 hospitals are projected to lose the maximum of

1% of their base Medicare reimbursements

Hospital Readmissions Reduction Program

38

Source: Rau J, Kaiser Health News, August 13, 2012

http://www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospitals-readmissions-penalties.aspx (Accessed September 24, 2012)

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 20

Best Practices

Reduced the 14-day

readmission rate three-

fold by employing

procedure-specific

discharge instructions

(4.1 per 1,000

outpatient procedures

to 1.5 per 1,000).

Discharge Instructions

39

Boast P, Potts C. PS&QH.

2010;7(1):14-16.

Courtesy of the Portland VA Medical Center

Best Practices

Most valuable if

they are sent well

prior to the 36-

hour threshold

Provided prior to

admission

Paper as well as

electronic

Discharge Instructions

40

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 21

Developing Initiatives in Your Own

“Meaningful Care Organization”

The Meaningful Care Organization

Making Good on ACOs’ Promise — The Final Rule for the

Medicare Shared Savings Program. N Engl J Med

2011;365(19):1753-1756. November 10, 2011.

http://www.nejm.org/doi/pdf/10.1056/NEJMp1111671

Meaningful Use – The Whiteboard Story – Stage 1 Final Rule

Meaningful Use Objectives and Measures Compared to Stage

2 Final Objectives and Measures... Created as a reference tool

for public use and convenience by The Advisory Board Company.

http://www.advisory.com/~/media/Advisory-com/CampaignItems/MU-

Stage-2-White-Board-Story-Poster-2.pdf

Resources

42

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 22

Stage 1 Stage 2

The Meaningful Care Organization

“Meaningful Care” Checklist

44

Is the initiative patient-centered?

Does it reduce risk?

Does it enhance safety?

Does it leverage the patient?

Can you utilize HIT (EHR or

other systems)?

Does it support Stage 1 or

Stage 2 Meaningful Objectives?

Yes No

The Meaningful Care Organization – Patient-Centered Strategies

for the Intersection of MU and ACOs

RL Solutions Webinar Series

October 11, 2012 Page 23

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