• Home

  • Documents

  • Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care...
66
Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of Orthopedic Anesthesia

Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

  • Upload
    others

  • View
    1

  • Download
    0

Embed Size (px)

Citation preview

Page 1: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Updates in Health Care Reform

Anthony Edelman, MD, MBAClinical Assistant Professor

Director, Division of Orthopedic Anesthesia

Page 2: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Disclosures• None

Page 3: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Objectives• Review a timeline of modern health care

reform

• Examine the current state of reform

• Examine how this reform directly impacts Anesthesia Professionals

Page 4: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

What we will stay away from• Political opinion

• Sensationalism

Page 5: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of
Page 6: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of
Page 7: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Pres. Johnson signs the Medicare bill into law

Sen Edward Kennedy proposes a national single-payer system

Pres. Nixon introduces employer mandate to provide benefits and offer federal subsidies for low-income workers

1965 1971

Pres Clinton launches universal coverage reform effort

Congress approves Emergency Medical Treatment and Labor Act

1986 1993 1996

Congress approves Health Insurance Portability and Accountability Act

1997

State Children’s Health Insurance Program singed into legislation

2003

Pres. Bush signs legislation creating Medicare Part D prescription drug benefit program

Page 8: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of
Page 9: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

2009• June: AMA announces it will back reform

• July: America’s Affordable Health Choices Act revealed by House Democratic leaders

• December: Both chambers approve a health care reform package

Page 10: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

2010• March 21: Votes in both House and Senate

approved along party lines

• March 23: President Obama signs the Senate bill into law

• 13 states’ AGs challenge act in federal court

Page 11: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

2011• January: U.S. District Judge rules law

unconstitutional

Page 12: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

2011• April: 11th U.S. Circuit Court of Appeals

strikes down mandates for individuals, rest of law can stand

• November: U.S. Court of Appeals upholds the individual mandate

Page 13: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

2012• June: Supreme Court rules the insurance

provision is constitutional

Page 14: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

PPACA Provisions• Medicaid expansion to 133% of poverty level for age

<65

• Creation of health insurance exchanges (Healthcare.gov)

• Prevents insurers from denying coverage any reason

• Most individuals must have health insurance in 2014

• Penalties to large employers who do not offer affordable health insurance

*Adopted from Kaiser Family Foundation

Page 15: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

PPACA ProvisionsChanges to Private Insurance

• Price variation only on age, geographic area, tobacco use, family size

• Age 26

• Prohibition on lifetime limits and rescinding coverage

• Premium increases subject to review

• 80% of premium must be on medical costs*Adopted from Kaiser Family Foundation

Page 16: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

PPACA Provisions• Employer Mandate

Page 17: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

2012• Individual Mandate (2014)

–Exceptions

Page 18: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

2012• Individual Mandate (2014)

–Exceptions

Page 19: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of
Page 20: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of
Page 21: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Trumps Stated Change Goals• Repeal & Replace

Page 22: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Repeal & Replace• Pre-existing conditions have access

• Stable transition from exchanges

• Flexibility in plan design

• Tax-credits and expanded HSA

*From Feb 2017 State of the Union address

Page 23: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Repeal & Replace• State run Medicaid resources

• Legal reforms

• Price reduction in high-costs drugs

• Create national insurance marketplace

*From Feb 2017 State of the Union address

Page 24: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

What has been done so far*• Advertising $$ cut

• Open enrollment time

• Cost-sharing subsidies

*Via executive orders, new regulations and legislation

Page 25: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

What has been done so far*• Individual Mandate

• States have greater control over Medicaid programs

• Small businesses and Individuals

*Via executive orders, new regulations and legislation

Page 26: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

What has been done so far*• Short-term health plans

• Contraception mandate

• Consumers v. Insurers

*Via executive orders, new regulations and legislation

Page 27: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of
Page 28: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of
Page 29: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

What is unlikely to change• MACRA

• QPP

Page 30: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Alphabet

Soup for the

Anesthesiologist

Page 31: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

• MACRA

• MIPS

• APMs

• QPP

• AQI

• NACOR

• QCDRs

• PQRS

• MPOG

• ASPIRE

Page 32: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

ASAHQ.ORG

Page 33: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of
Page 34: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

MACRA & QPP• Medicare Access & CHIP Reauthorization

Act of 2015

• Quality Payment Program

Page 35: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Triple Aims

Improved Population Health

Improved Patient Experience

Reduced per capita cost of healthcare

Page 36: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Value in Health Care

Page 37: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Medicare Access & CHIP Reauthorization Act of 2015• What is MACRA?

–PQRS (Physician Quality Reporting System)

–VBM (Value-based Payment Modifier)

–Medicare EHR incentive program

Page 38: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

MACRA• Eligibility to participate

–Who

Page 39: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

MACRA• Eligibility to participate

–Who

–How

Page 40: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

MACRA• Eligibility to participate

–Who

–How

–Why

Page 41: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

MACRA

• Qpp.cms.gov/participation-lookup

• Group Practice Reporting Option (GRPO)

Page 42: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Quality Payment Program• 2019

– Merit Based Incentive Payment System (MIPS)

• +/- 7% in 2021

– Advanced Alternative Payment Models (APMs)

• 5% upside

Page 43: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Merit-Based Incentive Payment System

• What is MIPS?

– Payment adjustment program

– Composite Score (2019)

• Quality (45%)

• Resource use/Cost (15%)

• Clinical practice improvement activities (15%)

• Meaningful use of certified EHR (25%)

Page 44: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Merit-Based Incentive Payment System

– Hospital-based & non-patient-facing clinicians

• Do not need to report EHR use

Page 45: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Advanced Alternative Payment Models

• 2 sided financial risk or Medical Home Model

• Use of certified EHR

• Quality reporting

Page 46: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Advanced APM• Financial risk

– Total risk must be at least 3% of APM spending target

– 8% average on all Medicare (through 2020)

– Either 25% of payments or 20% of patients

Page 47: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

APMs• Added incentive payments

• Specific clinical condition, care episode or a population

Page 48: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

APM 2019• All payer combination options (Advanced)

– State Medicaid Agencies

–Medicare Advantage

– “Other” Medicare Health Plans

– Commercial payers

– Private payers

Page 49: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Qualified Clinical Data Registries• Anesthesia QCDRs

– Anesthesia Business Group QCDR– Advance QCDR– AQI NACOR– Anesthesia Quality Registry (ePreop)– Blue Nine QCDR– Mednax QCDR– Miramed– Ortho[m]atrix– SCG Health

Page 50: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Anesthesia Quality Institute • Maintains National Anesthesia Clinical Outcomes

Registry (NACOR)

– Qualified QCDR

– Submits performance measures for MIPS

– ePreop

Page 51: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

ePreop• Partner with AQI

• Quality Concierge

– Measure selection

– Reporting options

– Data extraction & merging

Page 52: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

ASPIRE

www.mpog.org/aspire

Page 53: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

ASPIRE• Multicenter Perioperative Outcomes Group

(MPOG)

• Non-profit academic consortium

• Performance Improvement

• Research

Page 54: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

ASPIRE

Page 55: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

ASPIRE• Anesthesia Quality Improvement arm

of MPOG

• Approved QCDR

• Offers MOCA Part IV credits

Page 56: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

APM 2019

qpp.cms.gov/apms

Page 57: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

BPCI-Advanced• Qualify as an Advanced APM

• Combine all payments

• Voluntary

• 90 day clinical episode

• Payment tied to performance on quality measures

Page 58: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

BPCI-Advanced• 29 inpatient clinical episodes

– Spinal Fusion

– CABG

– Hip fx

– Joint Replacement

– Major Bowel Procedures

Page 59: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

BPCI-Advanced

• 3 Outpatient Clinical Episodes

–PCI

–Cardiac Defib

–Spinal Fusion

Page 60: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

BPCI-Advanced

• 7 quality measures to report

–All cause readmission

–Peri-op Care: ABX selection

–Hospital level complication rate after TKA/THA

–Hospital 30 day mortality after CABG

Page 61: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Conclusions

MACRAPPACA

Page 62: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Conclusions

MACRA

QPP

MIPS A-APMs

Page 63: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Conclusions• Change is the only constant

• Movement to value over volume

• Knowledge is power

Page 64: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of
Page 65: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Questions?

Page 66: Updates in Health Care Reform - University of Michigan · 2019-02-21 · Updates in Health Care Reform Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of

Thank You!


HEALTH CARE REFORM Preventive Care

HEALTH CARE REFORM Preventive Care

Documents
Health Care Reform Updates - AgeOptions...HEALTH CARE REFORM UPDATES Emily Gelber-Maturo Associate Director Strategic Health Initiatives Health & Disability Advocates HDA: 25 Years

Health Care Reform Updates - AgeOptions...HEALTH CARE REFORM UPDATES Emily Gelber-Maturo Associate Director Strategic Health Initiatives Health & Disability Advocates HDA: 25 Years

Documents
Health Care Reform SANDRA GILMAN Health Care Reform Outline ▪ Overview of Health Care Reform (HCR) ▪ The Effect of Health Care Reform on Hospitals and

Health Care Reform SANDRA GILMAN Health Care Reform Outline ▪ Overview of Health Care Reform (HCR) ▪ The Effect of Health Care Reform on Hospitals and

Documents
Health Care Reform Updates Presented by Barb Gerken, Legislative Co-Chair

Health Care Reform Updates Presented by Barb Gerken, Legislative Co-Chair

Documents
Health Care Reform- Patient Protection Affordable Care Act ... · Health Care Reform- Patient Protection Affordable Care Act (PPACA) - Overview DESCRIPTION Healthcare Reform/Patient

Health Care Reform- Patient Protection Affordable Care Act ... · Health Care Reform- Patient Protection Affordable Care Act (PPACA) - Overview DESCRIPTION Healthcare Reform/Patient

Documents
Healthcare Reform Updates: October 2015 Healthcare Reform€¦ ·  · 2017-01-20OCTOBER | 2015 . Healthcare Reform Updates: October 8, 2015 . September 22, 2015 . Technical Bulletins:

Healthcare Reform Updates: October 2015 Healthcare Reform€¦ ·  · 2017-01-20OCTOBER | 2015 . Healthcare Reform Updates: October 8, 2015 . September 22, 2015 . Technical Bulletins:

Documents
Blueprint for Aged Care Reform - National Aged Care Alliance · Blueprint for Aged Care Reform 3 The Alliance Blueprint requires fundamental reform of aged care Fundamental reform

Blueprint for Aged Care Reform - National Aged Care Alliance · Blueprint for Aged Care Reform 3 The Alliance Blueprint requires fundamental reform of aged care Fundamental reform

Documents
Health Care Reform: Updates and Compliance Strategies

Health Care Reform: Updates and Compliance Strategies

Documents
Updates on Export Control Reform (ECR)

Updates on Export Control Reform (ECR)

Documents
Health Care Reform

Health Care Reform

News & Politics
Investment Updates : reform and maintaining growth - AHKindonesien.ahk.de/fileadmin/ahk_indonesien/Bilder/Trade__Fairs/... · Investment Updates : reform and maintaining growth

Investment Updates : reform and maintaining growth - AHKindonesien.ahk.de/fileadmin/ahk_indonesien/Bilder/Trade__Fairs/... · Investment Updates : reform and maintaining growth

Documents
Aged Care Reform

Aged Care Reform

Documents
Seminar Series Presents Health Care Reform 2011 Updates

Seminar Series Presents Health Care Reform 2011 Updates

Documents
Health Care Reform: Leading Successfully Through Reform

Health Care Reform: Leading Successfully Through Reform

Documents
Health Care Reform Federal Updates and Priorities Grace Campbell Regional Director, State Advocacy December 5, 2013

Health Care Reform Federal Updates and Priorities Grace Campbell Regional Director, State Advocacy December 5, 2013

Documents
Basel III Reform Updates Webinar - Deloitte

Basel III Reform Updates Webinar - Deloitte

Documents
Health Care Reform Implementation: Medicaid Updates

Health Care Reform Implementation: Medicaid Updates

Documents
Colorado Updates: 2011 Health Report Card & Payment Reform

Colorado Updates: 2011 Health Report Card & Payment Reform

Documents
NADD Pre Conference Workshop Policy Updates in Addressing Challenges in Health Care Reform for Individuals with Intellectual/Developmental Disabilities

NADD Pre Conference Workshop Policy Updates in Addressing Challenges in Health Care Reform for Individuals with Intellectual/Developmental Disabilities

Documents